Effects of a new rule limiting full contact practice on the incidence of sport-related concussion in high school football players.
Pfaller AY, Brooks A, Hetzel SJ, and McGuine TA. Am J Sports Med. 2019. 47 (10):2294-2299.
https://journals.sagepub.com/doi/abs/10.1177/0363546519860120
Take Home Message
New rules that limit full-contact practice time are associated with fewer sport-related concussions during American football practices.
Summary
Athletic associations are adopting rules to limit contact in American football practice sessions to reduce the number of head impacts and sports-related concussion. However, it remains unknown whether these rules are effective. Pfaller and colleagues completed a retrospective cohort study to understand the impact of rule changes that decrease the amount of full contact practice time on the number of sport-related concussions in Wisconsin high school football players. In 2014, The Wisconsin Interscholastic Athletic Association implemented new rules that limited the amount of full-contact practice time for all Wisconsin high school football teams. The athletic trainers at each school recorded all sport-related concussions during the 2012 or 2013 seasons (before the rule) and 2014 season (after the rule). Athletic trainers and coaches recorded attendance at each game or practice and type of practice (full contact, drill contact, no contact).
Overall, the authors observed a very small decrease in the rate of sports-related concussions (2012-2013: 9% versus 2014: 7%). While concussion rates in competitions remained the same, there was a 57% decrease in the number of sports-related concussions during practice.
Viewpoints
Overall, the authors found that a rule that decreased the amount of full-contact time in high school football practices was associated with fewer sports-related concussions. While this is not surprising, it highlights that limiting the time teams spend in full contact may protect players from sustaining sports-related concussions. Furthermore, decreasing full-contact practice time may be unlikely to increase a player’s risk of a concussion during a game. As more communities and states seek to limit the number of sports-related concussions, rules such as the one implemented in Wisconsin could be good models to use. It is important to keep in mind that the authors are unable to show the rule change caused the decrease in concussions, but it would make sense. It is interesting to consider these findings in light of research by Dr. Swartz and colleagues that demonstrated that football practices without helmets during tackling and blocking drills can cause a 26-33% decrease in head impacts during games. There is no guarantee that less head impacts will lead to less concussions but it raises the interesting question about whether we should test which strategy is best at reducing concussions. Until analyses such as this can be completed, athletic trainers and parents should continue to advocate for rules controlling and decreasing the amount of full-contact practice time.
Questions for Discussion
What experiences do you have with rules limiting the amount of full contact practice time in football? What barriers have your felt which inhibit the expansion of these rules?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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This article brings a great viewpoint into reducing the concussion rate among football players. There’s no arguing with the numbers. 57% decrease during practice is huge and by doing this it will definitely be a positive change for student-athletes’ health. As athletic trainers, keeping the athletes safe should always be our number one priority. However, given that this is high school, I personally do not see how this will reduce concussions during games. Arguably, there’s a “ very small decrease in the rate of sports-related concussions (2012-2013: 9% versus 2014: 7%)”. Even the numbers show that the concussion rate pretty much remained the same.
Cutting practice times is not necessarily a good thing because the point of football is to tackle and block. If we cut practice time it does not allow the student-athletes to practice properly and that can be a bad thing when it comes to a game. I think this will likely increase sports-related concussions during a game. If the athletes do not know how to tackle properly, it can leave them at a higher risk of getting a concussion during a game. Practices and games are completely different. Another example is if the opposing team is bigger and stronger. I have watched the football team that I work with get dragged by the opposing team due to the fact that they were much smaller. If they attempt to tackle improperly they hurt themselves. I think there are better strategies that can be used in reducing concussion rates.
I look at it as both a positive and a negative thing. Positive for for reducing the concussion rate iat practice, negative for not getting enough practices and may or will result in getting a concussion during a game or even a higher risk of injury because of not knowing how to tackle properly. Again the safety of the student-athletes comes first, we should also be preparing the athletes for the games also. However, if the research is showing a significant decrease in concussion during practice then this may be in/for the best interest of the athlete’s health.
So to answer the question, I have yet to experience any coaches reduce practice time to decrease sport-related concussions. However, I am currently working with a high school football team and the coach reduces practice times for other purposes. They have done it to limit and reduce the chances of an athlete getting a heat illness and also to check helmets. The coaching staff are very cautious when it comes to both of those things. The football team has been dealing with muscle cramps during games. For that reason, the coaches reduced practice times. Of course there can be other things that play a factor but reducing practice in the heat has helped minimize heat muscle cramps. The head coach likes to check on the helmets and anything he feels is necessary to change. This includes any malfunctions or fitting. He cuts practice time to get these things fixed. Football is a contact sport. It is a sport that requires physical contact between the player. So if the rules of football keeps getting changed, soon enough it wouldn’t be football anymore. We wouldn’t want to keep changing the rules of lacrosse or it wouldn’t be lacrosse anymore. However, we can implement other ways to reduce injuries but we can not prevent them.
Overall, I think cutting practice times of the players should not be a major thing. The reality is it doesn’t prevent it from happening in a game. It also becomes a disadvantage to the student athletes who are trying to play college football with guys who are much bigger/stronger than them. The one way I can see it being good is if majority of practice time is used to teach them how to effectively tackle.
Daminska,
Thanks for your comments. I think your thinking is in line with other professionals who have a great interest in see how this strategy works out. One things that I think it important to acknowledge though is that what the study focused on was decreasing the amount of time that teams participated in full contact drills and not overall practice time. To your point about practicing specific skills, do you think focusing on fundamental skills during this time saved might help decrease the risk of concussions sustained in practice ? Could you see this also eventually having an impact on in-game concussion prevalence?
Thanks again for a great comment!
As an Athletic Training student, i have not had much experience with different rules limiting the amount of full contact practice time in football. However, where my clinical placement is now i am covering football at a junior college where the full pads and full contact practices are limited to two times a week. The different barriers i have felt that limit the expansion of this rule is the fact that these athletes need to learn the proper way to tackle without causing major injury to their head, neck, or spine. By limiting full contact practices it is limiting the amount of practice and amount of teachable moments that these athletes get to learn how to tackle and engage in contact in the safest way possible. Without having a decent amount of time practicing full contact i also feel that there may be more risk for a head, neck or spine injury during a game because the athletes to not have the proper knowledge and experience to try to avoid these types of injuries. Although I think it is great that the amount of sports-related concussions during practice time went down by 57%, there was no change in the concussions rates during competitions. As an AT student i have seen more head, neck and spine injuries during games as opposed to full contact practices in general. These injuries include concussions, spinal shock, bruised vertebrae, etc. The overall atmosphere of game day changes the way each athlete plays in comparison to full contact practice days. Overall, i think it is important for football athletes to have controlled full contact practices in order to replicate how a game day will be so they can learn the proper tackling forms and have knowledge about how to play the sport as aggressively and efficiently as possible without unknowingly putting themselves at risk for a head injury.
Erika,
Thanks for commenting. You have some valid concerns. While it wasn’t something this study explored, I wonder if the skills your bring up (blocking, tackling, etc.) need to be done in a full-contact environment. Do you think there is a specific advantage to blocking and tackling technique drills which allow full contact as compared to those that do not?
Thanks for your comments!
This blog was a very interesting post, because the amount of concussions that occur in football has always been on my mind. Football is a high impact sport, with a variety of injuries across the board, however concussions and further head injuries have been a key discussion. I found this article very necessary in the research of reducing he number of concussions associated with football. The study in which they are trying out a new method to minimize the amount of concussions is very important, because if we can find a solution now, it will extend a lot of athletes careers and livelihoods post-football. I found that starting this study with high school football was a brilliant first step, because these athletes are already applying so much damage to themselves in their youth, and then want to go on and have collegiate and professional experiences that could potentially cause even more damage/destruction. Decreasing the amount of full contact just seems to make sense, because the athletes wouldn’t be tackling/hitting as much which are the main ways in which they could get a concussion. I can see how the amount of concussions would be limited although further research and studies would need to be provided, it is a great start. If this one study alone already shows a 57% decrease in practice, imagine what more studies could show, and although game-time concussions are not included, the overall damage is what we are trying to control. As of now in my experience as an ATS, I have seen that football teams do not engage in full-contact practices 24/7, however it is in the regards that there are other things to work/practice on, rather than the the instance of wanting to reduce the amount of concussions. And I also feel that coaches and football fans worldwide play a factor in which a rule to limit full-contact has not been implemented yet, is because the big hits and aggressiveness is what they love about football. I believe they put so much emphasis on it because that is what the people want to see. Overall, I think this article sparks the initiative for more studies and for more ideas to come about on the limit of sports-related concussions.
Braylon,
I appreciate the comment! I agree that this is a great first step in this line of inquiry. I do think that based on feedback I have seen and read, that much more needs to be done to understand the impact that limiting full contact practice time has on athletes, both positive and negative. The conversation surrounding this study and other like it, actually make me think about some of the injury prevention literature with soccer. Many studies in this area are evaluating how certain drills and warm-up programs decrease the risk of lower extremity injury. I see this line of research eventually looking at what non-contact drills have the biggest protective impact on athletes. What do you see further down the road?
Hello kyle,
This is some great information, I was glad to see that this study is still taking place. I am a student studying AT I think that it is important to avoid as much full-contact as possible especially if it isn’t needed. Multiple forces to head can result into something more damaging than a concussion. Regardless of the numbers this study seems a bit genius to me.
As the future of ATC i definitely advocate for rules controlling and decreasing the amount of full contact practice time. Even though we have no control over what happens in the games for hard head impacts. We can slow down the affects or more dangerous injuries or even brain diseases like cte by implementing these rules during practice time.
Deja Johnson
Deja,
Thanks for commenting! I agree that I think this is overall a good line of questioning. With the emphasis on prevention, I think this is a very critical conversation starter. One question I would pose to you would be that while we are taking steps to decrease the risk during practices, do you think there will be any impact, positive or negative, on concussion rates during competition?
Thanks again!