Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 1;57(8):733-740.
doi: 10.4085/1062-6050-0341.21.

Avenues for Sport-Related Concussion Prevention in High School Football: Effect of Limiting Collision Practices

Abigail C Bretzin  1 , Christopher P Tomczyk  2 , Douglas J Wiebe  1 , Tracey Covassin  2
Affiliations

Avenues for Sport-Related Concussion Prevention in High School Football: Effect of Limiting Collision Practices

Abigail C Bretzin et al. J Athl Train. .

Abstract

Context: Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices.

Objective: To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons.

Design: Retrospective cohort study.

Setting: Michigan high school football.

Patients or other participants: High school (9th-12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events.

Main outcome measure(s): Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015-2016 through 2019-2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season.

Results: A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017-2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018-2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019-2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015-2016.

Conclusions: We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015-2016.

Keywords: American football; epidemiology; injury prevention; policies.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Michigan High School Athletic Association (MHSAA) head injury surveillance database.
Figure 2
Figure 2
Sport-related concussions (SRCs) occurring in practice versus competition and timing during each practice or competition event. Timing of event refers to whether an SRC occurred at the start, middle, or end of a given practice or competition.
Figure 3
Figure 3
Sport-related concussions (SRCs) occurring in A, both practice and competition, and in B, practice, and C, competition, separately, each week throughout the season, by athletic season. The vertical line represents the end of the preseason and start of the regular season.
See this image and copyright information in PMC

References

    1. Kerr ZY, Chandran A, Nedimyer AK, Arakkal A, Pierpoint LA, Zuckerman SL. Concussion incidence and trends in 20 high school sports. Pediatrics . 2019;144(5):e20192180. doi: 10.1542/peds.2019-2180. - DOI - PubMed
    1. Chun BJ, Furutani T, Oshiro R, Young C, Prentiss G, Murata N. Concussion epidemiology in youth sports: sports study of a statewide high school sports program. Sports Health . 2021;13(1):18–24. doi: 10.1177/1941738120932570. - DOI - PMC - PubMed
    1. O'Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J Athl Train . 2017;52(3):175–185. doi: 10.4085/1062-6050-52.1.15. - DOI - PMC - PubMed
    1. Bartley JH, Murray MF, Kraeutler MJ, et al. Epidemiology of injuries sustained as a result of intentional player contact in high school football, ice hockey, and lacrosse: 2005–2006 through 2015–2016. Orthop J Sports Med . 2017;5(12):2325967117740887. doi: 10.1177/2325967117740887. - DOI - PMC - PubMed
    1. Hammer E, Brooks MA, Hetzel S, Arakkal A, Comstock RD. Epidemiology of injuries sustained in boys' high school contact and collision sports, 2008–2009 through 2012–2013. Orthop J Sports Med . 2020;8(2):2325967120903699. doi: 10.1177/2325967120903699. - DOI - PMC - PubMed