Effect of Concussions on National Football League Quarterback 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.

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Effect of Concussions on the Performance of Running Backs and Wide Receivers in the National Football League

The American Journal of Sports Medicine ◽

10.1177/0363546519864581 ◽

2019 ◽

Vol 47 (11) ◽

pp. 2717-2722 ◽

Cited By ~ 3

Author(s):

Toufic R. Jildeh ◽

Kelechi R. Okoroha ◽

Kevin A. Taylor ◽

Patrick Buckley ◽

Samir Mehta ◽

...

Keyword(s):

National Football League ◽

Individual Performance ◽

High Rate ◽

Return To Play ◽

Control Group ◽

Football Players ◽

Professional Football ◽

Significant Difference ◽

Before And After ◽

Player Performance

Background: Concussion injuries are common in professional football players; however, their effect on player performance remains unclear. Purpose: To quantify the effect of concussions on the performance of running backs and wide receivers in professional football players. Study Design: Cohort study; Level of evidence, 3. Methods: Concussion data from the National Football League were collected for a period of 4 seasons (2012-2015) for running backs and wide receivers. Age, experience, position, time to return to play, yearly total yards, and touchdowns were recorded. A power rating (total yards divided by 10 plus touchdowns multiplied by 6) was calculated for each player’s injury season as well as for the 3 seasons before and after their respective injury. A control group of running backs and wide receivers without an identified concussion injury who competed in the 2012 season was assembled for comparison. Player performance up to 3 seasons before and after the injury season was examined to assess acute and longitudinal changes in player performance. Results: A total of 38 eligible running backs and wide receivers sustained a concussion during the study period. Thirty-four (89%) players were able to return to competition in the same season, missing an average of 1.5 ± 0.9 games; the remaining 4 players returned in the subsequent season. Power ratings for concussed players were similar to those of controls throughout the study period. Concussed players did not suffer an individual performance decline upon returning within the same season. Furthermore, no significant difference in change of power rating was observed in concussed players in the acute (±1 year from injury; −1.2 ± 4.8 vs –1.1 ± 3.9, P = .199) or chronic (±3 years from injury; –3.6 ± 8.0 vs –3.0 ± 4.5, P = .219) setting compared with controls. All concussed players successfully returned to competition in either the index or next season. Conclusion: A high rate of National Football League running backs and wide receivers are able to return to play after a concussion injury. These players were found to perform at a similar level in both the acute and long-term period after concussion.

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Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000314 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Selene Parekh ◽

Jay Shah

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

National Football League ◽

Achilles Tendon Rupture ◽

Return To Play ◽

Football Players ◽

Professional Football ◽

Post Injury ◽

Tendon Ruptures ◽

Player Performance

Category: Ankle, Sports Introduction/Purpose: While much less common than ankle sprains and other sports injuries, Achilles tendon ruptures have represented unexpected and potentially career-altering injuries for professional football athletes in the National Football League (NFL). Over the past decade, the technique for surgical repair of the ruptured Achilles tendon has evolved. Mini-open and percutaneous techniques have become more common, allowing for the minimization of wound complications and expediting the rehabilitation of athletes. Therefore, the objectives of this study were to update the epidemiology of Achilles tendon ruptures in the NFL, and to analyze how recovery and post-injury performance of professional football players with this injury have progressed in the last two decades. Methods: Several online sources including NFL news and injury reports, player registries, and player statistic databases were cross-referenced to conduct a retrospective identification of all NFL players sustaining complete Achilles tendon ruptures during the 2010-2015 NFL seasons. Yearly player performance statistics were also obtained and recorded for both offensive and defensive players. A power rating formula and “approximate value” algorithm, commonly used to evaluate player production, were borrowed to calculate yearly Offensive and Defensive performance metrics for each injured player. These calculated measurements were used to quantify both offensive and defensive player performance up to 3 seasons before and after their respective Achilles tendon rupture injuries, allowing for each player to serve as his own control. Results: 78 Achilles tendon ruptures were identified in professional football players during the 2010-2015 NFL seasons. 58% of these injuries occurred during the preseason. Of those that suffered an Achilles tendon rupture, 26% did not ever return to play in the NFL. Players who did return to play in the NFL took an average of 9 months to recover after the date of injury. Across all positions, there was a net decrease in power ratings by 22% and a net decrease in approximate value by 23% over 3 years following player return after Achilles tendon rupture. Across all positions, running backs saw the biggest decrease in production with a 78% decrease over 3 years post-injury in both power ratings and approximate value. Conclusion: While the incidence of Achilles tendon ruptures in NFL players, especially in the preseason, has increased substantially, more players are returning to play after injury and with better post-injury performance as compared to the previous two decades. These injuries should still be considered potentially career-altering as 26% of players never return to play after Achilles tendon ruptures and there is still a net decrease in power-ratings by 22% for those who do return. However, these numbers optimistically suggest that advancements in treatment protocol and rehabilitation are resulting in faster recovery and improved performance after Achilles tendon ruptures in NFL players.

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Estimating player value in American football using plus–minus models

Journal of Quantitative Analysis in Sports ◽

10.1515/jqas-2020-0033 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

R. Paul Sabin

Keyword(s):

Quantitative Analysis ◽

Field Performance ◽

American Football ◽

Football Players ◽

Model Framework ◽

Sports Analytics ◽

Starting Point ◽

Out Of Sample ◽

Sample Testing ◽

Player Performance

Abstract Calculating the value of football player’s on-field performance has been limited to scouting methods while data-driven methods are mostly limited to quarterbacks. A popular method to calculate player value in other sports are Adjusted Plus–Minus (APM) and Regularized Adjusted Plus–Minus (RAPM) models. These models have been used in other sports, most notably basketball (Rosenbaum, D. T. 2004. Measuring How NBA Players Help Their Teams Win. http://www.82games.com/comm30.htm#_ftn1; Kubatko, J., D. Oliver, K. Pelton, and D. T. Rosenbaum. 2007. “A Starting Point for Analyzing Basketball Statistics.” Journal of Quantitative Analysis in Sports 3 (3); Winston, W. 2009. Player and Lineup Analysis in the NBA. Cambridge, Massachusetts; Sill, J. 2010. “Improved NBA Adjusted +/− Using Regularization and Out-Of-Sample Testing.” In Proceedings of the 2010 MIT Sloan Sports Analytics Conference) to estimate each player’s value by accounting for those in the game at the same time. Football is less amenable to APM models due to its few scoring events, few lineup changes, restrictive positioning, and small quantity of games relative to the number of teams. More recent methods have found ways to incorporate plus–minus models in other sports such as Hockey (Macdonald, B. 2011. “A Regression-Based Adjusted Plus-Minus Statistic for NHL players.” Journal of Quantitative Analysis in Sports 7 (3)) and Soccer (Schultze, S. R., and C.-M. Wellbrock. 2018. “A Weighted Plus/Minus Metric for Individual Soccer Player Performance.” Journal of Sports Analytics 4 (2): 121–31 and Matano, F., L. F. Richardson, T. Pospisil, C. Eubanks, and J. Qin (2018). Augmenting Adjusted Plus-Minus in Soccer with Fifa Ratings. arXiv preprint arXiv:1810.08032). These models are useful in coming up with results-oriented estimation of each player’s value. In American football, many positions such as offensive lineman have no recorded statistics which hinders the ability to estimate a player’s value. I provide a fully hierarchical Bayesian plus–minus (HBPM) model framework that extends RAPM to include position-specific penalization that solves many of the shortcomings of APM and RAPM models in American football. Cross-validated results show the HBPM to be more predictive out of sample than RAPM or APM models. Results for the HBPM models are provided for both Collegiate and NFL football players as well as deeper insights into positional value and position-specific age curves.

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Outcomes of Concussion Injuries to Running Backs and Wide Receivers in the National Football League

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00412 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0041

Author(s):

Kelechi R. Okoroha ◽

Toufic Raja Jildeh ◽

Kevin Taylor ◽

Patrick Buckley ◽

Samir Mehta ◽

...

Keyword(s):

National Football League ◽

Football Player ◽

Return To Play ◽

Total Power ◽

Control Group ◽

Professional Football ◽

Four Seasons ◽

Before And After ◽

Player Performance ◽

The Impact

Objectives: Concussion injuries are common in professional football players, however the impact on player careers remains unclear. The purpose of this study was to quantify the effect of concussions on professional football player performance. Methods: Concussion data from the National Football League was collected for a period of four seasons (2012-2015) for running backs and wide receivers. Demographic variables (age, experience, position, time to return, yearly total yards and touchdowns) were recorded. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after the injury. A control group consisted of running backs and wide receivers without an identified concussion injury who competed in the 2014 season. Results: One hundred and eighteen running backs and wide receivers sustained a concussion over a 4-season period, 25 players (21%) never returned to a National Football League game. Players were able to return in an average of 18.5 ± 8.2 days, missing 1.6 ± 1.0 games. For 18 players with a minimum total power rating of (sum of 4 seasons) of 200 points, power rating per game decreased 43.4 ± 0.4 points from three seasons prior to the concussion to three years postinjury. This change in performance was not statistically significant (P=0.422) when compared with the change for the 343 control players. Conclusion: Over one fifth of National Football League running backs and wide receivers who sustain a concussion never return to play in a game. On return to competition, player performance of injured players reduced from before injury, however there was no difference compared to controls.

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Patellar Tendon Ruptures in National Football League Players

The American Journal of Sports Medicine ◽

10.1177/0363546511417083 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2436-2440 ◽

Cited By ~ 32

Author(s):

Martin Boublik ◽

Theodore Schlegel ◽

Ryan Koonce ◽

James Genuario ◽

Charles Lind ◽

...

Keyword(s):

Patellar Tendon ◽

National Football League ◽

Surgical Repair ◽

Acl Injury ◽

Return To Play ◽

Common Mechanism ◽

Football Players ◽

Professional Football ◽

Tendon Ruptures ◽

Eccentric Overload

Background: Although knee injuries are common among professional football players, ruptures of the patellar tendon are relatively rare. Predisposing factors, mechanisms of injury, treatment guidelines, and recovery expectations are not well established in high-level athletes. Hypothesis: Professional football players with isolated rupture of the patellar tendon treated with timely surgical repair will return to their sport. Study Design: Case series; Level of evidence, 4. Methods: Twenty-four ruptures of the patellar tendon in 22 National Football League (NFL) players were identified from 1994 through 2004. Team physicians retrospectively reviewed training room and clinic records, operative notes, and imaging studies for each of these players. Player game statistics and draft status were analyzed to identify return to play predictors. A successful outcome was defined as participating in 1 regular-season NFL game. Results: Eleven of the 24 injuries had antecedent symptoms. The most common mechanism of injury was an eccentric overload to a contracting extensor mechanism. Physical examination demonstrated a palpable defect in all players. Twenty-two were complete ruptures, and 2 were partial injuries. Three of the 24 cases had a concomitant anterior cruciate ligament (ACL) injury. In 19 of the 24 injuries, the player returned to participate in at least 1 game in the NFL. Players who returned were drafted, on average, in the fourth round, while those who failed to return to play were drafted, on average, in the sixth round. Of those players who returned to play, the average number of games played was 45.4, with a range of 1 to 142 games. Conclusion: Patellar tendon ruptures can occur in otherwise healthy professional football players without antecedent symptoms or predisposing factors. The most common mechanism of injury is eccentric overload. Close attention should be paid to stability examination of the knee given the not uncommon occurrence of concomitant ACL injury. Although this is usually a season-ending injury when it occurs in isolation, acute surgical repair generally produces good functional results and allows for return to play the following season. Players chosen earlier in the draft are more likely to return to play.

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Concussion in National Football League Athletes Is Not Associated With Increased Risk of Acute, Noncontact Lower Extremity Musculoskeletal Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211003491 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110034

Author(s):

Toufic R. Jildeh ◽

Fabien Meta ◽

Jacob Young ◽

Brendan Page ◽

Kelechi R. Okoroha

Keyword(s):

Lower Extremity ◽

National Football League ◽

Field Performance ◽

Return To Play ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Lower Extremity Injuries ◽

Increased Risk ◽

Extremity Injuries ◽

And Control

Background: Impaired neuromuscular function after concussion has recently been linked to increased risk of lower extremity injuries in athletes. Purpose: To determine if National Football League (NFL) athletes have an increased risk of sustaining an acute, noncontact lower extremity injury in the 90-day period after return to play (RTP) and whether on-field performance differs pre- and postconcussion. Study Design: Cohort study, Level of evidence, 3. Methods: NFL concussions in offensive players from the 2012-2013 to the 2016-2017 seasons were studied. Age, position, injury location/type, RTP, and athlete factors were noted. A 90-day RTP postconcussive period was analyzed for lower extremity injuries. Concussion and injury data were obtained from publicly available sources. Nonconcussed, offensive skill position NFL athletes from the same period were used as a control cohort, with the 2014 season as the reference season. Power rating performance metrics were calculated for ±1, ±2, and ±3 seasons pre- and postconcussion. Conditional logistic regression was used to determine associations between concussion and lower extremity injury as well as the relationship of concussions to on-field performance. Results: In total, 116 concussions were recorded in 108 NFL athletes during the study period. There was no statistically significant difference in the incidence of an acute, noncontact lower extremity injury between concussed and control athletes (8.5% vs 12.8%; P = .143), which correlates with an odds ratio of 0.573 (95% CI, 0.270-1.217). Days (66.4 ± 81.9 days vs 45.1 ± 69.2 days; P = .423) and games missed (3.67 ± 3.0 vs 2.9 ± 2.7 games; P = .470) were similar in concussed athletes and control athletes after a lower extremity injury. No significant changes in power ratings were noted in concussed athletes in the acute period (±1 season to injury) when comparing pre- and postconcussion. Conclusion: Concussed, NFL offensive athletes did not demonstrate increased odds of acute, noncontact, lower extremity injury in a 90-day RTP period when compared with nonconcussed controls. Immediate on-field performance of skill position players did not appear to be affected by concussion.

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Effect of Turf Toe on Foot Contact Pressures in Professional American Football Players

Foot & Ankle International ◽

10.3113/fai-2009-0405 ◽

2009 ◽

Vol 30 (5) ◽

pp. 405-409 ◽

Cited By ~ 17

Author(s):

Robert H. Brophy ◽

Seth C. Gamradt ◽

Scott J. Ellis ◽

Ronnie P. Barnes ◽

Scott A. Rodeo ◽

...

Keyword(s):

Body Mass Index ◽

National Football League ◽

Peak Pressure ◽

American Football ◽

Football Players ◽

Plantar Pressures ◽

History Of ◽

Turf Toe ◽

The Relationship ◽

Contact Pressures

Background: The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Materials and Methods: Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. Results: First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 ± 15.1 degrees versus 48.4 ± 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 ± 288 kPa versus 414 ± 202 kPa, p = 0.05) even after normalizing for athlete body mass index ( p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. Conclusion: This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.

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Increasing Incidence of Pectoralis Major Ruptures in NFL Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00396 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0039

Author(s):

Patrick Wise ◽

Robert A. Gallo

Keyword(s):

Bench Press ◽

National Football League ◽

Relative Strength ◽

Pectoralis Major ◽

Definitive Treatment ◽

Football Players ◽

Professional Football ◽

The Past ◽

Playing Time ◽

Performance Enhancing

Objectives: Pectoralis major ruptures are considered an uncommon injury in football. A previous study showing that only 10 compete ruptures occurred in the NFL between the years 2000-2010. The purpose of the study is to report the incidence of pectoralis ruptures in National Football League (NFL) players from 2010-2017 and identify any characteristics that could have contributed. We hypothesized that incidence of pectoralis major ruptures would increase over the past eight years. Methods: Using publicly available reports from websites such as ESPN.com and NFL.com, pectoralis major injuries in professional football players were identified during the years 2010-2017. Details about age, position played, injury setting, performance enhancing drug (PED) suspensions, and combine performance were obtained from NFL Combine and compared to peers at the same workout. Results: During the eight years analyzed 51 separate NFL players suffered a total of 55 pectoralis major ruptures. Defensive players accounted for 82% (42 of 51) of the injured players. The ruptures happened at the average age of 26±1 years, and 76.4% (42 of 55) of them occurred during games. After the rupture, 87.3% (48 of 55) required surgery, while definitive treatment could not be determined for the remaining seven injuries. For athletes that received playing time before injury and had their rupture occur prior to the most recent 2017 season, 85.4% (41 of 48) returned to play in a game. When comparing athletes at the combine who later ruptured their pectoralis major to peers at their position, those who tore their pectoralis major tendon on-average ranked in the 63 rd percentile for bench press (N=40), 50th percentile for arm length (N=14), and 52nd percentile for 20-yard shuttle (N=20). When the NFL suspension records were examined, only 5.9% (3 of 51) of players with a pectoralis major rupture had been suspended for (performance-enhancing drug) PED use before or after the injury. Conclusion: The total number of pectoralis major ruptures has drastically risen from 10 cases between 2000-2010 to 55 cases from 2010-2017. The reason behind this increase remain uncertain but appears to be independent of relative strength, agility, and arm length, and suspension for PED use.

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Return to Play and Performance After Primary ACL Reconstruction in American Football Players: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959654 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095965

Author(s):

Bailey J. Ross ◽

Ian Savage-Elliott ◽

Symone M. Brown ◽

Mary K. Mulcahey

Keyword(s):

Systematic Review ◽

Acl Reconstruction ◽

Study Design ◽

Acl Injury ◽

Performance Level ◽

American Football ◽

Return To Play ◽

Football Players ◽

Cochrane Central Register ◽

And Performance

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, and they can have a negative impact on players’ ability to return to play (RTP). There is a paucity of literature focused on RTP after ACL reconstruction (ACLR) in collision sports. Purpose: To characterize the impact that an ACL injury has on the ability to RTP and the post-ACLR performance level in American football players. Study Design: Systematic review; Level of evidence, 4. Methods: An electronic search was performed using the following databases: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Included studies were written in English; were published since the year 2000; examined only American football players; and reported on RTP, performance, and/or career length after primary ACLR. Results: The initial search yielded 442 unique studies. Of these, 427 were removed after screening, leaving 15 studies that met inclusion criteria. An additional 2 studies were identified in these studies’ references, yielding a total of 17. The rate of RTP after ACLR for football players was 67.2% (1249/1859), and the mean time to return was 11.6 months (range, 35.8-55.8 weeks). Although considerable heterogeneity existed in the study design and outcomes measured, in general, a majority of football players experienced greater declines from their preinjury performance level than controls over the same time period. Conclusion: An ACL injury negatively affected football players’ ability to RTP and their post-ACLR performance. The degree of effect varied by several factors, including playing position, preinjury performance level, and National Football League Draft round. These results may be used by physicians and football players to develop reasonable expectations for returning to play and performance after an ACL injury.

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