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. 2017 Jul 24;5(7):2325967117708744.
doi: 10.1177/2325967117708744. eCollection 2017 Jul.

Epidemiology of Injuries Identified at the NFL Scouting Combine and Their Impact on Performance in the National Football League: Evaluation of 2203 Athletes From 2009 to 2015

Brendin R Beaulieu-Jones  1 , William H Rossy  2 , George Sanchez  3 , James M Whalen  4 , Kyle P Lavery  2 , Kevin J McHale  2 , Bryan G Vopat  5 , Joseph J Van Allen  4 , Ramesses A Akamefula  3 , Matthew T Provencher  3   6
Affiliations

Epidemiology of Injuries Identified at the NFL Scouting Combine and Their Impact on Performance in the National Football League: Evaluation of 2203 Athletes From 2009 to 2015

Brendin R Beaulieu-Jones et al. Orthop J Sports Med. .

Abstract

Background: At the annual National Football League (NFL) Scouting Combine, the medical staff of each NFL franchise performs a comprehensive medical evaluation of all athletes potentially entering the NFL. Currently, little is known regarding the overall epidemiology of injuries identified at the combine and their impact on NFL performance.

Purpose: To determine the epidemiology of injuries identified at the combine and their impact on initial NFL performance.

Study design: Cohort study; Level of evidence, 3.

Methods: All previous musculoskeletal injuries identified at the NFL Combine from 2009 to 2015 were retrospectively reviewed. Medical records and imaging reports were examined. Game statistics for the first 2 seasons of NFL play were obtained for all players from 2009 to 2013. Analysis of injury prevalence and overall impact on the draft status and position-specific performance metrics of each injury was performed and compared with a position-matched control group with no history of injury or surgery.

Results: A total of 2203 athletes over 7 years were evaluated, including 1490 (67.6%) drafted athletes and 1040 (47.2%) who ultimately played at least 2 years in the NFL. The most common sites of injury were the ankle (1160, 52.7%), shoulder (1143, 51.9%), knee (1128, 51.2%), spine (785, 35.6%), and hand (739, 33.5%). Odds ratios (ORs) demonstrated that quarterbacks were most at risk of shoulder injury (OR, 2.78; P = .001), while running backs most commonly sustained ankle (OR, 1.39; P = .040) and shoulder injuries (OR, 1.55; P = .020) when compared with all other players. Ultimately, defensive players demonstrated a greater negative impact due to injury than offensive players, with multiple performance metrics significantly affected for each defensive position analyzed, whereas skilled offensive players (eg, quarterbacks, running backs) demonstrated only 1 metric significantly affected at each position.

Conclusion: The most common sites of injury identified at the combine were (1) ankle, (2) shoulder, (3) knee, (4) spine, and (5) hand. Overall, performance in the NFL tended to worsen with injury history, with a direct correlation found between injury at a certain anatomic location and position of play. Defensive players tended to perform worse compared with offensive players if injury history was present.

Keywords: National Football League; epidemiology; football (American); injury rate.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.T.P. is a consultant for Arthrex and the Joint Restoration Foundation (Allosource) and receives royalties from Arthrex and SLACK Inc.

Figures

Figure 1.
Figure 1.
Risk of collegiate football injuries by position as identified in offensive and defensive players who participated in medical and performance testing at the NFL Combine, 2009 to 2015. *P < .05; **P < .01; ***P < .001.
Figure 2.
Figure 2.
(A) Defensive backs: impact of hand and knee injuries on National Football League (NFL) performance. Overall, 33% (n = 78) of defensive backs had a hand injury, with a mean overall pick of 109.7 ± 58.4 compared with controls (112.6 ± 68.6, P = .78). A total of 51% (n = 120) of defensive backs had a knee injury, with a mean overall pick of 118.8 ± 69.4 compared with controls (111.6 ± 63.4) (P = .49). Defensive backs with a hand or knee injury missed 0.1 ± 0.5 and 1.2 ± 2.6 games in college, respectively. # P < .1; *P < .05. (B) Defensive linemen: impact of knee and ankle injuries on NFL performance. A total of 54% (n = 124) of defensive linemen had a knee injury, with a mean overall pick of 114.9 ± 76.0 compared with controls (96.5 ± 76.5, P = .12). In all, 53% (n = 122) of linemen had an ankle injury, with a mean overall pick of 107.9 ± 74.6 compared with controls (100.2 ± 75.6, P = .54). Defensive linemen with a knee or ankle injury missed 1.6 ± 3.5 and 0.6 ± 1.6 games in college, respectively. # P < .1; *P < .05; **P < .01. QB, quarterback.
Figure 3.
Figure 3.
(A) Quarterbacks: impact of shoulder injuries on National Football League (NFL) performance. A total of 71% (n = 42) of quarterbacks had a shoulder injury, with a mean overall pick of 110.1 ± 81.8 compared with controls (107.9 ± 76.0) (P = .94). Quarterbacks with a shoulder injury missed 1.0 ± 2.1 games in college. *P < .05. (B) Wide receivers: impact of knee injuries on NFL performance. A total of 48% (n = 75) of wide receivers had a knee injury, with a mean overall pick of 120.8.1 ± 71.2 compared with controls (100.0 ± 66.3, P = .13). Wide receivers with a knee injury missed 1.0 ± 2.1 games in college. **P < .01. QB, quarterback.
Figure A1.
Figure A1.
Linebackers: impact of spine and ankle injuries on NFL performance. In total, 40% (n = 56) of linebackers had a spine injury, with a mean overall pick of 119 ± 67.4 compared to controls (112.9 ± 71.9, P = .68). A total of 48% (n = 66) of linebackers had an ankle injury, with a mean overall pick of 119.7 ± 68.1 compared to controls (111.2 ± 69.9, P = .58). Linebackers with a spine or ankle injury missed 0.4 ± 1.7 and 0.9 ± 2.3 games in college, respectively. **P < .01; *P < .05; # P < .1.
Figure A2.
Figure A2.
Offensive linemen: impact of shoulder and ankle injuries on NFL performance. In total, 39% (n = 73) of offensive linemen had a shoulder injury, with a mean overall pick of 122.9 ± 73.8 compared to controls (96.1 ± 68.8, P = .04). A total of 57% (n = 108) of lineman had an ankle injury, with a mean overall pick of 111.9 ± 66.6 compared to controls (94.5 ± 72.8, P = .19). Offensive linemen with a shoulder or ankle injury missed 0.7 ± 2.1 and 0.8 ± 2.1 games in college, respectively. ***P < .001; **P < .01; *P < .05; # P < .0.
Figure A3.
Figure A3.
Running backs: impact of hand injuries on NFL performance. In total, 25% (n = 31) of running backs had a hand injury, with a mean overall pick of 138.5 ± 51.3 compared to controls (121.9 ± 76.0, P = .38). Running backs with a hand injury missed 0.2 ± 0.8 games in college. *P < .01.
Figure A4.
Figure A4.
Tight ends: impact of shoulder and hand injuries on NFL performance. In total, 50% (n = 36) of tight ends had a shoulder injury, with a mean overall pick of 125 ± 68.6 compared to controls (138.4 ± 66.5, P = .55). A total of 35% (n = 25) of tight ends had a hand injury, with a mean overall pick of 122 ± 62.7 compared to controls (151.9 ± 54.7, P = .15). Tight ends with a shoulder or hand injury missed 0.9 ± 2.5 and 0 games in college, respectively. *P < 0.1.
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