Athletic Injury Monitoring System
Football Injury Project
Brief Summary of the 1997 Football Injury Data
The 1997 football injury data collection project has proven very successful, with data collected on nearly 8900 players and over 610,000 Athlete-Exposures for the season. The data on over 360 cerebral concussions from this sample provides a concussion database that is already nearly fifty percent larger than the database collected during a preliminary version of this study done during the five seasons from 1986 to 1990. This project provides what is undoubtedly the largest current database on football injuries available, and it will continue to grow in the future, providing a rich data source for analyzing football injuries. The cooperation from the certified athletic trainers at the schools involved in the project has been excellent, and has resulted in an extremely high response rate (99.8%) for the weekly submission of data forms.
Several of the results from the 1997 data, when taken together, appear to imply the need for a more vigorous and sustained education program for athletes and coaches regarding the head and the helmet in this sport. The fact that cerebral concussion is the second most frequent injury at the high school level (exceeded only by ankle sprains) and the third most frequent injury at the college level (following ankle sprains and knee ligament sprains/tears) by itself should raise some warning flags, especially when considering research showing that measurable cognitive deficits in memory and information processing for up to thirty days occur following a closed head injury, even when there is no loss of consciousness [e.g., Lancet 2:605-609 (1974); Lancet 2:995-997 (1975)]. In addition, anywhere from one-half to three-quarters of all football concussions involve direct impact from another player’s helmet, which implies that the head is still being used as an initial contact point far too often. Given the nature of this sport, there undoubtedly are many instances where such contact is accidental or unavoidable. But when the helmet is the causative agent in three to four times the percentage of concussions as it is for injuries in general, this is a strong indication that players still tend to use the head as a battering ram and are not keeping the head up, particularly in head on collisions. This also has implications for the risk of neck injuries. This is supported by the observation that tackling and being tackled are generally the most frequent mechanisms for concussion. Finally, the observation that at about one in five high schools the person responsible for fitting helmets has no training to do so (and nearly that proportion of the smaller colleges) has implications for ensuring the optimal protective capabilities of the helmet as well. To a certain degree all of these problems may be inter-related, and can be addressed by a comprehensive education program aimed at players (and their parents at the high school level) and coaches. It needs to be more coordinated and more comprehensive than the sporadic attempts of the past. There should be an effort to encourage governing bodies (state and national high school associations, NCAA, NAIA, etc.) to put much more emphasis on enforcement by game officials of the existing rules regarding use of the head as an initial contact point.
It has been known for many years that players with a previous concussion appear to be more likely to incur a new concussion than players with no history of previous concussions, but there has been little data on exactly how much more likely. The data from the 1997 season indicates that players with a history of concussion within the previous five years are 4.5 times as likely to suffer a new concussion during the season than those with no history of concussion. Among other areas, this information will have implications for questions regarding when it is appropriate to allow a concussed player to return to activity, and for research on the "second impact" syndrome.
The database being collected by this project is a rich source of information about football injuries, and a number of analyses beyond those presented here are possible.