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

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

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?

by: Jane McDevitt, PhD
by: Jeff Driban


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