Head Impact Exposure in Practices Correlates With Exposure in Games for Youth Football Players

This study aimed to compare head impact exposures between practices and games in football players ages 9 to 14 years, who account for approximately 70% of all football players in the United States. Over a period of 2 seasons, 136 players were enrolled from 3 youth programs, and 49,847 head impacts were recorded from 345 practices and 137 games. During the study, individual players sustained a median of 211 impacts per season, with a maximum of 1226 impacts. Players sustained 50th (95th) percentile peak linear acceleration of 18.3 (46.9) g, peak rotational acceleration of 1305.4 (3316.6) rad·s−2, and Head Impact Technology Severity Profile of 13.7 (24.3), respectively. Overall, players with a higher frequency of head impacts at practices recorded a higher frequency of head impacts at games (P < .001,r2 = .52), and players who sustained a greater average magnitude of head impacts during practice also recorded a greater average magnitude of head impacts during games (P < .001). The youth football head impact data quantified in this study provide valuable insight into the player exposure profile, which should serve as a key baseline in efforts to reduce injury.

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Subconcussive head impact exposure differences between drill intensities in U.S. high school football

10.1101/2020.03.29.20047167 ◽

2020 ◽

Author(s):

Kyle Kercher ◽

Jesse A. Steinfeldt ◽

Jonathan T. Macy ◽

Keisuke Ejima ◽

Keisuke Kawata

Keyword(s):

High School ◽

Linear Acceleration ◽

Head Impact ◽

Football Players ◽

Impact Frequency ◽

High School Football ◽

Head Impacts ◽

Air Bags ◽

Frequency Peak ◽

Impact Data

ABSTRACTPurposeUSA Football established five levels of contact (LOC) to guide the intensity of high school football practices. However, it remains unclear whether head impact exposure differs by LOC. The purpose of this study was to examine head impact frequency and magnitude by LOC in the overall sample and three position groups.MethodsThis longitudinal observational study included 24 high school football players during all practices and games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational head acceleration (PRA). Practice/game drills were filmed and categorized into 5 LOCs (air, bags, control, thud, live), and head impact data were assigned into 5 LOCs. Player position was categorized into linemen, hybrid, and skill.ResultsA total of 6016 head impacts were recorded during 5 LOCs throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in an incremental manner (air<bags<control<thud<live), with the most head impacts in live (113.7±17.8 hits/player) and the least head impacts in air (7.7±1.9 hits/player). The linemen and hybrid groups had consistently higher impact exposure than the skill group. Average head impact magnitudes by position group were higher during live drills (PLA (41.0-45.9g) and PRA (3.3-4.6 krad/s2) per head impact), whereas other LOCs had lower magnitudes (PLA (18.2-23.2g) and PRA (1.6-2.3krad/s2) per impact).ConclusionOur data suggest that LOC may influence cumulative head impact exposure in high school football, with players incurring frequent head impacts during live, thud, and control. The data indicate the importance of considering LOCs to refine practice guidelines and policies to minimize head impact burden in high school football athletes.

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Drill-specific head impact exposure in youth football practice

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.5.peds1696 ◽

2016 ◽

Vol 18 (5) ◽

pp. 536-541 ◽

Cited By ~ 17

Author(s):

Eamon T. Campolettano ◽

Steven Rowson ◽

Stefan M. Duma

Keyword(s):

United States ◽

The United States ◽

High Impact ◽

Head Impact ◽

Football Players ◽

Head Impacts ◽

Youth Football ◽

Impact Rate ◽

High Magnitude ◽

Specific Activities

OBJECTIVE Although 70% of football players in the United States are youth players (6–14 years old), most research on head impacts in football has focused on high school, collegiate, or professional populations. The objective of this study was to identify the specific activities associated with high-magnitude (acceleration > 40g) head impacts in youth football practices. METHODS A total of 34 players (mean age 9.9 ± 0.6 years) on 2 youth teams were equipped with helmet-mounted accelerometer arrays that recorded head accelerations associated with impacts in practices and games. Videos of practices and games were used to verify all head impacts and identify specific drills associated with each head impact. RESULTS A total of 6813 impacts were recorded, of which 408 had accelerations exceeding 40g (6.0%). For each type of practice drill, impact rates were computed that accounted for the length of time that teams spent on each drill. The tackling drill King of the Circle had the highest impact rate (95% CI 25.6–68.3 impacts/hr). Impact rates for tackling drills (those conducted without a blocker [95% CI 14.7–21.9 impacts/hr] and those with a blocker [95% CI 10.5–23.1 impacts/hr]) did not differ from game impact rates (95% CI 14.2–21.6 impacts/hr). Tackling drills were observed to have a greater proportion (between 40% and 50%) of impacts exceeding 60g than games (25%). The teams in this study participated in tackling or blocking drills for only 22% of their overall practice times, but these drills were responsible for 86% of all practice impacts exceeding 40g. CONCLUSIONS In youth football, high-magnitude impacts occur more often in practices than games, and some practice drills are associated with higher impact rates and accelerations than others. To mitigate high-magnitude head impact exposure in youth football, practices should be modified to decrease the time spent in drills with high impact rates, potentially eliminating a drill such as King of the Circle altogether.

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Comparison of head impact exposure in practice drills among multiple youth football teams

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.9.peds18314 ◽

2019 ◽

Vol 23 (3) ◽

pp. 381-389 ◽

Cited By ~ 4

Author(s):

Mireille E. Kelley ◽

Mark A. Espeland ◽

William C. Flood ◽

Alexander K. Powers ◽

Christopher T. Whitlow ◽

...

Keyword(s):

Open Field ◽

Linear Models ◽

Linear Acceleration ◽

Head Impact ◽

Head Acceleration ◽

Head Impacts ◽

Youth Football ◽

Impact Rate ◽

Full Speed ◽

Impact Data

OBJECTIVELimiting contact in football practice can reduce the number of head impacts a player receives, but further research is needed to inform the modification of optimal drills that mitigate head impact exposure (HIE) while the player develops the skills needed to safely play the game. This study aimed to compare HIE in practice drills among 6 youth football teams and to evaluate the effect of a team on HIE.METHODSOn-field head impact data were collected from athletes (ages 10–13 years) playing on 6 local youth football teams (teams A–F) during all practices using the Head Impact Telemetry System. Video was recorded and analyzed to verify and assign impacts to a specific drill. Drills were identified as follows: dummy/sled tackling, half install, install, install walk through, multiplayer tackle, Oklahoma, one-on-one, open field tackling, other, passing, position skill work, scrimmage, special teams, tackling drill stations, and technique. HIE was quantified in terms of impacts per player per minute (ppm) and peak linear and rotational head acceleration. Generalized linear models were used to assess differences in head impact magnitude and frequency among drills as well as among teams within the most common drills.RESULTSAmong 67 athlete-seasons, a total of 14,718 impacts during contact practices were collected and evaluated in this study. Among all 6 teams, the mean linear (p < 0.0001) and rotational (p < 0.0001) acceleration varied significantly among all drills. Open field tackling had significantly (p < 0.001) higher mean linear acceleration than all other drills. Multiplayer tackle had the highest mean impact rate (0.35 ppm). Significant variations in linear acceleration and impact rate were observed among teams within specific drills. Team A had the highest mean linear acceleration in install, one-on-one, and open field tackling and the highest mean impact rate in Oklahoma and position skill work. Although team A spent the greatest proportion of their practice on minimal- or no-player versus player contact drills (27%) compared to other teams, they had the highest median (20.2g) and 95th percentile (56.4g) linear acceleration in practice.CONCLUSIONSFull-speed tackling and blocking drills resulted in the highest HIE. Reducing time spent on contact drills relative to minimal or no contact drills may not lower overall HIE. Instead, interventions such as reducing the speed of players engaged in contact, correcting tackling technique, and progressing to contact may reduce HIE more effectively.

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Football concussion case series using biomechanical and video analysis

Neurology ◽

10.1212/01.wnl.0000550623.36010.20 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S2.2-S2

Author(s):

Mirellie Kelley ◽

Jillian Urban ◽

Derek Jones ◽

Alexander Powers ◽

Christopher T. Whitlow ◽

...

Keyword(s):

Video Analysis ◽

Case Series ◽

Linear Acceleration ◽

The United States ◽

Head Impact ◽

Rotational Acceleration ◽

Impact Location ◽

Injury Mechanisms ◽

The Mean ◽

Impact Data

Approximately 1.1–1.9 million sport-related concussions among athletes ≤18 years of age occur annually in the United States, but there is limited understanding of the biomechanics and injury mechanisms associated with concussions among lower level football athletes. Therefore, the objective of this study was to combine biomechanical head impact data with video analysis to characterize youth and HS football concussion injury mechanisms. Head impact data were collected from athletes participating on 22 youth and 6 HS football teams between 2012 and 2017. Video was recorded, and head impact data were collected during all practices and games by instrumenting players with the Head Impact Telemetry (HIT) System. For each clinically diagnosed concussion, a video abstraction form was completed, which included questions concerning the context in which the injury occurred. Linear acceleration, rotational acceleration, and impact location were used to characterize the concussive event and each injured athlete's head impact exposure on the day of the concussion. A total of 9 (5 HS and 4 youth) concussions with biomechanics and video of the event were included in this study. The mean [range] linear and rotational acceleration of the concussive impacts were 62.9 [29.3–118.4] g and 3,056.7 [1,046.8–6,954.6] rad/s2, respectively. Concussive impacts were the highest magnitude impacts for 6 players and in the top quartile of impacts for 3 players on the day of injury. Concussions occurred in both practices (N = 4) and games (N = 5). The most common injury contact surface was helmet-to-helmet (N = 5), followed by helmet-to-ground (N = 3) and helmet-to-body (N = 1). All injuries occurred during player-to-player contact scenarios, including tackling (N = 4), blocking (N = 4), and collision with other players (N = 1). The biomechanics and injury mechanisms of concussions varied among athletes in our study; however, concussive impacts were among the highest severity for each player and all concussions occurred as a result of player-to-player contact.

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Game-Related Impacts in High School Boys’ Lacrosse

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119835587 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711983558 ◽

Cited By ~ 2

Author(s):

Shane V. Caswell ◽

Patricia Kelshaw ◽

Andrew E. Lincoln ◽

Lisa Hepburn ◽

Reginald Dunn ◽

...

Keyword(s):

High School ◽

Rotational Velocity ◽

Linear Acceleration ◽

The United States ◽

Head Impact ◽

Level Of Evidence ◽

Cross Sectional ◽

Head Impacts ◽

Direct Head ◽

The Impact

Background: The rate of concussions in boys’ lacrosse is reported to be the third highest among high school sports in the United States, but no studies have described game-related impacts among boys’ lacrosse players. Purpose: To characterize verified game-related impacts, both overall and those directly to the head, in boys’ varsity high school lacrosse. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 77 male participants (mean age, 16.6 ± 1.2 years; mean height, 1.77 ± 0.05 m; mean weight, 73.4 ± 12.2 kg) were instrumented with sensors and were videotaped during 39 games. All verified game-related impacts ≥20 g were summarized in terms of frequency, peak linear acceleration (PLA), and peak rotational velocity (PRV). Descriptive statistics and impact rates per player-game (PG) with corresponding 95% CIs were calculated. Results: Overall, 1100 verified game-related impacts were recorded (PLA: median, 33.5 g [interquartile range (IQR), 25.7-51.2]; PRV: median, 1135.5 deg/s [IQR, 790.0-1613.8]) during 795 PGs. The rate for all verified game-related impacts was 1.38 impacts per PG (95% CI, 1.30-1.47). Of these, 680 (61.8%) impacts (PLA: median, 35.9 g [IQR, 26.7-55.5]; PRV: 1170.5 deg/s [IQR, 803.2-1672.8]) were directly to the head (impact rate, 0.86 impacts/PG [95% CI, 0.79-0.92]). Overall, midfielders (n = 514; 46.7%) sustained the most impacts, followed by attackers (n = 332; 30.2%), defenders (n = 233; 21.2%), and goalies (n = 21; 1.9%). The most common mechanisms for overall impacts and direct head impacts were contact with player (overall: n = 706 [64.2%]; head: n = 397 [58.4%]) and stick (overall: n = 303 [27.5%]; head: n = 239 [35.1%]), followed by ground (overall: n = 73 [6.6%]; head: n = 26 [3.8%]) and ball (overall: n = 15 [1.4%]; head: n = 15 [2.2%]). Direct head impacts were associated with a helmet-to-helmet collision 31.2% of the time, and they were frequently (53.7%) sustained by the players delivering the impact. Nearly half (48.8%) of players delivering contact used their helmets to initiate contact that resulted in a helmet-to-helmet impact. Players receiving a head impact from player contact were most often unprepared (75.9%) for the collision. Conclusion: The helmet is commonly used to initiate contact in boys’ high school lacrosse, often targeting defenseless opponents. Interventions to reduce head impacts should address rules and coaching messages to discourage intentional use of the helmet and encourage protection of defenseless opponents.

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In-season variations in head impact exposure among youth football players

Neurology ◽

10.1212/01.wnl.0000550621.28386.81 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S1.3-S2

Author(s):

Jillian Urban ◽

Mirellie Kelley ◽

Mark Espeland ◽

Elizabeth Davenport ◽

Christopher T. Whitlow ◽

...

Keyword(s):

Head Impact ◽

Cumulative Exposure ◽

Football Players ◽

Sample Mean ◽

Head Impacts ◽

Youth Football ◽

Single Number ◽

Practice Time ◽

Time Frames ◽

Season Variations

Sport-related head impacts are of increasing concern as early evidence has demonstrated a relationship between subconcussive head impact exposure (HIE) experienced in contact sports, such as football, and changes in pre-to post-season imaging and cognitive measures. Cumulative HIE is often measured with a single number that amounts to the total exposure measured over the season and does not give any indication as to how the exposure was accumulated, nor how it varies during the season. Therefore, the objective of this study was to compare HIE during preseason, the first and second halves of the regular season, and playoffs in a sample of youth football players (n = 119, ages 9–13). Athletes were divided into 1 of 4 exposure groups based on quartiles computed from the distribution of risk-weighted cumulative exposure (RWECP). The mean 95th percentile linear and rotational accelerations and impacts per session in practices and games were compared across 4 exposure groups and time frames using mixed effects models. Within games, the sample mean 95th percentile linear and rotational accelerations ranged from 47.2 g and 2,331.3 rad/s2 during preseason to 52.1 g and 2,533.4 rad/s2 during the second half of regular season. Mean impacts per practice increased from preseason to the second half of regular season and declined into playoffs among all exposure groups; however, the variation between time frames was not greater than 2 impacts per practice. Time of season had a significant effect on mean 95th percentile linear and rotational acceleration in games (both p = 0.01) but not on practice accelerations or impacts/session. Mean 95th percentile accelerations for games showed significant interaction effects between exposure group and season segment (linear p = 0.05 and rotational p = 0.04). The results of this study improve our understanding of in-season variations in youth football HIE and may inform important opportunities for future interventions.

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Similar head impact acceleration measured using instrumented ear patches in a junior rugby union team during matches in comparison with other sports

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.12.peds15605 ◽

2016 ◽

Vol 18 (1) ◽

pp. 65-72 ◽

Cited By ~ 15

Author(s):

Doug A. King ◽

Patria A. Hume ◽

Conor Gissane ◽

Trevor N. Clark

Keyword(s):

Injury Risk ◽

Linear Acceleration ◽

Rugby Union ◽

Head Impact ◽

American Football ◽

Football Players ◽

Head Impacts ◽

Impact Acceleration ◽

The Impact ◽

Rugby Players

OBJECTIVE Direct impact with the head and the inertial loading of the head have been postulated as major mechanisms of head-related injuries, such as concussion. METHODS This descriptive observational study was conducted to quantify the head impact acceleration characteristics in under-9-year-old junior rugby union players in New Zealand. The impact magnitude, frequency, and location were collected with a wireless head impact sensor that was worn by 14 junior rugby players who participated in 4 matches. RESULTS A total of 721 impacts > 10g were recorded. The median (interquartile range [IQR]) number of impacts per player was 46 (IQR 37–58), resulting in 10 (IQR 4–18) impacts to the head per player per match. The median impact magnitudes recorded were 15g (IQR 12g–21g) for linear acceleration and 2296 rad/sec2 (IQR 1352–4152 rad/sec2) for rotational acceleration. CONCLUSIONS There were 121 impacts (16.8%) above the rotational injury risk limit and 1 (0.1%) impact above the linear injury risk limit. The acceleration magnitude and number of head impacts in junior rugby union players were higher than those previously reported in similar age-group sports participants. The median linear acceleration for the under-9-year-old rugby players were similar to 7- to 8-year-old American football players, but lower than 9- to 12-year-old youth American football players. The median rotational accelerations measured were higher than the median and 95th percentiles in youth, high school, and collegiate American football players.

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Head Impact Exposure in Youth Football: Middle School Ages 12–14 Years

Journal of Biomechanical Engineering ◽

10.1115/1.4027872 ◽

2014 ◽

Vol 136 (9) ◽

Cited By ~ 38

Author(s):

Ray W. Daniel ◽

Steven Rowson ◽

Stefan M. Duma

Keyword(s):

High School ◽

Middle School ◽

Head Impact ◽

Football Players ◽

Head Acceleration ◽

Limited Data ◽

Head Impacts ◽

Football Helmet ◽

Injury Criteria ◽

Youth Football

The head impact exposure experienced by football players at the college and high school levels has been well documented; however, there are limited data regarding youth football despite its dramatically larger population. The objective of this study was to investigate head impact exposure in middle school football. Impacts were monitored using a commercially available accelerometer array installed inside the helmets of 17 players aged 12–14 years. A total of 4678 impacts were measured, with an average (±standard deviation) of 275 ± 190 impacts per player. The average of impact distributions for each player had a median impact of 22 ± 2 g and 954 ± 122 rad/s2, and a 95th percentile impact of 54 ± 9 g and 2525 ± 450 rad/s2. Similar to the head impact exposure experienced by high school and collegiate players, these data show that middle school football players experience a greater number of head impacts during games than practices. There were no significant differences between median and 95th percentile head acceleration magnitudes experienced during games and practices; however, a larger number of impacts greater than 80 g occurred during games than during practices. Impacts to the front and back of the helmet were most common. Overall, these data are similar to high school and college data that have been collected using similar methods. These data have applications toward youth football helmet design, the development of strategies designed to limit head impact exposure, and child-specific brain injury criteria.

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High-magnitude head impact exposure in youth football

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds17185 ◽

2017 ◽

Vol 20 (6) ◽

pp. 604-612 ◽

Cited By ~ 16

Author(s):

Eamon T. Campolettano ◽

Ryan A. Gellner ◽

Steven Rowson

Keyword(s):

Open Field ◽

Body Mass ◽

Head Impact ◽

Football Players ◽

Head Impacts ◽

Video Recordings ◽

Youth Football ◽

High Magnitude ◽

Or Practice ◽

The Impact

OBJECTIVEEven in the absence of a clinically diagnosed concussion, research suggests that neurocognitive changes may develop in football players as a result of frequent head impacts that occur during football games and practices. The objectives of this study were to determine the specific situations in which high-magnitude impacts (accelerations exceeding 40g) occur in youth football games and practices and to assess how representative practice activities are of games with regard to high-magnitude head impact exposure.METHODSA total of 45 players (mean age 10.7 ± 1.1 years) on 2 youth teams (Juniors [mean age 9.9 ± 0.6 years; mean body mass 38.9 ± 9.9 kg] and Seniors [mean age 11.9 ± 0.6 years; mean body mass 51.4 ± 11.8 kg]) wore helmets instrumented with accelerometer arrays to record head impact accelerations for all practices and games. Video recordings from practices and games were used to verify all high-magnitude head impacts, identify specific impact characteristics, and determine the amount of time spent in each activity.RESULTSA total of 7590 impacts were recorded, of which 571 resulted in high-magnitude head impact accelerations exceeding 40g (8%). Impacts were characterized based on the position played by the team member who received the impact, the part of the field where the impact occurred, whether the impact occurred during a game or practice play, and the cause of the impact. High-magnitude impacts occurred most frequently in the open field in both games (59.4%) and practices (67.5%). “Back” position players experienced a greater proportion of high-magnitude head impacts than players at other positions. The 2 teams in this study structured their practice sessions similarly with respect to time spent in each drill, but impact rates differed for each drill between the teams.CONCLUSIONSHigh-magnitude head impact exposure in games and practice drills was quantified and used as the basis for comparison of exposure in the 2 settings. In this cohort, game impact rates exceeded those for practice. Back players, who were often positioned in the open field, were shown to experience elevated levels of head impact exposure relative to players at other positions. The analysis also suggests that practice intensity, which may be influenced by coaching style, may also affect high-magnitude head impact exposure. Future studies should investigate this aspect as a factor affecting head impact exposure.

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Magnitude of Head Impact Exposures in Individual Collegiate Football Players

Journal of Applied Biomechanics ◽

10.1123/jab.28.2.174 ◽

2012 ◽

Vol 28 (2) ◽

pp. 174-183 ◽

Cited By ~ 68

Author(s):

Joseph J. Crisco ◽

Bethany J. Wilcox ◽

Jason T. Machan ◽

Thomas W. McAllister ◽

Ann-Christine Duhaime ◽

...

Keyword(s):

Cognitive Deficits ◽

Linear Acceleration ◽

Head Impact ◽

Football Players ◽

Rotational Acceleration ◽

Head Impacts ◽

Factors Associated ◽

Impact Location ◽

Collegiate Football

The purpose of this study was to quantify the severity of head impacts sustained by individual collegiate football players and to investigate differences between impacts sustained during practice and game sessions, as well as by player position and impact location. Head impacts (N = 184,358) were analyzed for 254 collegiate players at three collegiate institutions. In practice, the 50th and 95th percentile values for individual players were 20.0 g and 49.5 g for peak linear acceleration, 1187 rad/s2 and 3147 rad/s2 for peak rotational acceleration, and 13.4 and 29.9 for HITsp, respectively. Only the 95th percentile HITsp increased significantly in games compared with practices (8.4%, p = .0002). Player position and impact location were the largest factors associated with differences in head impacts. Running backs consistently sustained the greatest impact magnitudes. Peak linear accelerations were greatest for impacts to the top of the helmet, whereas rotational accelerations were greatest for impacts to the front and back. The findings of this study provide essential data for future investigations that aim to establish the correlations between head impact exposure, acute brain injury, and long-term cognitive deficits.

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