WASHINGTON – Limiting the amount of full contact tackling that occurs in high school football practice reduced the rate of sports-related concussions that the athletes experienced, a prospective study showed.
“Something as simple as saying they can’t tackle all the time, limiting the amount of minutes each month, reduced the incidence,” Timothy A. McGuine, Ph.D., of the University of Wisconsin, Madison, said at the American Academy of Pediatrics annual meeting.
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“The majority of sports-related concussions sustained in high school football practice occurred during full contact activities,” he said. “The rate of sports-related concussions sustained in high school football practice was more than twice as high in the two seasons prior to a rule change limiting the amount and duration of full contact activities.”
In their study, Dr. McGuine and his associates tested the effects of a tackle-limiting rule implemented in 2014 in a state interscholastic athletic association for all players in grades 9-12. The rule prohibited full contact play during the first practice week, with full contact defined as “drills or game situations that occur at game speed when full tackles are made at a competitive pace and players are taken to the ground.” The players engaged in full contact play for up to 75 minutes total during the second week of practice and then a maximum of 60 min/wk for all subsequent weeks in the practice season. The rule did not apply to games.
For data on the 2 years before the rule change, 2,081 athletes with a mean age of 16 years reported their concussion history in the 2012 season, involving 36 schools, and the 2013 season, involving 18 schools. In 2014, licensed athletic trainers recorded the incidence and severity of each sports-related concussion for the 945 players at 26 schools. Across all three seasons, almost half the concussions (46%) occurred during tackling. Although the overall rate of concussions dropped from 1.57/1,000 athletic exposures in the combined 2012 and 2013 seasons to 1.28/1,000 athletic exposures in the 2014 season, the difference was not significant (P = .155). During the 2012 and 2013 seasons combined, 206 players (9%) sustained 211 concussions, compared with 67 players (7%) with 70 concussions in 2014.
However, the difference in concussions occurring during practice did differ significantly before and after the rule change. The rate of concussions during practice in 2014 was 0.33 concussions per 1,000 athletic exposures, compared with 0.76 concussions per 1,000 exposures in the 2012 and 2013 seasons (P = .003). Twelve of 15 concussions in 2014 practices occurred during full contact practices, a rate of 0.571,000 exposures, and 82 of 86 concussions in the 2012 and 2013 seasons occurred during full contact practices, a rate of 0.87/1,000 exposures (P = .216).
No difference in concussion rate occurred during the games following the rule change: The 2014 rate of concussions during games was 5.74/1,000 exposures, compared with 5.81 in the combined 2012 and 2013 seasons (P = .999). The severity of concussions sustained before and after the rule change also did not differ, and athletes’ years of football-playing experience had no effect on the concussion incidence in 2014.
Despite the relationship between full contact play and concussions, Dr. McGuine said banning tackling from football is not a policy he would support.
“I think the benefits of the sport far outweigh the risks,” Dr. McGuine said. “Concussions particularly have transcended a sports issue and become a public health issue and have become political, and I’m very much against legislators, policy makers, associations making blanket rules without the evidence to back those,” he said. “There are lingering long-term effects from all orthopedic injuries, but we’re focusing on concussions.”
Equipment modification is unlikely to make much difference in concussion rates either, said Dr. McGuine, whose previous study on football helmets found that the brand and model did not influence concussion risk. “Concussions are multifactorial,” he said. “We can’t just limit the amount of force transmitted to the brain and say we’re going to stop these injuries from occurring.”
One important strategy to reducing concussions is increasing parents’ and athletes’ awareness about multiple injuries and ways to reduce the risk, Dr. McGuine said.
“Concussions are like any other injury – ankle sprains, knee injuries and surgeries, shoulder dislocations,” he said. “If you have one, you’re more susceptible to having another one as opposed to somebody who never had that injury, so the problems are repeat injuries and lingering injuries.” Any of these injuries can have a lasting impact on a young athlete’s quality of life, Dr. McGuine added.