Effect of a New Rule Limiting Full Contact Practice on the Incidence of Sport-Related Concussion in High School Football Players

Abstract

Background: Sport-related concussion (SRC) has been associated with cognitive impairment, depression, and chronic traumatic encephalopathy. American football is the most popular sport among males in the United States and has one of the highest concussion rates among high school sports. Measured head impacts and concussions are approximately 4 times more common in contact practices compared with noncontact practices. The Wisconsin Interscholastic Athletic Association passed new rules defining and limiting contact during practice before the 2014 football season. Purpose: To determine if the SRC rate is lower after a rule change that limited the amount and duration of full-contact activities during high school football practice sessions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 2081 high school football athletes enrolled and participated in the study in 2012-2013 (before the rule change), and 945 players participated in the study in 2014 (after the rule change). Players self-reported previous concussion and demographic information. Athletic trainers recorded athlete exposures (AEs), concussion incidence, and days lost for each SRC. Chi-square tests were used to compare the incidence of SRC in prerule 2012-2013 seasons with the incidence in the postrule 2014 season. Wilcoxon rank sum tests were used to determine differences in days lost because of SRC. Results: A total of 67 players (7.1%) sustained 70 SRCs in 2014. The overall rate of SRC per 1000 AEs was 1.28 in 2014 as compared with 1.58 in 2012-2013 ( P = .139). The rate of SRC sustained overall in practice was significantly lower ( P = .003) after the rule change in 2014 (15 SRCs, 0.33 per 1000 AEs) as compared with prerule 2012-2013 (86 SRCs, 0.76 per 1000 AEs). There was no difference ( P = .999) in the rate of SRC sustained in games before (5.81 per 1000 AEs) and after (5.74 per 1000 AEs) the rule change. There was no difference ( P = .967) in days lost from SRC before (13 days lost [interquartile range, 10-18]) and after (14 days lost [interquartile range, 10-16]) the rule change. Conclusion: The rate of SRC sustained in high school football practice decreased by 57% after a rule change limiting the amount and duration of full-contact activities, with no change in competition concussion rate. Limitations on contact during high school football practice may be one effective measure to reduce the incidence of SRC.

The Effectiveness of Regulations and Behavioral Interventions on Head Impacts and Concussions in Youth, High-School, and Collegiate Football: A Systematized Review

“…Of the 20 included studies, 8 studies evaluated interventions in high-school football, 7,9,13,24,30,39,48,55 5 studies evaluated interventions in collegiate football, 10,50,51,54,60 6 studies evaluated interventions in youth football, [25][26][27]29,38,58 and 1 study evaluated interventions in both, high-school and collegiate football. 57 Summaries of included articles for youth, highschool, and collegiate, football are presented separately in Tables 1, 2, and 3 respectively.…”

“…Seven studies evaluated the effectiveness of rule changes, 7,25,27,39,50,51,60 two studies evaluated the effectiveness of training programs, 10,57 9 studies evaluated the effectiveness of education/instruction/coaching tactical changes, 9,13,24,26,27,30,48,54,55 and 3 studies evaluated the effectiveness of alternatives to tackle football. 29,38,58 Of the 7 studies that evaluated the effectiveness of rule changes, 5 articles assessed rule changes targeting practice conditions, 7,27,39,50,51 1 article evaluated rule changes targeting game conditions, 60 and 1 article analyzed the difference between rules for player enrollments. 25 Two alternatives to tackle football were evaluated in studies that met inclusion criteria.…”

“…Eight studies evaluated the effectiveness of interventions or regulations in high-school football and were included in this review: one randomized controlled trial (RCT), four cohort studies, one crosssectional study, one clustered quasi-experimental study, and one experimental study. 7,9,13,24,30,39,48,55 The methods used to recruit teams and participants varied across experimental designs. Shanley et al 48 recruited teams that met certain criteria.…”

“…Only one study accounted for players previous playing experience, mentioning that there was no difference amongst players' experience. 39 Swartz et al 55 mentioned participants playing level (upper-level, entry-level) at the time of enrollment but did not account for the difference in number of years players had been playing football.…”

Public Online Interest in Injuries Sustained by National Football League Quarterbacks

“…2 Despite football’s sustained popularity, concerns of injuries occurring during the playing of football, including neurologic and musculoskeletal injuries, have led to recent publications in which the authors encourage orthopaedic surgeons to ask whether “supporting American football at all is consistent with our best professional norms.” 3 Because of this concern among the academic community, numerous studies have been conducted regarding the understanding, prevention, and rehabilitation of concussions and head injuries in football. 4 , 5 , 6 , 7 Similarly, numerous studies regarding the prevention and rehabilitation of musculoskeletal injuries in football have also been undertaken. 8 , 9 , 10 Interest in injuries sustained during the play of football is not concerning only to the academic community; indeed, football and the dangers that the game presents have become a prevalent concern among players, parents, and spectators alike.…”