The Epidemiology of Overuse Conditions in Youth Football and High School Football Players

Context: High-intensity sport training at the youth level has led to increased concern for overuse conditions. Few researchers have examined overuse conditions in youth sports.Objective: To examine the rates, risks, and distributions of overuse conditions between youth and high school football players.Design: Descriptive epidemiologic study.Setting: Youth and high school football teams.Patients or Other Participants: The Youth Football Safety Study (YFSS) investigated youth football athletes from age 5 to 14 years. The National Athletic Treatment, Injury and Outcomes Network (NATION) focused on high school football athletes 14 to 18 years old. The YFSS data consisted of 210 team-seasons, and the NATION data consisted of 138 team-seasons.Main Outcome Measure(s): Athletic trainers collected football injury and exposure data during the 2012 and 2013 seasons. Injury rates, risks, and distributions were calculated, with injury rate ratios, risk ratios, and injury proportion ratios with 95% confidence intervals (CIs) comparing youth and high school football players.Results: The YFSS reported 1488 injuries, of which 53 (3.6%) were overuse conditions. The NATION reported 12 013 injuries, of which 339 (2.8%) were overuse conditions. The overuse condition rate did not differ between high school and youth football (3.93 versus 3.72/10 000 athlete-exposures; injury rate ratio = 1.06; 95% CI = 0.79, 1.41). However, the 1-season risk of overuse condition was higher in high school than in youth football players (2.66% versus 1.05%; risk ratio = 2.53; 95% CI = 1.84, 3.47). Compared with high school football players, youth football players had greater proportions of overuse conditions that were nontime loss (ie, <24 hours participation-restriction time; 83.0% versus 67.0%; injury proportion ratio = 1.24; 95% CI = 1.07, 1.43) and affecting the lower extremity (92.5% versus 62.5%; injury proportion ratio = 1.48; 95% CI = 1.32, 1.65).Conclusions: Overuse conditions may not present a primary concern in youth and high school football players. However, differences existed between the 2 levels of competition. Although additional research on the incidence of overuse conditions across all youth and high school sports is needed, these findings may highlight the need for programming that is specific to competition level.

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Examining Play Counts and Measurements of Injury Incidence in Youth Football

Journal of Athletic Training ◽

10.4085/1062-6050-52.7.06 ◽

2017 ◽

Vol 52 (10) ◽

pp. 955-965 ◽

Cited By ~ 4

Author(s):

Zachary Y. Kerr ◽

Susan W. Yeargin ◽

Aristarque Djoko ◽

Sara L. Dalton ◽

Melissa M. Baker ◽

...

Keyword(s):

Outcome Measure ◽

Age Groups ◽

Injury Rate ◽

Football Players ◽

Injury Incidence ◽

Injury Rates ◽

Head Impacts ◽

Youth Football ◽

Rate Ratios ◽

Age Range

Context: Whereas researchers have provided estimates for the number of head impacts sustained within a youth football season, less is known about the number of plays across which such impact exposure occurs.Objective: To estimate the number of plays in which youth football players participated during the 2013 season and to estimate injury incidence through play-based injury rates.Design: Descriptive epidemiology study.Setting: Youth football.Patients or Other Participants: Youth football players (N = 2098; age range, 5−15 years) from 105 teams in 12 recreational leagues across 6 states.Main Outcome Measure(s): We calculated the average number of athlete-plays per season and per game using independent-samples t tests to compare age groups (5–10 years old versus 11–15 years old) and squad sizes (<20 versus ≥20 players); game injury rates per 1000 athlete-exposures (AEs) and per 10 000 athlete-plays; and injury rate ratios (IRRs) with 95% confidence intervals (CIs) to compare age groups.Results: On average, youth football players participated in 333.9 ± 178.5 plays per season and 43.9 ± 24.0 plays per game. Age groups (5- to 10-year-olds versus 11- to 15-year-olds) did not differ in the average number of plays per season (335.8 versus 332.3, respectively; t2086.4 = 0.45, P = .65) or per game (44.1 versus 43.7, respectively; t2092.3 = 0.38, P = .71). However, players from smaller teams participated in more plays per season (373.7 versus 308.0; t1611.4 = 8.15, P < .001) and per game (47.7 versus 41.4; t1523.5 = 5.67, P < .001). Older players had a greater game injury rate than younger players when injury rates were calculated per 1000 AEs (23.03 versus 17.86/1000 AEs; IRR = 1.29; 95% CI = 1.04, 1.60) or per 10 000 athlete-plays (5.30 versus 4.18/10 000 athlete-plays; IRR = 1.27; 95% CI = 1.02, 1.57).Conclusions: A larger squad size was associated with a lower average number of plays per season and per game. Increasing youth football squad sizes may help reduce head-impact exposure for individual players. The AE-based injury rates yielded effect estimates similar to those of play-based injury rates.

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Epidemiology of Cervical Muscle Strains in Collegiate and High School Football Athletes, 2011–2012 Through 2013–2014 Academic Years

Journal of Athletic Training ◽

10.4085/1062-6050-229-18 ◽

2019 ◽

Vol 54 (7) ◽

pp. 780-786

Author(s):

Katherine M. Lee ◽

Melissa C. Kay ◽

Kristen L. Kucera ◽

William E. Prentice ◽

Zachary Y. Kerr

Keyword(s):

High School ◽

Rate Ratio ◽

National Collegiate Athletic Association ◽

Injury Rate ◽

Adverse Outcomes ◽

Surveillance Program ◽

Football Players ◽

Surveillance Systems ◽

High School Football ◽

Cervical Muscle

Context Cervical muscle strains are an often-overlooked injury, with neck- and spine-related research typically focusing on spinal cord and vertebral injuries. Objective To examine the rates and distributions of cervical muscle strains in collegiate and high school football athletes. Design Descriptive epidemiology study. Setting Collegiate and high school football teams. Patients or Other Participants The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) collected data from collegiate football athletes. The High School National Athletic Treatment, Injury and Outcomes Network (HS NATION) and High School Reporting Information Online (HS RIO) collected data from high school football athletes. Data from the 2011–2012 through 2013–2014 academic years were used. Main Outcome Measure(s) Athletic trainers collected injury and exposure data for football players. Injury counts, injury rates per 10 000 athlete-exposures (AEs), and injury rate ratios with 95% confidence intervals (CIs) were calculated. Results The NCAA-ISP reported 49 cervical muscle strains (rate = 0.96/10 000 AEs), of which 28 (57.1%) were TL (time loss; rate = 0.55/10 000 AEs). High School NATION reported 184 cervical muscle strains (rate = 1.66/10 000 AEs), of which 33 (17.9%) were TL injuries (rate = 0.30/10 000 AEs). The HS RIO, which collects only TL injuries, reported 120 TL cervical muscle strains (rate = 0.51/10 000 AEs). The overall injury rate was lower in the NCAA-ISP than in HS NATION (injury rate ratio = 0.58; 95% CI = 0.42, 0.79); when restricted to TL injuries, the overall injury rate was higher in the NCAA-ISP (injury rate ratio = 1.83; 95% CI = 1.11, 3.03). No differences were found when comparing TL injuries in HS RIO and the NCAA-ISP. Cervical muscle-strain rates were higher during competitions than during practices across all 3 surveillance systems for all injuries. Most cervical muscle strains were due to player contact (NCAA-ISP = 85.7%, HS NATION = 78.8%, HS RIO = 85.8%). Conclusions The incidence of cervical muscle strains in football players was low compared with other injuries. Nonetheless, identifying and implementing interventions, particularly those aimed at reducing unsafe player contact, are essential to further decrease the risk of injury and associated adverse outcomes.

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A - 02 The Epidemiology of Concussion in Middle School Football

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab035.02 ◽

2021 ◽

Vol 36 (4) ◽

pp. 642-642

Author(s):

Blackstone A ◽

Kelshaw P ◽

Hacherl S ◽

Erdman N ◽

Lincoln A ◽

...

Keyword(s):

High School ◽

Middle School ◽

Return To Sport ◽

Injury Rate ◽

American Football ◽

High School Football ◽

Certified Athletic Trainers ◽

Older Athletes ◽

Public Middle School ◽

Rate Ratios

Abstract Objective Middle school is often the first exposure to American football for many children. However, research examining concussion in football has primarily focused on high school and older athletes. Therefore, we investigated the incidence of concussion and subsequent sport time loss (TL) in MS football. Methods Athlete exposure (AE) and injury rates (IR) were gathered by onsite Certified Athletic Trainers within public middle school for all events across the 2015/16–2019/20 school years. AE was defined as one athlete participating in one practice or game. TL was defined as the number of days between the injury and return to sport dates. Concussion rates per 1000AE with corresponding confidence intervals (CI) were calculated. Injury rate ratios (IRR) with 95% CIs were compared IR between practices and games. CIs excluding 1.0 were considered significant. Results 75 concussions (IR = 1.38/1000AE, 95% CI = 1.06–1.69) occurred across 54,544 AEs. The concussion rate was significantly higher in games (n = 31, IR = 3.51, 95%CI = 2.27–4.75) than practices (n = 44, IR = 0.96, 95%CI = 0.68–1.25; IRR = 3.65, 95%CI = 2.30–5.77). The mean sport TL was 16.50 ± 8.25 days. Conclusions We observed middle school football concussion rates (practices and games) and associated TL from sport to be consistent with prior youth and high school football research. However, the concussion rate for middle school games was more than 3 times that of practices. This is similar to prior middle school football findings, but less than reported in high school football. Continued research evaluating modifiable risk factors for concussion in middle school football games and practices is needed.

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Evaluating Postural Control and Ankle Laxity Between Taping and High-Top Cleats in High School Football Players

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0084 ◽

2018 ◽

Vol 27 (2) ◽

pp. 111-117

Author(s):

Douglas A. Pizac ◽

Charles B. Swanik ◽

Joseph J. Glutting ◽

Thomas W. Kaminski

Keyword(s):

High School ◽

Postural Control ◽

Athletic Training ◽

Training Session ◽

Football Players ◽

Ankle Sprains ◽

High School Football ◽

High School Sports ◽

School Sports ◽

Ankle Arthrometer

Context: Lateral ankle sprains are the most common injuries in high school sports. While ankle taping is a preferred method of external prophylactic support, its restrictive properties decline during exercise. The Under Armour® Highlight cleat is marketed on the premise that it provides added support without the need for additional ankle taping. Objective: To determine if differences in ankle joint laxity and postural control exist between football players wearing the Under Armour® Highlight cleat (Under Armour Inc, Baltimore, MD) as compared to a low/mid-top cleat with ankle tape. Design: Crossover trial. Setting: Athletic training room and football practice field sideline. Patients: 32 interscholastic football players (15.8 ± 1.0 y; 178.9 ± 7.4 cm; 87.1 ± 21.4 kg). Interventions: Ankle laxity was assessed using an instrumented ankle arthrometer (Blue Bay Research Inc, Milton, FL), while postural control testing was performed on the Tekscan MobileMat™ Balanced Error Scoring System (BESS; South Boston, MA). The 2 treatments included Under Armour® Highlight cleats and a low/mid-top cleat with ankle tape applied to the nondominant ankle only. Measurements were taken before and immediately after practice. Main Outcome Measures: The independent variable was treatment (Highlight vs low/mid-top cleat with ankle tape). Dependent variables included ankle arthrometry measures of anterior displacement (mm), inversion/eversion rotation (deg), and the modified BESS error scores. A linear mixed-effects model was used for analysis. Results: The low/mid-top cleat with tape condition had significantly higher inversion range-of-motion (ROM) and inversion/eversion rotation postexercise when compared to the Highlight cleat (P < 0.05). Conclusions: The results of this study provide some evidence that the Under Armour® Highlight cleat restricts ankle ROM following a training session better than the taped low/mid-top cleat. Further study is warranted to determine if this high-top style of football cleat can reduce the incidence of ankle sprains and how it might compare to spat taping.

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Epidemiology of Knee Sprains in Youth, High School, and Collegiate American Football Players

Journal of Athletic Training ◽

10.4085/1062-6050-52.3.09 ◽

2017 ◽

Vol 52 (5) ◽

pp. 464-473 ◽

Cited By ~ 3

Author(s):

Daniel R. Clifton ◽

James A. Onate ◽

Eric Schussler ◽

Aristarque Djoko ◽

Thomas P. Dompier ◽

...

Keyword(s):

High School ◽

Injury Rate ◽

American Football ◽

Football Players ◽

Prevention Strategies ◽

Football Team ◽

Competition Level ◽

Surveillance Programs ◽

Rate Ratios ◽

Collegiate Football

Context: Variations in knee-sprain incidence among competition levels are unclear but may help inform prevention strategies in American football players. Objective: To describe the epidemiology of knee sprains in youth, high school, and collegiate football players. Design: Descriptive epidemiology study. Setting: Injury and athlete-exposure (AE) data were collected from 3 injury-surveillance programs at the youth, high school, and collegiate competition levels. Patients or Other Participants: Data from 310 youth, 184 high school, and 71 collegiate football team-seasons were collected during the 2012 through 2014 seasons. Main Outcome Measure(s): Knee-sprain rates and risks were calculated for each competition level. Injury rate ratios (IRRs) and risk ratios (RRs) compared knee-sprain rates by competition level. Injury proportion ratios (IPRs) compared differences in surgery needs, recurrence, injury mechanism, and injury activity by competition level. Results: Knee-sprain rates in youth, high school, and collegiate football were 0.16/1000 AEs, 0.25/1000 AEs, and 0.69/1000 AEs, respectively. Knee-sprain rates increased as the competition level increased (high school versus youth: IRR = 1.60; 95% confidence interval [CI] = 1.12, 2.30; collegiate versus high school: IRR = 2.73; 95% CI = 2.38, 3.96). Knee-sprain risk was highest in collegiate (4.3%), followed by high school (2.0%) and youth (0.5%) athletes. Knee-sprain risk increased as the competition level increased (high school versus youth: RR = 3.73; 95% CI = 2.60, 5.34; collegiate versus high school: RR = 2.14; 95% CI = 1.83, 2.51). Collegiate football had the lowest proportion of knee sprains that were noncontact injuries (collegiate versus youth: IPR = 0.54; 95% CI = 0.31, 0.95; collegiate versus high school: IPR = 0.59; 95% CI = 0.44, 0.79) and the lowest proportion that occurred while being tackled (collegiate versus youth: IPR = 0.44; 95% CI = 0.26, 0.76; collegiate versus high school: IPR = 0.71; 95% CI = 0.51, 0.98). Conclusions: Knee-sprain incidence was highest in collegiate football. However, level-specific variations in the distributions of knee sprains by injury activity may highlight the need to develop level-specific policies and prevention strategies that ensure safe sports play.

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Epidemiology of 10,000 High School Football Injuries: Patterns of Injury by Position Played

Journal of Physical Activity and Health ◽

10.1123/jpah.10.2.160 ◽

2013 ◽

Vol 10 (2) ◽

pp. 160-169 ◽

Cited By ~ 28

Author(s):

Marcus A. Badgeley ◽

Natalie M. McIlvain ◽

Ellen E. Yard ◽

Sarah K. Fields ◽

R. Dawn Comstock

Keyword(s):

High School ◽

Athletic Trainers ◽

Injury Rate ◽

The United States ◽

Data Collection Tool ◽

High School Athletes ◽

High School Football ◽

Certified Athletic Trainers ◽

Nationally Representative ◽

Patterns Of Injury

Background:With more than 1.1 million high school athletes playing annually during the 2005−06 to 2009−10 academic years, football is the most popular boys’ sport in the United States.Methods:Using an internet-based data collection tool, RIO, certified athletic trainers (ATs) from 100 nationally representative US high schools reported athletic exposure and football injury data during the 2005−06 to 2009−10 academic years.Results:Participating ATs reported 10,100 football injuries corresponding to an estimated 2,739,187 football-related injuries nationally. The injury rate was 4.08 per 1000 athlete-exposures (AEs) overall. Offensive lineman collectively (center, offensive guard, offensive tackle) sustained 18.3% of all injuries. Running backs (16.3%) sustained more injuries than any other position followed by linebackers (14.9%) and wide receivers (11.9%). The leading mechanism of injury was player-player contact (64.0%) followed by player-surface contact (13.4%). More specifically, injury occurred most commonly when players were being tackled (24.4%) and tackling (21.8%).Conclusions:Patterns of football injuries vary by position. Identifying such differences is important to drive development of evidence-based, targeted injury prevention efforts.

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Physical and Performance Characteristics of Successful High School Football Players

The American Journal of Sports Medicine ◽

10.1177/036354659402200621 ◽

1994 ◽

Vol 22 (6) ◽

pp. 859-862 ◽

Cited By ~ 10

Author(s):

Henry N. Williford ◽

Jane Kirkpatrick ◽

Michele Scharff-Olson ◽

Daniel L. Blessing ◽

Nai Zhen Wang

Keyword(s):

High School ◽

Performance Characteristics ◽

Football Players ◽

High School Football ◽

And Performance

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Athletic Scholarships in Intercollegiate Football

Journal of Sports Economics ◽

10.1177/1527002511409239 ◽

2011 ◽

Vol 13 (5) ◽

pp. 515-535 ◽

Cited By ~ 4

Author(s):

Joshua D. Pitts ◽

Jon Paul Rezek

Keyword(s):

High School ◽

Intercollegiate Athletics ◽

Negative Binomial ◽

Negative Relationship ◽

Field Performance ◽

The United States ◽

Football Players ◽

High School Football ◽

Football Coaches ◽

Athletic Scholarships

Despite the financial and cultural importance of intercollegiate athletics in the United States, there is a paucity of research into how athletic scholarships are awarded. In this article, the authors empirically examine the factors that universities use in their decision to offer athletic scholarships to high school football players. Using a Zero-Inflated Negative Binomial (ZINB) model, the authors find a player’s weight, height, body mass index (BMI), race, speed, on-the-field performance, and his high school team’s success often have large and significant impacts on the number of scholarship offers he receives. There is also evidence of a negative relationship between academic performance and scholarship offers. In addition, the authors find evidence of a scholarship premium for players from Florida and Texas. The results also show that running backs, wide receivers, and defensive backs appear to generate the most attention from college football coaches, other things equal.

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