College football two-a-day practices appear to be ending. For safety reasons, the NCAA Sport Science Institute has recommended eliminating the popular two-a-day preseason practices and reducing contact at all practices, including limiting full contact to once a week during the season.

The recommendations, which are endorsed by 16 medical organizations and five football organizations, would put college football more in line with NFL rules adopted several years ago. NCAA members received the 17-page document last week at the NCAA Convention and now must decide whether to create legislation to fit the recommendations. If two-a-day practices end, the preseason could be extended by one week to accommodate the lost practice.

For generations of college football players, two-a-days have served as an annual ritual and grind each summer. Coaches use them to evaluate the toughness of players. Players try to survive these practices and some speak of creating bonds with teammates through two-a-days.

But the NCAA Sport Science Institute says preseason practices have the highest injury rate, whether through concussions, heat illness or overuse injuries. According to a Big 12 analysis of players from 2013-15, 58 percent of practice concussions during the entire season occur in the preseason.

“The consensus at our Safety in College Football Summit committee meeting was the preseason was a high-risk time and two-a-days doesn’t really make sense anymore,” NCAA chief medical officer Brian Hainline said.

Other new NCAA recommendations include:

  • In-season practices: Allow three days per week of non-contact/minimal contact, one day of live contact/tackling, and one day of live contact/thud. Currently, the recommendation is no more than two live contact/tackling days. Live contact means tackling to the ground and/or full-speed blocking. Non-contact/minimal contact practices don’t involve tackling, thud (in which players hit but don’t take each other to the ground), or full-speed blocking.

“Full pad practice, shell practice and helmet only practice all carry a risk of concussion,” the NCAA report says. “No helmet and no shoulder pad practice is the only evidence-based non-contact practice with negligible concussion risk.”

Last year, the Ivy League took the extraordinary step of eliminating all full-contact hitting at practices. Hainline said NCAA members decided one day of live tackling still made sense, “but the amount of contact restriction we have is greater than the Ivy League currently has.”

  • Preseason practices: Allow up to three days of live contact per week (tackling or thud) and three non-contact/minimal contact practices per week. One day must be no practice. A non-contact/minimal contact practice must follow a scrimmage.
  • Postseason practices: If there’s two weeks or less between the final regular-season game/conference championship game and the bowl game, in-season practice recommendations should remain in place. If there’s more than two weeks, then up to three days per week may be live contact and three days of non-contact/minimal contact.
  • Spring practices: Eight of the 15 allowable practices may involve live contact, including three that can be scrimmages. Live contact should be limited to two practices per week and not on consecutive days.

The NCAA report acknowledges that accelerometer data shows offensive and defensive linemen “have a greater likelihood of sustaining repetitive head impact during practice.” The report advises coaches to be mindful of unnecessary head impact exposure for linemen, such as in individual line board drills, live sessions with pass protection, and one-on-one blocking. Head accelerometers can be used to assess differences for head exposure by position but not yet by individual player, the NCAA says.

Among the organizations supporting the NCAA document are the American Academy of Neurology, the American Academy of Pediatrics, and the American College of Sports Medicine. Perhaps more interesting is the endorsements from the American Football Coaches Association, National Football Foundation, NCAA Football Oversight Committee, NCAA Football Rules Committee and USA Football.

Coaches often pride themselves on intense practices, especially in the summer, to prepare players for a violent sport. For instance, new Texas coach Tom Herman loved calling his preseason camp at Houston the hardest in the country.

“I tell our team all the time, nobody once in the history of this great game — nor will they ever, I hope — has stood at a championship stage or podium holding a championship trophy and say, ‘We out-finessed everybody,'” Herman said last August during two-a-days. “Football is a violent, violent sport, and you have to practice that way in order to get at elite levels on Saturday, in my opinion.”

When the NCAA initially issued practice-reduction guidelines in 2014, Hainline said some coaches pushed back and asked for justification. Hainline said coaches are “very data driven” so he spent time over the past year visiting with many to sell them on data, such as showing Big 12 concussion and injury rates declined with once-a-week tackling.

“You have to ask yourself, ‘What am I gaining by having this full-throttle practice vs. what am I potentially losing?'” Hainline said. “And what you’re losing really is the health and safety of the kids.”

Of course, these changes are just recommendations. Even if the NCAA writes these guidelines into legislation, “you can choose to do what you want,” Hainline acknowledged. “But culturally, to ignore this public document that has such widespread endorsement, I don’t think it makes any sense from any point of view that you can point to.”

That raises a larger question often asked: Is the NCAA — which was founded in the name of player safety — ever going to turn medical guidelines into medical rules that are enforced by penalties? For instance, the NFL now can investigate and penalize teams for not following proper concussion protocol with players.

“I believe the NCAA is closer (to enforceable safety rules) because it is a very active discussion within the membership,” Hainline said. “But it’s tricky because traditionally the enforcement (staffers), who are trained in a certain way, they have not dealt with health and safety issues. This is all happening at a good pace, and I think that’s probably going to be the next stage of what you’re going to be seeing. I can’t predict when. I can just say that compared to a year ago, the discussions are very palpable and on the table.”

Hainline said he thinks recent NCAA legislation specifically stating medical personnel have unchallenged authority to care for players will lead to enforceable medical rules. The Power Five conferences in 2015 created the Concussion Safety Protocol Committee to annually review and approve schools’ written procedures for handling concussions in each sport. But there’s no mechanism to address schools if they violate their protocol.

“That’s the problem,” said Dr. Robert Cantu, a prominent expert on sports concussions. “Everybody has to have written protocol and they don’t do a damn thing about enforcing them. It’s not an easy thing to do when you’ve got 1,100 schools and all that. But since they seem to be able to figure out whether you’re getting a free lunch (and violating NCAA extra benefit rules), I think they can figure this out, too. I think it could be fairly easily done in (Division I) schools, and I think it would probably be tough to do at (Division III) schools because they don’t even all have on-site team physicians.”

One of the most difficult challenges to address concussions in football is changing the culture. Players can receive all the education in the world about the risks of concussions, yet still ignore symptoms to remain in games. In December, Clemson linebacker Ben Boulware said he’s pretty sure he played through a concussion sustained in a game against Pittsburgh. Boulware said he kept playing because “that’s my job” and he has to “suck it up.”

Hainline hopes new data from the NCAA’s ongoing concussion study with the Department of Defense may change this mentality. So far, the study has examined about 28,000 NCAA athletes from 30 schools and tracked more than 1,600 concussions. Athletes who immediately report concussions on average return to play two days earlier than those who don’t for whatever reason, such as hiding symptoms or being unaware.

“Now we can take this data and look at the athletes and coaches and say, ‘You know what, if you don’t get your concussion managed immediately, you’re actually letting your team down because you’re not going to be able to get back to play as soon because you’re not going to recover as quickly,'” Hainline said. “We think this is going to be important information as a culture shift.”

The study also found 3.5 percent of concussed NCAA athletes sustain a repeat concussion in the same year. No repeat concussion happened in the first 10 days and the average time until the next concussion is 74 days. The last major concussion study of college athletes, in 2001, showed 6.5 percent of concussed athletes had a repeat concussion in the same year and 92 percent of those reoccurrence happened within 10 days, Hainline said.

Hainline said preliminary results of the NCAA study are starting to show potential biomarkers through blood tests and brain images. According to Hainline, some brain MRIs of concussed athletes show abnormal images, such as disruption of white matter that connects cells. The hope is brain images and blood tests become a way to test for concussions and when the brain is neurologically recovered, not unlike how blood tests and electrocardiograms can tell if chest pain is actually a heart attack.

“If you were concussed and came to see me and I examined you and maybe you’re a little off here and there, and I see you a week later and you seem fine, you’re recovered clinically,” Hainline said. “But I don’t know if your brain is recovered. That’s one of the things we’re mapping out in this study.”