In an opinion column, a former team doctor and a former coach recommend six new rules for professional, college, and high school football to reduce brain injuries.

Offensive and defensive linemen standing up to start a play.

Players with suspected concussions not playing or practicing for four weeks.

No more tackling using the top of the helmet as a battering ram.

Those are some of the rule changes proposed for professional, college, and high school football in an opinion column published today in the Journal of the American Medical Association (JAMA).

The co-authors also suggest that tackling be banished from all youth football programs below the high school level.

The provocative column was written by Dr. Paul S. Auerbach, M.S., a former emergency room physician and team doctor who is now part of the Department of Emergency Medicine at Stanford University’s School of Medicine, and William H. Waggoner II, a first vice president at Morgan Stanley who is a former college football player and high school coach.

The co-authors state that the way football is played now “imposes an epidemic of TBI (traumatic brain injury) on its players.”

“The evolving consensus is that unless there is a way to reduce the number of TBIs caused by the sport, football will remain a threat to the brains and future health futures of the players, including impaired cognitive function and reasoning, memory loss, emotional depression, and other sequelae that profoundly erode quality of life,” Auerbach and Waggoner wrote.

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In their opinion column, Auerbach and Waggoner note that three decades ago the medical profession debated the sport of boxing and brain damage.

They say that due to the number of youth and adults who play football, the sport is a “colossally greater cause of significant injuries” than boxing.

Auerbach and Waggoner suggest six rules changes.

The first is the elimination of the so-called “down lineman” on both sides of the football. The co-authors point out that offensive and defensive linemen typically start a play with one or two hands on the ground and their helmets pointed at their opponent. They recommend these large players begin each play in a standing position.

The second is banning a tackler from using the top of his helmet to intentionally strike any part of an opponent’s body. They suggest making that part of the helmet a different color. The first infraction would result in a 15-yard penalty and loss of a down. The second infraction would be the same penalty with the offending player ejected from the rest of that game and the following game.

The third is the prohibition of forearm blows to an opponent’s head at the line of scrimmage or during blocking or tackling. Infractions would result in the same penalties as helmet tackling.

The fourth is limiting full contact practice to no more than two days during any calendar week for any player. On those days, a player would be limited to no more than 20 full contact plays.

The fifth is requiring any player who suffers a suspected concussion to be prohibited from contact practice or games for at least four weeks.

The sixth is suspending any coach for three games who allows an athlete to practice or play in a game when they exhibit symptoms of a concussion.

Auerbach and Waggoner also write that full contact football be abolished below the high school level. They say younger players should be taught proper blocking and tackling techniques that avoid head injuries.

Read more: Youth football can be safe enough for kids, pediatricians say »

Auerbach and Waggoner acknowledge critics will protest that the new rules will change football in a negative way.

The critics, they say, will state the game of football will become less exciting.

“In that regard, we disagree, unless their enjoyment is based on seeing persons become injured,” wrote Auerbach and Waggoner.

There have been some changes in recent years.

New rules in the National Football League (NFL) prohibit blows to the head as well as “spearing” another player in the open field with their helmet.

In addition, USA Football has developed a Heads Up program to teach younger players safer tackling and blocking techniques.

The co-authors suggest football go further and adapt to a new era of playing where there is more creativity in play calling, nimbler runners and passers, and different linemen formations.

“The key will be combining player safety with an entertaining contest,” they wrote. “Why not give it a try? Why not have some high school, college, and professional teams show the bravery to play a season under these proposed rule changes and see what happens?”

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