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Front-of-Head Impacts Take Most Blame for Youth-Football Concussions

If youth football programs are looking to prevent concussions, removing front-of-the-head collisions from the game would be a great jumping-off point.

According to a study published online in the journal Pediatrics Monday, 44.7 percent of all concussions suffered during player-to-player collisions came from front-of-the-head impacts, while an additional 22.3 percent occurred during side-of-the-head impacts. 

The study authors gathered data from the National High School Sports-Related Injury Surveillance System, which consists of a nationally representative sample of high schools with at least one National Athletic Trainers' Association-affiliated athletic trainer. Beginning in the 2008-09 school year, athletic trainers began reporting more information about each concussion suffered during player-to-player collisions, specifically what area of the head suffered the impact.

Thus, the study drew upon all football-related concussions from the 2008-09 through 2012-13 school years suffered during either practice or games and caused by player-to-player collisions. In total, athletic trainers reported 2,526 concussions that met all of those criteria in 2,517,207 athletic exposures, defined as one athlete participating in a practice or competition.

Of the 2,526 concussions, 1,486 (58.8 percent) occurred during competition, while the remaining 1,040 (41.2 percent) occurred during practice. The authors determined football players to have an injury rate of 10.0 concussions from player-to-player collisions per 10,000 athletic exposures.

Over that five-year time span, 1,130 front-of-the-head collisions (44.7 percent) resulted in concussions, followed by side-of-the-head (22.3 percent), back-of-the-head (5.7 percent) and top-of-the-head (5.5 percent). The remaining 551 concussions had an unknown impact location, according to the study.

Below is a visual representation of those impact locations:

Among all of the concussions suffered, 190 (9.6 percent) were reported to be recurrent rather than new. While injury recurrence was not associated with impact location, players with recurrent concussions suffered from side-of-the-head and top-of-the-head impacts reported a higher average number of symptoms compared to players with new concussions.

Here's a look at the average number of symptoms reported by each player, based on impact location and whether the concussion was new or recurrent:

No single symptom was associated with impact location aside from loss of consciousness, the study authors discovered. Eight percent of those who suffered concussions from top-of-the-head impacts lost consciousness, compared to 3.5 percent of those who suffered concussions from all other type of head impacts from a player-to-player collision.

A majority of the concussions caused by player-to-player collisions came as a result of head-to-head contact (70.7 percent), followed by contact with another player's body parts, such as knees, elbows, or feet (23.0 percent) and contact with the playing surface after a player-to-player collision (6.3 percent). Most player-to-player concussions stemmed from either tackling (35.8 percent) or being tackled (28.3 percent).

"Players must never initiate contact with the helmet, or make contact while head-down," the authors concluded. "In addition, it may be beneficial to revisit the 'no-spearing' rules of the late 1970s, which led to a significant reduction in catastrophic cervical spine and brain injuries in the subsequent decades."

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