For all the attention the National Football League has paid to reducing the number and severity of concussions, it’s made little progress against the serious leg injuries that end many players’ seasons and alter the competitive landscape.

The latest reminders are the gruesome injury that ended Washington Redskins quarterback Alex Smith’s season in a Nov. 18 game, followed two weeks later by the broken leg that sidelined his backup, Colt McCoy.

At least 17 players are currently sidelined by broken bones, many of them leg fractures, according to Pro Football Reference, which catalogs NFL injuries. Fifty-seven NFL players suffered season-ending tears of the anterior cruciate ligament in their knees in 2017, the same as in 2016.

Both the league and the National Football League Players’ Association say the game is much safer than it was years ago, but some plaintiffs’ lawyers say that theme wears thin as injuries mount.

“The NFL has done an admirable job implementing rules changes in an attempt to improve safety, but clearly more needs to be done and hopefully a devastating injury or lawsuit isn’t the only impetus towards doing so,” plaintiffs’ lawyer Paul Edelstein, of The Edelsteins, Faegenburg & Brown LLP in New York, told Bloomberg Law.

The NFL points to 50 rules changes since 2002 designed to eliminate potentially dangerous tactics and the introduction of cleats designed for synthetic turf fields.

The NFL outlawed in 2015 chop blocks—in which an offensive player blocks an opponent at the thigh while another blocks the same player above the waist —as a way to reduce knee ligament tears. The move has reduced the incidence of knee injuries in defensive players, according to an April research study published in the Orthopaedic Journal of Sports Medicine.

Field Conditions

Brad Sohn, of the Brad Sohn Law Firm PLLC, in Coral Gables, Florida, represents plaintiffs in litigation against football helmet makers. He said football’s playing surfaces continue to contribute to injuries.

“I’m immediately reminded of data on artificial playing surfaces, which are only a creature of the last 40 or 50 years, that suggest these new surfaces of play—Astroturf and even today’s synthetic turf—create added stresses on the knee, ankle, and soft-tissue,” he said.

A study published in the American Journal of Sports Medicine in 2012, for example, found that college football players suffer knee injuries 40 percent more often on artificial surfaces than on natural grass.

Both the league and its players are attuned to the importance of good playing fields, said Carl Francis, a NFLPA spokesman.

“We just made a decision not two weeks ago to play a game in Los Angeles instead of Mexico City because of the horrendous condition of the field,” Francis said.

The question is whether more can be done, or whether serious injuries are inevitable in a game featuring collisions among players who continue to get bigger, stronger and faster.

Number One Priority

A century ago, before the NFL existed, 18 deaths and 100 major injuries caused then President Theodore Roosevelt to propose a complete ban on college football if rules changes weren’t made.

Questions linger even today over what risks players assume by playing the game, and what duties the NFL owes to those players.

“The NFL’s number one priority is the health and safety of its players,” a spokesperson for the league said Dec. 6.

“With our partners at the NFLPA, we work to ensure players receive unparalleled medical care and that our policies and protocols are informed by the most up-to-date scientific and medical consensus,” the league said in an email.

Continuing concern over player safety raises a countervailing concern: whether more rules changes run the risk of altering football’s essential character.

“Are we at a space where there is a possibility that without major changes in the sport you can’t play the sport”? said Paul Haagen, co-director of the Center for Sports Law and Policy at Duke University Law School in Durham, N.C.

It’s not clear any rule or equipment could have spared Smith, whose leg and ankle buckled at a grotesque angle as he was being tackled. His team, which was on track to make the playoffs when Smith got hurt, hasn’t won a game since.

Smith’s recovery is being hampered by an infection after multiple surgeries to repair the break, ESPN reports. It’s not clear whether he will be able to play again.

“It’s a sport of terrifically violent speed, livelihoods are based on players doing certain things at certain times, and people are going to get hurt,” Haagen told Bloomberg Law.