There are over 70,000 college football players in the United States. This is a sport that involves passionate fans, elite athletes, and the ability to generate unimaginable amounts of money. While American football is exciting to watch, the sports medicine physician must always have the health and safety of athletes as their primary focus. This presentation will highlight how the National Collegiate Athletic Association (NCAA) and National Football League (NFL) in the United States have created rules to try to minimise concussions while still allowing teams to train hard and optimise their performance.  Research on equipment such as helmet add-ons to reduce concussions will also be reviewed.