Comparison of Indiana High School Football Injury Rates by Inclusion of the USA Football “Heads Up Football” Player Safety Coach

Abstract

Background:In Indiana, high school football coaches are required to complete a coaching education course with material related to concussion awareness, equipment fitting, heat emergency preparedness, and proper technique. Some high schools have also opted to implement a player safety coach (PSC). The PSC, an integral component of USA Football’s Heads Up Football (HUF) program, is a coach whose primary responsibility is to ensure that other coaches are implementing proper tackling and blocking techniques alongside other components of the HUF program.Purpose:To compare injury rates in Indiana high school football teams by their usage of a PSC or online coaching education only.Study Design:Cohort study; Level of evidence, 2.Methods:Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2015 high school football season. Players were drawn from 6 teams in Indiana. The PSC group, which used the PSC component, was comprised of 204 players from 3 teams. The “education only” group (EDU), which utilized coaching education only, was composed of 186 players from 3 teams. Injury rates and injury rate ratios (IRRs) were reported with 95% confidence intervals (CIs).Results:During 25,938 athlete-exposures (AEs), a total of 149 injuries were reported, of which 54 (36.2%) and 95 (63.8%) originated from the PSC and EDU groups, respectively. The practice injury rate was lower in the PSC group than the EDU group (2.99 vs 4.83/1000 AEs; IRR, 0.62; 95% CI, 0.40-0.95). The game injury rate was also lower in the PSC group than the EDU group (11.37 vs 26.37/1000 AEs; IRR, 0.43; 95% CI, 0.25-0.74). When restricted to concussions only, the rate was lower in the PSC group (0.09 vs 0.73/1000 AEs; IRR, 0.12; 95% CI, 0.01-0.94), although only 1 concussion was reported in the PSC group. No differences were found in game concussion rates (0.60 vs 4.39/1000 AEs; IRR, 0.14; 95% CI, 0.02-1.11).Conclusion:Findings support the PSC as an effective method of injury mitigation in high school football. Future research should seek to replicate this study using larger samples from additional states.

What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review

“…Kerr et al 64 examined the combined effectiveness of a Heads Up First Education Program and limiting contact in practices in youth football and found no protective effect in reducing concussion risk combined or individually in games or practices. However, in a later study, Kerr et al 63 demonstrate a protective effect of introducing a player safety coach in reducing the risk of concussion in practices. Tackle training without helmets and shoulder pads in youth football did not lead to a reduction in head impacts in games 65.…”

A Systematic Review of the Effectiveness of Concussion Education Programs for Coaches and Parents of Youth Athletes

“…Nine out of 13 studies had a low risk of bias due to missing outcome data; most studies included data for all participants. Three studies provided no information regarding missing data and were therefore rated as no information for this category [7,9,14]. Six studies were rated as having a serious risk of bias in measurement outcomes; these studies had only one group and the outcome measures could be influenced by the knowledge of the intervention [4,8,10,11,15,16].…”

“…Two studies used randomized designs to examine the influence of the HUF program coach education on the incidence of concussion in youth athletes [7,9]. Kerr et al (2015) [9] (N = 70) found that players whose coaches who completed the HUF education program experienced 24% fewer head-impacts above 10Gs, compared to those whose coaches received no educational training.…”

“…Given the limited number of studies examining the efficacy of educational program on parent knowledge of concussion and a dearth of programs specifically designed for parents, additional research is necessary to investigate changes in parental knowledge following education interventions. Kerr et al (2015Kerr et al ( , 2016 [7,9] suggest that while the HUF education program may reduce concussion incidence compared to no education, the online component alone was less effective than when combined with an in-person training session for a PSC. Additionally, Rivara et al (2014) [14] suggests that coaches who have used videos or a quiz to complete their concussion education requirements are less likely to be aware of their athletes' concussions than those who used a written, PowerPoint, or in-person training.…”

Overuse Injuries in Youth Sports: Legal and Social Responsibility

“…Certainly, the education of parents, coaches, physicians, and players about the benefits of early diversification and the harms of early specialization, including stress, injury, and burnout, is crucial. Training programs for coaches regarding the safety of players have proven effective in this regard (Kerr et al, 2016). Similarly, misperceptions related to the likelihood of youth becoming elite athletes ought to be corrected, and the links between parental pressure and child disengagement should be publicized.…”