American football is a cutting/pivoting contact sport with high-speed and high-energy collisions among players on every play during games and training or practice. Although there have been constant rules and equipment changes in an attempt to limit the frequency of injuries, the incidence of musculoskeletal injuries remains high at every level of play in this sport. Imaging plays an important role in managing these players by helping in making an accurate diagnosis as well as guiding therapy and monitoring response to treatment. This article describes the major mechanisms and patterns of injury seen in these athletes, with a discussion of how imaging, primarily magnetic resonance imaging, assists the team physician in choosing a conservative versus surgical approach to recovery and return to play.