scholarly journals Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982921 ◽  
Author(s):  
Rachel G. Grashow ◽  
Andrea L. Roberts ◽  
Ross Zafonte ◽  
Alvaro Pascual-Leone ◽  
Herman Taylor ◽  
...  
Keyword(s):  
American Football ◽  
Epidemiological Methods ◽  
Football Players ◽  
Professional Football ◽  
Head Impacts ◽  
Adverse Health Outcomes ◽  
Acute Injuries ◽  
Full Complement ◽  
Occupational Cohort

Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.

scholarly journals Concussion related deficits in the general population predict impairments in varsity footballers

2019 ◽  
Author(s):  
Clara Alexandra Stafford ◽  
Bobby Stojanoski ◽  
Conor Wild ◽  
Danielle Brewer-Deluce ◽  
Timothy D. Wilson ◽  
...  
Keyword(s):  
General Population ◽  
Inhibitory Control ◽  
Population Level ◽  
American Football ◽  
Cognitive Tasks ◽  
Football Players ◽  
Head Impacts ◽  
Demographic Questionnaire ◽  
History Of

ObjectiveWe investigated the long-term cognitive effects of concussion in 19,261 members of the general population and a cohort of varsity American football players with a history of frequent head impacts, using tests that are known to be sensitive to small changes in performance. MethodsWe asked 19,261 participants to complete a demographic questionnaire and 12 cognitive tests measuring aspects of executive function, including inhibitory control. We compared the performance of those reporting a history of concussion (post-concussion) to those reporting no history of concussion (non-concussed) on the cognitive battery and four non-cognitive variables. We used the results of this population-level study to predict the profile of cognitive performance in varsity American football players, who completed the same cognitive tasks. ResultsPost-concussion and non-concussed participants did not differ on 11 of the 12 cognitive tasks employed. However, on a test of inhibitory control based on the classic Stroop paradigm, post-concussion participants showed accuracy-related impairments specific to the incongruent conditions of the task. Post-concussion participants reported higher levels of anxiety, depression, and trouble concentrating. An entirely independent sample of 74 varsity American football players demonstrated the same pattern of impairment: compared to healthy controls, they scored significantly lower on the test of inhibitory control but were indistinguishable from controls on the 11 other tasks.InterpretationSelf-reported concussion is not associated with long-term general effects on cognitive function. Nevertheless, those who report at least one concussion and those who expose themselves to long-term frequent sport-related head impacts, do have a modest, but statistically robust, deficit of inhibitory control.

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013012
Author(s):  
Madeline Uretsky ◽  
Sylvain Bouix ◽  
Ronald J. Killiany ◽  
Yorghos Tripodis ◽  
Brett Martin ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Microvascular Disease ◽  
Head Impact ◽  
American Football ◽  
Football Players ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
Pathological Correlation ◽  
Daily Function

Background and Objectives:Late neuropathologies of repetitive head impacts from contact sports can include chronic traumatic encephalopathy (CTE) and white matter degeneration. White matter hyperintensities (WMH) on fluid attenuated inversion recovery (FLAIR) MRI scans are often viewed as microvascular disease from vascular risk, but might have unique underlying pathologies and risk factors in the setting of repetitive head impacts. We investigated the neuropathological correlates of antemortem WMH in brain donors exposed to repetitive head impacts. The association between WMH, and repetitive head impact exposure and informant-reported cognitive and daily function were tested.Methods:This imaging-pathological correlation study included symptomatic deceased men exposed to repetitive head impacts. Donors had antemortem FLAIR scans from medical records and were without evidence of CNS neoplasm, large vessel infarcts, hemorrhage, and/or encephalomalacia. WMH were quantified using log-transformed values for total lesion volume (TLV), calculated using the lesion prediction algorithm from the Lesion Segmentation Toolbox. Neuropathological assessments included semi-quantitative ratings of white matter rarefaction, cerebrovascular disease, p-tau severity (CTE stage, dorsolateral frontal cortex), and Aβ. Among football players, years of play was a proxy for repetitive head impact exposure. Retrospective informant-reported cognitive and daily function were assessed using the Cognitive Difficulties Scale (CDS) and Functional Activities Questionnaire (FAQ). Regression models controlled for demographics, diabetes, hypertension, and MRI resolution. Statistical significance was defined as p<0.05.Results:The sample included 75 donors: 67 football players and 8 non-football contact sport athletes and/or military veterans. Dementia was the most common MRI indication (64%). Fifty-three (70.7%) had CTE at autopsy. Log-TLV was associated with white matter rarefaction (OR=2.32, 95% CI=1.03,5.24, p=0.04), arteriolosclerosis (OR=2.38, 95% CI=1.02,5.52, p=0.04), CTE stage (OR=2.58, 95% CI=1.17,5.71, p=0.02), and dorsolateral frontal p-tau severity (OR=3.03, 95% CI=1.32,6.97, p=0.01). There was no association with Aβ. More years of football play was associated with log-TLV (b=0.04, 95% CI=0.01,0.06, p=0.01). Greater log-TLV correlated with higher FAQ (unstandardized beta=4.94, 95% CI=0.42,8.57, p=0.03) and CDS scores (unstandardized beta=15.35, 95% CI=-0.27,30.97, p=0.05).Discussion:WMH might capture long-term white matter pathologies from repetitive head impacts, including those from white matter rarefaction and p-tau, in addition to microvascular disease. Prospective imaging-pathological correlation studies are needed.Classification of Evidence:This study provides Class IV evidence of associations between FLAIR white matter hyperintensities, and neuropathological changes (white matter rarefaction, arteriolosclerosis, p-tau accumulation), years of American football play, and reported cognitive symptoms in symptomatic brain donors exposed to repetitive head impacts.

Association Between History of Multiple Concussions and Health Outcomes Among Former College Football Players: 15-Year Follow-up From the NCAA Concussion Study (1999-2001)

2018 ◽  
Vol 46 (7) ◽  
pp. 1733-1741 ◽  
Author(s):  
Zachary Y. Kerr ◽  
Leah C. Thomas ◽  
Janet E. Simon ◽  
Michael McCrea ◽  
Kevin M. Guskiewicz
Keyword(s):  
Alcohol Dependence ◽  
Health Outcomes ◽  
Severe Depression ◽  
College Football ◽  
Football Players ◽  
Professional Football ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Patient Health ◽  
Concussion History

Background: Previous research has examined associations between concussion history and adverse health outcomes among former professional football players. Less is known about the potential effects of concussion among former college football players without additional exposure at the professional level. Purpose: To examine the association between concussion and adverse health outcomes in a cohort of former college football players without exposure to professional football, 15 years after their playing careers ended. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 204 former collegiate football players (23.4% of eligible athletes with available contact information)—all of whom played at least 1 season of football from 1999 to 2001 in the National Collegiate Athletic Association (NCAA) and had no professional football exposure—completed a general health survey that assessed lifetime concussion history and included the following: the Veterans RAND 36 Item Health Survey, containing a physical composite score (PCS) and mental composite score (MCS); the depression module of the Patient Health Questionnaire; and the 4-item CAGE alcohol dependence questionnaire (for “cutting down, annoyance by criticism, guilty feeling, and eye-openers”). Multivariable binomial regression models estimated adjusted prevalence ratios (PRs) with 95% CIs while controlling for demographics and playing history covariates through forward selection model building. Results: Most participants reported a concussion history (84.3%). Overall, 22.1% and 39.2% of participants reported a PCS and an MCS <50, respectively (indicating worse health than the US national average); 19.1% reported Patient Health Questionnaire scores ≥10 (indicating moderate/severe depression); and 24.8% reported CAGE scores ≥2 (indicating alcohol dependence). The prevalence of having an MCS <50 was higher among those reporting ≥3 versus 0 concussions (PR, 2.5; 95% CI, 1.3-4.9). Controlling for body mass index (BMI), the prevalence of moderate/severe depression was higher among those reporting ≥3 versus 0 concussions (PR, 4.2; 95% CI, 1.0-16.3). Controlling for BMI, the prevalence of having a PCS <50 was higher among those reporting ≥3 versus 1 or 2 concussions (PR, 2.6; 95% CI, 1.3-5.0) but not 0 concussions (PR, 1.5; 95% CI, 0.6-3.6). No associations were found for alcohol dependence. Conclusion: Associations between a history of multiple concussions and adverse health outcomes were found among former collegiate football players without professional football exposure but were limited to those reporting ≥3 prior concussions. Because only 23.4% of eligible athletes responded to the survey, the possibility of ascertainment bias exists, and our findings should thus be interpreted with some caution. Continued examination within nonprofessional football populations is needed, but findings highlight the need for prevention efforts to reduce concussion incidence.

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

2016 ◽  
Vol 18 (1) ◽  
pp. 65-72 ◽  
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.

scholarly journals Left Atrial Mechanical Functions in Professional Soccer Players: A Pilot Study

2017 ◽  
Vol 5 (11) ◽  
pp. 141
Author(s):  
Alper Kartal ◽  
Hasan Güngör ◽  
Reşat Kartal ◽  
Esin Ergin
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
P Wave ◽  
Volume Index ◽  
Football Players ◽  
Professional Football ◽  
Control Subjects ◽  
Professional Soccer ◽  
Atrial Contraction

Long-term regular exercise is associated with physiologic and morphologic alterations in the heart chambers. The aim of this study to evaluate left atrium (LA) phasic functions in professional football players and compare with control subjects. Left atrial volume was calculated at end-systole (Vmax), end-diastole and pre-atrial contraction by echocardiography in 20 professional male football players (mean age, 20.15+2.11 years) and 20 male control subjects (mean age, 22.3+1.49 years). Echocardiographic assessments were per­formed were performed using the criteria of the American Society of Echocardiography. The following LAVs were measured: maximal volume (Vmax), minimal volume (Vmin) and LAV before atrial contraction (VpreA) at the onset of the P wave of the simultaneously recorded ECG. Left atrial ejection fraction (LAEF), expansion index (LAEI), active emptying volume index (LAAEVI) and fraction(LAAEFr), passive emptying volume index (LAPEVI) and fraction (LAPEFr) were calculated. Baseline characteristics, demographics, two dimensional and tissue Doppler echocardiographic parameters were not statistically significant between the groups (Table 1). Both groups were similar in terms of Vmax index but Vmin index and VpreA index were significantly higher in football players. LAEF, LAEI, LAAEVI and LAAEFr were lesser in football player but they were not statistically significant. Also LAPEVI and LAPEFr were similar in both groups (Table 2). Professional football playing can be associated with morphologic alteration in left atrium mechanical functions. Further prospective, randomized, controlled trials with long term follow-up are necessary to make more robust interpretations of this issue.

scholarly journals Medications and Nutritional Supplements in Athletes during the 2000, 2004, 2008, and 2012 FIFA Futsal World Cups

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
André Pedrinelli ◽  
Leandro Ejnisman ◽  
Lorenzo Fagotti ◽  
Jiri Dvorak ◽  
Philippe M. Tscholl
Keyword(s):  
Similar Pattern ◽  
Nutritional Supplements ◽  
Football Players ◽  
Professional Football ◽  
World Cup ◽  
Retrospective Survey ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Prescription Practice

Objective. To examine the use of medications and nutritional supplements among top-level male futsal players during international tournaments.Materials and Methods. This retrospective survey of the four consecutive 2000 to 2012 FIFA (Fédération Internationale de Football Association) Futsal World Cup tournaments analyzes data about the use of medications and nutritional supplements by each player prior to every match. A total of 5264 reports on 1064 futsal players were collected from the 188 matches played.Results. A total of 4237 medications and 8494 nutritional supplements (0.8 and 1.6 per player per match, resp.) were prescribed, and 64% of the players used at least one type of medication over the four tournaments. The most frequently prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (41.1%), whereby 45.7% of all players consumed at least one NSAID during the tournament and 27.4% did so prior to every match.Conclusions. The intake of medications, particularly of NSAIDs, is frequently high among top-level futsal players and follows a similar pattern to that found in FIFA Football World Cups. Campaigns should be instituted to understand this prescription practice by team physicians involving professional football players, with the aim to decrease its use and to prevent athletes from potential short- and long-term risks.

scholarly journals Effect of Concussions on National Football League Quarterback Performance

2020 ◽  
Vol 8 (4) ◽  
pp. 19
Author(s):  
Elizabeth C. Heintz ◽  
Emily F. Foret ◽  
Jeremy J. Foreman
Keyword(s):  
Decision Making ◽  
National Football League ◽  
Field Performance ◽  
American Football ◽  
Return To Play ◽  
Football Players ◽  
Professional Football ◽  
Career Outcomes ◽  
Neurocognitive Performance ◽  
Player Performance

Background: Sports-related concussion (SRC) rates are higher in American football than any other sport; therefore, the effects of SRCs on professional football players is a prevalent topic. Previous research has shown that sustaining an SRC has negative financial and overall career outcomes for athletes and may cause performance decrements after an athlete returns to play, however, the results of previous research regarding athlete performance after returning from an SRC are mixed. While some studies found that player performance in the National Football League (NFL) was unaffected upon returning from an SRC, evidence also suggests significant scoring reductions in offensive players. Although previous research has found that NFL running backs and wide receivers perform at levels similar to their performance before sustaining an SRC, little is known about quarterback performance after an SRC. There is also evidence that SRCs decrease neurocognitive performance, a quality that is crucial, especially for quarterbacks. Objective: The purpose of this study is to examine changes in NFL quarterback performances upon return to play from an SRC. Method: Quarterback ratings (QBRs) and concussion data from 2012-2015 were used to determine if changes occurred in NFL quarterback performance following an SRC. Results: QBRs decreased by 13.3 points (p = 0.014) after quarterbacks return from an SRC. Conclusions: Changes in on-field performance for NFL quarterbacks after sustaining an SRC could be the result of neurocognitive decrements that impact quick reaction and decision-making skills, which may have greater impacts on quarterbacks than other positions.

scholarly journals Long-term Mortality in NFL Professional Football Players

JAMA ◽  
2018 ◽  
Vol 319 (8) ◽  
pp. 773 ◽  
Author(s):  
Steven T. DeKosky ◽  
Michael Jaffee ◽  
Russell Bauer
Keyword(s):  
Football Players ◽  
Professional Football ◽  
Long Term Mortality

Behavioral Tackling Interventions Decrease Head Impact Frequency in American Football Players: A Critically Appraised Topic

2020 ◽  
pp. 1-7
Author(s):  
Ashley E. Evans ◽  
Madeline Curtis ◽  
Marguerite (Meg) Montjoy ◽  
Erica Beidler
Keyword(s):  
High School ◽  
Injury Prevention ◽  
Head Impact ◽  
American Football ◽  
Football Players ◽  
Clinical Question ◽  
Impact Frequency ◽  
Bottom Line ◽  
Head Impacts ◽  
Different Types

Context: The rate of sport-related concussion diagnosis has significantly increased in recent years, which has created a need for injury prevention initiatives. There have been efforts put forth by researchers and American football organizations to teach athletes how to tackle properly in order to decrease the number of subconcussive head impacts and concussions. Clinical Question: Does the implementation of a behavioral tackling intervention decrease the head impact frequency in American football players? Clinical Bottom Line: There is moderate SORT Level B evidence to support the use of behavioral tackling interventions as a means for reducing head impact frequency in football athletes. All four included studies found a significant reduction in head impacts following a behavioral tackling intervention with study findings ranging from a 26–33% reduction in impact frequency. These findings were consistent in youth, high school, and college football players and for different types of behavioral tackling interventions. Therefore, these results indicate that behavioral tackling interventions have the potential to reduce the number of head impacts sustained by American football players, which may ultimately lead to a reduction in concussion occurrence as well.

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