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Concussion Rate for H.S. Football Players Found Higher in Games Than Practices

A larger number of concussions occurred during practices as opposed to games in both high school and collegiate football during the 2012 and 2013 seasons, but the concussion rate at both levels was higher during games, according to a study published online Monday in the journal JAMA Pediatrics.

The study authors used three injury-surveillance programs—the Youth Football Safety Study, the National Athletic Treatment, Injury and Outcomes Network, and the National Collegiate Athletic Association—to examine injury data from youth-football, high school football and collegiate football programs, respectively. They considered 4,092 athlete-seasons from youth-football players, 11,957 athlete-seasons from high school football players, and 4,305 athlete-seasons from collegiate football players.

Across all levels, 1,198 concussions were reported during the 2012 and 2013 seasons: 141 in youth-athletes between the ages of 5 and 14, 795 in high school athletes, and 262 in college athletes. Concussions represented 9.6 percent, 4.0 percent, and 8.0 percent of all injuries reported at each of the three levels, respectively, during those two seasons.

At both the high school and collegiate levels, more concussions were reported during practice than games (57.7 percent and 57.6 percent, respectively, of all concussions at those levels). Having a higher number of concussions in practices rather than games shouldn't come as a huge surprise, however. According to the data, high school players had roughly four practices for every one game and college players had nearly 10 practices per game.

In youth football, meanwhile, slightly more concussions were reported in games (53.9 percent) than practices. The authors surmised that the lower number of concussions in youth-football practices could be due to a smaller number of players and practices at that level. While high school and college teams often practice multiple times per week and play more games, youth-football teams typically practice just once or twice per week and have smaller rosters, too.

Though there were more concussions in practice than in games at the high school and collegiate football players, players were far more likely to sustain a concussion in games than practices at all three levels. Collegiate football players sustained 3.74 concussions per 1,000 athletic exposures (defined as each time a player participated in a practice or a game), according to the study, while high school football players suffered 2.01 per 1,000 AEs and youth-football players sustained 2.38 per 1,000 AEs. The college concussion rate in practice (0.53 per 1,000 AEs) was lower than the high school rate (0.66 per 1,000 AEs).

It's unclear why the collegiate game concussion rate was so much higher than the other levels and why the practice concussion rate was lower. However, the study authors hypothesized the "difference may reflect increased intensity of contact in college competition or attempts to mitigate injury by limiting full or player-to-player contact during practice by focusing more on game preparation."

The authors also deduced the "risk" of players sustaining a concussion at each of the three levels by dividing the number of players who sustained at least one concussion by the total number of players who began the season at each level. The risk of players sustaining a concussion in the 2012 season was highest in high school football (9.98 percent), followed by college (5.54 percent) and youth football (3.53 percent). The risk dropped for each of the three levels in the 2013 season, with high school football experiencing the largest plummet (from 9.98 percent in 2012 to 4.50 percent in 2013). College football players in 2013 were more likely to sustain a concussion (5.52 percent) than high school players that year.

The study authors couldn't say for certain, but they suggested the drop in the high school concussion rate in 2013 might be due to one district with more than 20 schools requiring all coaches to participate in a coaching-education program before the start of the 2013 season. The program offered coaches alternatives to full-contact drills in practice and provided concussion awareness materials to them, too.

Using the average of the two one-season risks in their study, the authors suggested as many as 182,000 football players in total may sustain at least one concussion each year: 99,000 in youth football, 79,640 in high school football and 3,905 in collegiate football. Those numbers translate to roughly one in 30 youth-football players, one in 14 high school players, and one in 20 collegiate players.

The study authors suggested their findings about concussions during football practices at all levels "should prompt an evaluation of technique and head impact exposure. Although it is more difficult to change the intensity or conditions of a game, many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors."

Some states and organizations have already taken matters into their own hands in regard to the former. Back in 2012, Pop Warner began limiting the amount of practice time coaches could use for full-contact drills and prohibited certain types of blocking and tackling drills. Last summer, California enacted a law restricting middle and high school football coaches from holding more than two full-contact practices per week. Around the same time, the NCAA and the College Athletic Trainers' Society issued guidelines recommending a limit of two live-contact football practices per week during the regular season, postseason, and bowl season.

In 2012, the Boston-based Sports Legacy Institute called upon all youth-sports organizations to limit the amount of head contact student-athletes endure, proposing a so-called "hit count" for athletes under the age of 18. They recommended limiting such athletes to no more than "1,000 hits to the head exceeding 10 g's of force in a season, and no more than 2,000 times in a year. Many youth athletes already exceed this high threshold, and would not be allowed to finish a season."

There's no way to fully legislate contact out of football without dramatically changing the game. Making more subtle tweaks, however—such as a limit on the number of full-contact practices allowed in a given time frame—could seemingly help reduce the risk of concussion, given the number of head injuries that occurred during high school and college football practices in the 2012 and 2013 seasons.

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