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Studies Show Decline in Rate of Concussions

By Cody Porter
NFHS High School Today

The NFHS and its member associations’ attempts to further minimize the risk of head trauma and concussion in football have proven effective, according to data of individual studies prepared by the University of Wisconsin-Madison, and Dr. R. Dawn Comstock, director of the National High School Sports-Related Injury Surveillance System and associate professor of epidemiology at Colorado Children’s Hospital.

Comstock’s study revealed a notable decline in sports-related concussion rates during football practice. Although the overall rate and number of competition-related concussions increased during the 2015-16 season, Comstock found that the rate of concussions during practice dropped below 5.0 per 1,000 athletic exposures to 4.77 for the first time since 2010-11, when it was 3.11.

“Clearly, if there’s less opportunity for injury as a result of limiting total contact time, we will see less concussions, as well as other injuries,” said Michael Koester, M.D., Chair, NFHS Sports Medicine Advisory Committee (SMAC). “However, some of the decrease in the concussion rate is also likely coming from coaches teaching and enforcing proper blocking and tackling techniques.”

In July 2014, at the request of the NFHS Board of Directors, a task force on concussion management was organized to discuss strategies geared towards reducing head impacts and minimizing concussion risk in high school football players. The strategies discussed were to limit the participation of student-athletes during contests and practices, as well as during activities conducted outside of the fall football season, namely during spring and summer practices.

The Wisconsin Interscholastic Athletic Association (WIAA) implemented new contact-reduction rules for the 2014 season that prohibited full contact during the first week of practice, limited full contact to 75 minutes during week two, and capped it at 60 minutes for each week thereafter.

A 2015 study by the University of Wisconsin-Madison, presented at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Washington, D.C., revealed that the rate of concussions during the 2014 season was reduced by more than 50 percent from the previous two seasons.

“This study confirms what athletic trainers who work with high school football programs have long believed regarding the association of full contact drills or practices and the likelihood a player will sustain a concussion,” said Wisconsin-Madison senior scientist Timothy A. McGuine, PhD, ATC. “This is probably also true for other football injuries such as sprains, fractures and dislocations.”

Wisconsin-Madison’s study employed data from the Wisconsin Interscholastic Sports Injury Research Network, which recruited and enrolled more than 16,000 student-athletes from 103 high schools and sports venues throughout Wisconsin.

When the NFHS released its recommendations and guidelines at the July 2014 NFHS Concussion Summit Task Force, the Missouri State High School Activities Association’s (MSHSAA) football advisory committee convened to discuss USA Football’s five levels of contact: “Air,” “Bags,” “Control,” “Live Action,” and “Thud.” The NFHS task force suggested a restriction in practice for the full-contact levels, “Live Action” and “Thud.”

According to recently retired MSHSAA Associate Executive Director Harvey Richards, the MSHSAA opted for a two-year, “methodic” study to gauge how much contact is actually taking place during a high school football game.

“If we’re looking at an actual football game, how much contact is occurring during that game? About 12 or 14 minutes? It’s not three hours’ worth of contact,” Richards said.

As part of the MSHSAA study, now in its second year, 31 coaches across the state script their practices so the MSHSAA has details on the length, level of contact and how many people are involved in practice activity. The study is being conducted by evaluating each athlete, not the time-period allotment per week as many states impose. Richards said using the NFL as an example, a quarterback may take 20 percent of snaps in 10 minutes; however, in that time, he was only participating for two minutes.

This season, the MSHSAA staff, led by MSHSAA Assistant Executive Director Greg Stahl, will have those same 31 coaches submit their practice scripts, in addition to visiting six of the schools to script and time athletes.

“The big reason why we did this test group of 31 coaches for a two-year window is so our football coaches will have buy-in and ownership into limiting contact in practice,” Stahl said. “It’ll get data out in front of them and put them in positions to have ownership in whatever those formal restrictions end up being after the two years.”

The MSHSAA is currently in its sixth year of posting concussion data to MSHSAA.org as the “Interscholastic Youth Sports Brain Injury Report.” Based on data collected from the first week of MSHSAA football practice through the end of district competition, football dropped from 1,512 head injuries during the 2013-14 season to 1,332 in 2014-15 out of 22,337 participants participating in 72 practices.

Among other studies, the NATA, in conjunction with the Michigan High School Athletic Association (MHSAA), recently found a 42-percent decline in head-impact exposures in 2014 when limitations were placed on full-contact high school football practices.

The NATA also found that, while declines differed by position, the most notable reduction came with linemen, who experienced a 46-percent decrease. Prior to 2014, the MHSAA had no regulation on the amount or length of regular-season contact practice sessions.

It was then that the MHSAA required its teams to “conduct no more than two collision practice days in any week” after the first regular-season game. Before the season’s first regular-season game, teams are not allowed to hold more than one “collision” practice in a day.

The study, “Football Players’ Head-Impact Exposure After Limiting of Full-Contact Practices,” can be found online at natajournals.org, and in the July issue of the Journal of Athletic Training.

Elsewhere, measures put in place by the Colorado High School Activities Association (CHSAA) and Pennsylvania Interscholastic Athletic Association (PIAA) since July 2014 have placed further restriction on contact time allowed on a weekly basis. Colorado permits its high school teams no more than 90 minutes throughout three days of full-contact practice during the preseason and regular season. In any one day, Colorado high schools may not have contact practice exceed 40 minutes. As the season progresses, that time limit is lowered so that a 75-minute, two-day cap is in place for postseason play.

Pennsylvania has taken a similar stance, enforcing a rule that allows its high school teams 60 minutes of full-contact practice across three days in a calendar week. That length of time dropped from last year’s first set of guidelines that allowed teams 90 minutes.

“I think the biggest impact that we’ve had in Pennsylvania is that we’ve had a longstanding tradition of prohibiting contact outside of the defined season,” said PIAA Chief Operating Officer Mark Byers. “Football players, although they can experience contact during a defined season, the PIAA Sports Medicine Advisory Committee (SMAC) and our board have ensured that once they’ve had their final contest of the year, they cannot have contact again until the first practice date of the following season.”

In Illinois, the Illinois High School Association (IHSA) is looking to place stricter guidelines on its three days of 90-minute contact. IHSA Associate Executive Director Kurt Gibson said the state association discovered last year that coaches were adding one to two additional minutes to that 90-minute limit when “Live Action” and “Thud” were added to the policy. Gibson said if that remains consistent during the 2015-16 season, the IHSA will look to alter the rule next year so that all full-contact occurs within the 90-minute limit.

In an effort to improve scenarios such as those that have occurred with coaches adding time in Illinois, Dr. McGuine’s recommendation of continued concussion education could prove helpful.

“Educating high school coaches to limit the amount of full contact would be an effective and economical way to help protect students from head injuries,” Dr. McGuine said.

Through the NFHS Learning Center, concussion awareness has reached nearly three million individuals who have taken the “Concussion in Sports” online course. Launched in May 2010, “Concussion in Sports” was the NFHS Learning Center’s first free course and paved the way for its student-specific counterpart. This past July, NFHS Learn released “Concussion for Students” after working with the Arizona Barrow Neurological Institute to disseminate the Barrow Brainbook. All Arizona student-athletes must pass Barrow Brainbook before they are allowed to participate, and the Florida High School Athletic Association (FHSAA) requires all of its student-athletes to pass “Concussion for Students” before they play.
“By nature of the sport, football is always going to present a risk for concussion,” Koester said. “We won’t be able to eliminate concussions, but we will continue to minimize the risk through a variety of approaches, such as practice contact limitations, coach and player education, rules changes and other innovations similar to what we’ve seen over the last couple of years.”

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