The NCAA opposes all such efforts, and so far the courts have backed it. The NCAA fears a slippery slope leading to the end of its fraudulent “amateur” model. It says it was founded “to keep college athletes safe” and is working to ensure athletes get “the best care possible.” It essentially admitted that claim is just PR with a 2013 court filing in which it denied it has a “legal duty to protect student-athletes.”

Clearly, the NCAA and its member schools cannot be trusted to protect the safety of athletes, especially those in the revenue-producing sports of football and men’s basketball. Theoretically, team physicians and athletic training staff should be the independent authority looking out for the safety of players. In April 2017 the NCAA adopted “recommendations” for allowing those personnel to make medical decisions for athletes “free of pressure or influence from non-medical factors.”

However, an organization that has reams of rules prohibiting non-salaried players from receiving “extra benefits” created no penalties for schools that did not follow the independent medical model recommendations. You can guess how well that worked.

Only 53 percent of respondents to a National Athletic Trainers Association survey of members who work at colleges said their program follows the NCAA’s independent model of care. About half of respondents said their schools had no formal documents describing the model. Nearly 19 percent of athletic trainers responding to the survey said a coach an athlete who had been declared medically ineligible.

Tory Lindley, the NATA president, said there are “a number of coaches who have health and safety as a primary concern” and allow athletic trainers to make medical decisions without interference. He cited the NATA survey, in which about 76 percent of respondents said they have the authority to do so.

“There was a time when this was much more of an issue,” said Lindley, who also is head athletic trainer for Northwestern University. “We feel like a shift is happening now.”

Still, the results of the NATA survey suggest that lots of NCAA programs don’t take the recommendations of the independent medical model seriously and a significant number of coaches override medical decisions. The NCAA’s safety measures have no teeth. Its efforts to reduce head impacts suffered by football players during the preseason backfired because coaches still are free to decide how much players hit during practice.

The NCAA can keep adopting “recommendations” for player safety, but real reform requires college athletes have more power to stand up for their own interests. College athletes need union representation that comes with the backing of the National Labor Relations Board. The problem with that is that the NLRB and the courts have aided and abetted the NCAA’s efforts to curtail players’ rights.

Advocates for players’ rights won a rare, short-lived victory in 2014. The regional director of the Chicago office of the NLRB ruled that Northwestern football players are university employees who can collectively bargain for their rights. The unionization effort by Northwestern players was led by quarterback Kain Colter, who wanted to improve working conditions for players.

But a unanimous ruling by the five-member board of the NLRB led to dismissal of the players’ petition and the end of their unionization effort. The NLRB sidestepped the issue of whether NCAA athletes are employees with the right to unionize and instead based its ruling on its lack of jurisdiction over public schools.

Clearly, college athletes need advocates to look after their welfare who aren’t vested in preserving the status quo. A union wouldn’t be a perfect solution for college football players. NFL players have representation, but for years improvements in player safety were incremental.

Yet players have won concessions from owners regarding player safety in recent years. The 2011 lockout ended with NFL players successfully negotiating for fewer organized offseason workout days, limited full-contact practices, limited on-field practice time overall and more days off.

Since then the NFL has adopted more game rules geared toward player safety, including prohibitions against helmet-to-helmet hits and targeting any area of an opponent with the helmet. (Targeting is one player-safety issue in which the NCAA has been ahead of the NFL.) No doubt NFL owners are feeling pressure to improve player safety after settling a class-action concussion lawsuit and seeing reduced levels of participation in football at lower levels as public perception shifts about the safety of the game.

Similar pressure has spurred the NCAA change its approach to player safety. It is facing a wave of concussion-related lawsuits filed by former college athletes. The NCAA recently settled a class-action suit in which it agreed to spend $70 million on a 50-year medical monitoring program for college athletes, $5 million for a concussion research and make changes to its concussion management protocols to include mandatory reporting and return-to-play guidelines.

But those changes won’t do anything about all the “repetitive impact burden” on players during preseason practices. The players need the leverage of a union. Then they could advocate for less hitting during practices, file grievances with the union when coaches circumvent the rules and go to the NLRB when the NCAA engages in unfair labor practices.

Right now, the players have no one with power advocating for their safety because the NCAA wants to keep them in their place as non-salaried employees with no labor rights. The athletic trainers who are charged with caring for athletes are stymied by a culture in which coaches have too much authority. The only realistic way to change that is to give power to the players to look out for their own interests.

The NCAA will never do that without being forced by the courts (which so far have balked) or the Congress (where a handful of members seem to care about players’ rights but not enough). The National College Players Association is an independent organization advocating for player safety. Others who claim to care about the issue should do the same.