Sports Medicine Research: In the Lab & In the Field: Concussion Rates Differ Depending on Amount of Equipment and Type of Practice (Sports Med Res)
Wednesday, June 17, 2015

Concussion Rates Differ Depending on Amount of Equipment and Type of Practice

Association of equipment worn and concussion injury rates in National Collegiate Athletic Association football practices: 2004-2005 to 2008-2009 academic years

Kerr ZY., Hayden R., Dompier TP., Cohen R. Am J Sport Med. 2015;43(5):1134-1141

Take Home Message: Practice concussion rates are highest during fully padded practices, preseason, and scrimmages.

Preventing a concussion or subconcussive impact in collision sports like football is difficult. Initiatives such as the release of the NCAA practice contact restrictions are put into place to reduce the risk of sustaining brain injuries. However, the effectiveness of these restrictions has not been determined. Additionally, cofactors associated with practice, like equipment worn, has yet to be investigated and may be associated with concussion risk. Therefore, the authors estimated concussion rates during practices with different equipment worn and identified whether equipment-specific practice concussion rates varied by division, time of season, or type of practice. The authors used the NCAA Injury Surveillance System to look at data from 2004 to 2009 (concussion, injury data, amount of equipment worn, Division, time of season, type of practice). The injury surveillance system included data from 60 football program’s (28 Division I, 10 Division II, 22 Division III). Within this time frame, athletic trainers reported 1,367 football-related concussions, of which 795 (58%) occurred during more than 2 million practice exposures, resulting in an injury rate of 0.39 per 1,000 athletic exposures. Division III had the highest concussion rate (0.54/1,000 athletic exposures), followed by Division I (0.34/1,000 athletic exposures), and Division II (0.24/1,000 athletic exposures). Most practice-related concussions occurred when players were fully padded (70%), during the preseason (69%), and during regular practice sessions (89%). However, the highest practice concussion rate occurred during scrimmages (1.55/1,000 athletic exposures). Practice concussion rates were two times higher in fully padded practiced (0.66/1,000 athletic exposures) compared with practices when only shells were worn (0.33/1,000 athletic exposures) and 22 times higher than practices when only helmets were worn (0.03/1,000 athletic exposures). There were a greater proportion of severe concussions (those taking longer to recover or did not return) when players were wearing only shells (18%) compared with practicing fully padded or wearing helmets only. The proportion of specific activities or mechanisms of injury did not vary by the amount of equipment, division, time of season, or type of practice.

This is one of the first studies to examine the nature of football practices and concussions. Specifically, if the equipment worn during those practices influenced the risk of concussions. The rates of concussions are highest during fully padded practices, preseason practices, and scrimmages. These findings support the NCAA guidelines recommending limits in the amount of contact occurring during football practices. Important factors include amount of equipment worn, football division, time of season, and type of practice. The authors report that the majority of concussions occur during practices, which may be attributed to larger number of football student-athletes who participate in practices compared with competitions. Scrimmages have the highest rate of concussions. This finding suggests that the nature, focus, and intensity of practices have an effect on concussion rates, since concussion rates are highest when the intensity and focus are as game like as possible. Concussion rates are also higher during fully padded practices, and decreased when less equipment was worn; however, a greater proportion of severe concussions occurred when players wore shells only. This suggests that when players are padded from the shoulders above, they are more likely to hit with only those parts of the body with pads, placing more repetitive stress on the head and neck. Medical personnel and coaches need to continually monitor and correct player’s behavior as they practice, and also be aware of what types of practices their players are most at risk for sustaining a concussion.

Questions for Discussion: Should there be a rule change to require full pads during scrimmages? Do you think the amount of fully padded practices should be decreased?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Kerr ZY, Hayden R, Dompier TP, & Cohen R (2015). Association of equipment worn and concussion injury rates in national collegiate athletic association football practices: 2004-2005 to 2008-2009 academic years. The American Journal of Sports Medicine, 43 (5), 1134-41 PMID: 25931501

2 comments:

Mark Colapietro said...

One variable that would have been interesting to include was what was the timing during the practice that the concussion occurred? If there was a trend that concussions typically occurred during the end of practices, would fatigue be a factor that would lead to higher concussions during practice? With fatigue, football players may not be using the same technique they would use when fully energized, as well as making risky plays to "catch up" whenever they are falling behind in practices due to fatigue. In regards to the question regarding using football pads during scrimmages, I believe that pads should be worn, for it will give the necessary exposure to a real game and the players would be more prepared for game-time decision making. If players didn't have this exposure, they may make poor decisions in regards what tackling technique to use or ways to incorrect ways to protect the body, which may result in a higher concussion rate in games. The amount of fully padded practices should remain the same, but coaches should utilize tackling techniques and ways to brace against tackles throughout multiple stages of practice (beginning, middle, end). By reminding them the proper technique at different times during practice, the players will develop these skills while in a fatigue state.
-Mark Colapietro

Jane McDevitt said...

I agree, the timing of when the concussion occurred is an interesting variable, and it makes sense that if the concussions were sustained at the end of a practice or game that it very well could be associated with fatigue. I think your second point of the number of fully padded practice remain the same to keep the practice/scrimmages "game-like" and having tackling strategies implemented at different times during practice seem like that is a good approach to ensure proper technique and decision even in a fatigued state.

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