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Holcomb TD, Marks ME, Pritchard NS, Miller LE, Rowson S, Bullock GS, Urban JE, Stitzel JD. On-Field Evaluation of Mouthpiece-and-Helmet-Mounted Sensor Data from Head Kinematics in Football. Ann Biomed Eng 2024; 52:2655-2665. [PMID: 39058402 PMCID: PMC11402845 DOI: 10.1007/s10439-024-03583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system. METHODS Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes. RESULTS A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively. CONCLUSION If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.
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Affiliation(s)
- Ty D Holcomb
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Madison E Marks
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Steve Rowson
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Garrett S Bullock
- Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA.
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA.
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
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Bussey MD, Salmon D, Nanai B, Romanchuk J, Gomez RM, Tong D, Sole G, Tucker R, Falvey É. Assessing Head Acceleration Events in Female Community Rugby Union Players: A Cohort Study Using Instrumented Mouthguards. Sports Med 2024:10.1007/s40279-024-02111-3. [PMID: 39235574 DOI: 10.1007/s40279-024-02111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND The rapid growth of women's rugby union has underscored the need for female-specific player welfare protocols, particularly regarding the risk of head injuries. Instrumented mouthguards (iMGs) play a vital role in gathering comprehensive data on head acceleration events (HAEs), including their frequency, magnitude, and spatial distribution during games and training. By doing so, iMGs offer valuable context for circumstances in women's matches that may increase player risk. OBJECTIVES The study aimed to contextualize HAEs in female community rugby players using instrumented mouthguards and video review. METHODS This prospective, observational cohort study involved 332 female rugby players across 38 matches and 80 training sessions during the 2021/2022 seasons. Players were representative of four playing grades: U13 (N = 9), U15 (N = 111), U19 (N = 95) and Premier women (N = 115). HAEs were recorded using boil-and-bite iMGs, with a single-axis recording threshold of 5 g. The incidence and prevalence of HAEs was expressed by grade, years of experience, playing positions, and session types (match or training). The effect of playing grade and previous playing experience on HAE propensity during tackles and rucks was also examined. RESULTS Throughout the study, 9151 iMG events over 5 g were recorded, with 80% verified for analysis. Overall, the incidence rate (IR) was highest for HAEs between 10 and 29 g, 12-18 times higher than the IR for > 30-g events. Premier grade players had the highest weekly HAE load (26.2 per player per week) and the highest prevalence of players (49%) exposed to events over 30 g. An inverse relationship was found between years of rugby experience and peak angular acceleration (PAA) in U13-U19 players (p = 0.002, 95% CI [47,177 rads/s2]), showing that more experienced school-age players had lower rotational acceleration during HAEs. However, propensity for HAEs in tackle events was highest in Premier players with > 9 years of experience compared with U13-U19 grade players with similar years of experience (RR = 1.21, 95% CI 1.06-1.37; p = 0.004). Ball carries consistently resulted in the highest propensity of events over 30 g, regardless of playing grade or experience. CONCLUSIONS This research presents unique information regarding head accelerations that occur during women's community rugby matches and practices. The results have significant implications for recognising populations that are at the highest risk of experiencing high cumulative and acute head accelerations. The findings may assist in managing training loads and instructing skill execution in high-risk activities, particularly for younger players who are new to the sport. Consideration of playing grade, experience, and contact phases is crucial for understanding head acceleration exposure and injury risk in female rugby players. These insights can inform injury prevention strategies.
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Affiliation(s)
- Melanie D Bussey
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand.
| | - Danielle Salmon
- New Zealand Rugby, Wellington, New Zealand
- World Rugby, Dublin, Ireland
| | - Bridie Nanai
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Janelle Romanchuk
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
- New Zealand Rugby, Wellington, New Zealand
| | - Raul M Gomez
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Darryl Tong
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
- New Zealand Rugby, Wellington, New Zealand
- Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
- World Rugby, Dublin, Ireland
- School of Medicine & Health, University College Cork, Cork, Ireland
- Department of Oral Diagnostic and Surgical Science, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
- New Zealand Rugby, Wellington, New Zealand
- Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
- World Rugby, Dublin, Ireland
- School of Medicine & Health, University College Cork, Cork, Ireland
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ross Tucker
- Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
- World Rugby, Dublin, Ireland
| | - Éanna Falvey
- World Rugby, Dublin, Ireland
- School of Medicine & Health, University College Cork, Cork, Ireland
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Lloansi Rodriguez I, Freemyer B, Hashida K, Tamura K, Murata N, Furutani T, Gioia G, Myers J, Swartz E. Helmetless Tackling Training Intervention and Preseason Self-efficacy Effects on Head Impacts in Hawai'i High School Football. Clin J Sport Med 2024:00042752-990000000-00204. [PMID: 38975901 DOI: 10.1097/jsm.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/06/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To determine how football head impacts are influenced by self-efficacy (SE), helmetless tackling intervention participation (IP), and years of experience (YE) playing football. DESIGN Cross-sectional. SETTING Three high schools. PARTICIPANTS 120 (male; n = 118, female; n = 2, 15.57 ± 1.23 years) participants were recruited from 5 high school teams (3 varsity and 2 junior-varsity). INDEPENDENT VARIABLES SE, days of IP, and YE playing tackle football. MAIN OUTCOME MEASURES SE was measured using a 53-question survey and categorized into 5 subscales. The accumulation of total head impacts (THI) was measured using Riddell InSite Speedflex helmets (Elyria, OH) throughout the season. Head impact exposure (HIE) was standardized as a ratio of impacts per session (games, scrimmages, and practices). Multiple regression analyses tested the relationship between THI or HIE with the predictor variables. RESULTS For THI, 22.1% was explained by the predictors (r = 0.470, r2 = 0.221). Intervention participation had a negative correlation (B = -4.480, P = 0.019), whereas confidence in performing proper tackling and blocking (SE1) (B = 3.133, P = 0.010) and >8 YE (B = 135.9, P = 0.009) positively correlated with THI. For HIE, 25.4% was explained by the predictors (r = 0.504, r2 = 0.254). Intervention participation negatively correlated (B = -0.077, P = 0.007), whereas SE1 (B = 3.133, P = 0.010) and >8 YE (B = 2.735, P ≤ 0.001) correlated positively with HIE. CONCLUSIONS Increased head impacts were associated with less helmetless tackling participation, more than 8 YE, and more self-confidence in tackling ability. Increasing the amount of time athletes spend practicing proper tackling and blocking techniques to reduce head first and risky play is warranted to reduce the amount of head impacts received over time.
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Affiliation(s)
- Ivet Lloansi Rodriguez
- Department of Kinesiology and Rehabilitation Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Bret Freemyer
- Department of Kinesiology and Rehabilitation Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Kumiko Hashida
- UGA Concussion Research Laboratory, Department of Kinesiology, Athens, GA
| | - Kaori Tamura
- Department of Kinesiology and Rehabilitation Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Nathan Murata
- Department of Kinesiology and Rehabilitation Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Troy Furutani
- Hawaii Concussion Awareness Management Program, Honolulu, HI
| | - Gerald Gioia
- Division of Pediatric Neuropsychology, Children's National Hospital, Washington, DC
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Jay Myers
- Southern New Hampshire University, Hooksett, NH; and
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4
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Ta APD, Hsu MD, Chu H, San Pedro A, Chu H, Leo A, Iwamoto S, Chen H, Chu G. Striking Differences in Kendo Headgear. Cureus 2024; 16:e61723. [PMID: 38975472 PMCID: PMC11227291 DOI: 10.7759/cureus.61723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Kendo, a martial art developed by the samurai, is rooted deep in Japanese culture with traditional armor that has seen little change over the past centuries. Despite its century-old design, kendo helmets are manufactured without third-party testing to verify their quality and effectiveness against head trauma. OBJECTIVE To evaluate the effectiveness of different helmet stitching patterns and padding materials in mitigating impact forces that could lead to sports-related concussions (SRC) in kendo, and to assess variations in safety performance across different genders and kendo ranks (Dan and Kyu). METHODS We collected data from 10 kendo practitioners (six males and four females), analyzing over 4,000 strikes using shinai on a sensor-equipped mannequin. Various helmet stitching patterns (ranging from 2 mm to 9 mm) and padding types (polyurethane-based and different thicknesses of cotton-based pads) were tested under controlled conditions simulating realistic impacts encountered in kendo practice. RESULTS The results indicated that helmets with wider stitching patterns (e.g. 8 mm and 9 mm) generally offered better energy absorption, exhibiting statistically significant lower mean g-forces with a 95% confidence interval compared to tighter patterns (2 mm, 4 mm, 6 mm, and 8 mm x 2 mm) (p < 0.001). Additionally, the polyurethane-based padding outperformed cotton-based padding by a statistically significant reduction of impact force (p < 0.001). Significant differences in striking force were also observed between genders and ranks, with male and higher-rank (Dan) practitioners delivering stronger impacts (both p < 0.001). CONCLUSIONS This study highlights the critical influence of helmet stitching patterns and padding materials on the protective capabilities against concussions in kendo. Even though helmets with narrower stitching patterns cost more, helmets with wider stitching patterns and polyurethane padding material provide enhanced safety benefits. We do not know how the difference in striking force between genders and ranks affects the outcome of a kendo match.
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Affiliation(s)
- An Phuc D Ta
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Megan D Hsu
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Harrison Chu
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Audrey San Pedro
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Hillary Chu
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Alexis Leo
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Satori Iwamoto
- College of Medicine, California Northstate University, Elk Grove, USA
| | - Hao Chen
- Respiratory Medicine, Yokohama City University Hospital, Yokohama, JPN
| | - Gary Chu
- College of Medicine, California Northstate University, Elk Grove, USA
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Tooby J, Till K, Gardner A, Stokes K, Tierney G, Weaving D, Rowson S, Ghajari M, Emery C, Bussey MD, Jones B. When to Pull the Trigger: Conceptual Considerations for Approximating Head Acceleration Events Using Instrumented Mouthguards. Sports Med 2024; 54:1361-1369. [PMID: 38460080 PMCID: PMC11239719 DOI: 10.1007/s40279-024-02012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.
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Affiliation(s)
- James Tooby
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Leeds Rhinos Rugby League Club, Leeds, UK
| | - Andrew Gardner
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Keith Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
- Medical Services, Rugby Football Union, Twickenham, UK
| | - Gregory Tierney
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Sport and Exercise Sciences Research Institute, School of Sport, Ulster University, Belfast, UK
| | - Daniel Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Steve Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
- Leeds Beckett University, Leeds, UK
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie Dawn Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and Sports Science Institute of South Africa, Cape Town, South Africa
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
- Rugby Football League, England Performance Unit, Red Hall, Leeds, UK
- Premiership Rugby, London, UK
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Brooks JS, Dickey JP. Effect of Repetitive Head Impacts on Saccade Performance in Canadian University Football Players. Clin J Sport Med 2024; 34:280-287. [PMID: 38150378 PMCID: PMC11042529 DOI: 10.1097/jsm.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/07/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Investigate the effect of cumulative head impacts on saccade latency and errors, measured across two successive football seasons. DESIGN Participants were acquired from a sample of convenience-one Canadian university football team. Head impacts were collected during training camp, practices, eight regular season games, and four playoff games in each season. Saccade measurements were collected at five time points-before and after training camp, at midseason, after regular season, and after playoffs. SETTING Two seasons following players from a single USports football team during practices and games. PARTICIPANTS Players who completed a baseline saccade measurement and a minimum of one follow-up measurement were included in the study. A total of 127 players were monitored across two competitive seasons, including 61 players who participated in both seasons. INDEPENDENT VARIABLES Head impact measurements were collected using helmet-mounted sensors. MAIN OUTCOME MEASURES Saccade latency and number of errors were measured using high-speed video or electro-oculography. RESULTS On average, each head impact increased prosaccade latency by 5.16 × 10 -3 ms (95% confidence interval [CI], 2.26 × 10 -4 -1.00 × 10 -2 , P = 0.03) and antisaccade latency by 5.74 × 10 -3 ms (95% CI, 7.18 × 10 -4 -1.06 × 10 -2 , P = 0.02). These latency increases did not decrease between the two seasons; in fact, prosaccade latencies were 23.20 ms longer (95% CI, 19.40-27.14, P < 0.001) at the second season's baseline measurement than the first. The number of saccade errors was not affected by cumulative head impacts. CONCLUSIONS Repetitive head impacts in Canadian university football result in cumulative declines in brain function as measured by saccade performance. CLINICAL RELEVANCE Football organizations should consider implementing policies focused on reducing head impacts to improve player safety.
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Affiliation(s)
- Jeffrey S. Brooks
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, ON, Canada; and
| | - James P. Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
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Sundaram V, Sundar V, Pearce AJ. Biomechanical characteristics of concussive and sub-concussive impacts in youth sports athletes: A systematic review and meta-analysis. J Sports Sci 2023:1-15. [PMID: 37393593 DOI: 10.1080/02640414.2023.2231317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
This study aimed to quantitatively investigate and report the biomechanical characteristics of concussive and sub-concussive impacts in youth sports. A systematic search was conducted in September 2022 to identify biomechanical impact studies in athletes ≤18 years of age. Twenty-six studies met the inclusion criteria for quantitative synthesis and analysis. DerSimonian Laird random effects model was used to pool data across the included studies. The pooled estimate of mean peak linear and rotational acceleration of concussive impacts in male youth athletes was 85.56 g (95% CI 69.34-101.79) and 4505.58 rad/s2 (95% CI 2870.28-6140.98), respectively. The pooled estimate of mean peak linear and rotational acceleration of sub-concussive impacts in youth athletes was 22.89 g (95% CI 20.69-25.08) and 1290.13 rad/s2 (95% CI 1050.71-1529.55), respectively. A male vs female analysis in sub-concussive impacts revealed higher linear and rotational acceleration in males and females, respectively. This is the first study to report on impact data in both sexes of youth athletes. Disparity in kinematic impact values suggests future research should aim for standardised measures to reduce heterogeneity in data. Despite this, the data reveals notable impact data that youth athletes are exposed to, suggesting modifications may be required to reduce long-term neurological risks.
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Affiliation(s)
- Vasanth Sundaram
- Department of Sports Biomechanics and Kinesiology, Tamil Nadu Physical Education and Sports University, Chennai, India
| | - Viswanath Sundar
- Physical Education and Sports Science, Visva-Bharati University, West Bengal, India
| | - Alan J Pearce
- College of Science, Health, and Engineering, La Trobe University, Bundoora, Melbourne, Australia
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8
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kercher KA, Steinfeldt JA, Rettke DJ, Zuidema TR, Walker MJ, Martinez Kercher VM, Silveyra P, Seo DC, Macy JT, Hulvershorn LA, Kawata K. Association Between Head Impact Exposure, Psychological Needs, and Indicators of Mental Health Among U.S. High School Tackle Football Players. J Adolesc Health 2023; 72:502-509. [PMID: 36610880 PMCID: PMC10033334 DOI: 10.1016/j.jadohealth.2022.11.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players. METHODS This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes. RESULTS A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (β = -0.035, SE = 0.008, p = < .001), fewer anxiety symptoms (β = -0.021, SE = 0.008, p = .010), and greater thriving scores (β = 0.278, SE = 0.040, p = < .001) at postseason. DISCUSSION This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.
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Affiliation(s)
- Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jesse A Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Devin J Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Taylor R Zuidema
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Miata J Walker
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Vanessa M Martinez Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jonathan T Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana; Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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10
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Kercher KA, Steinfeldt JA, Macy JT, Seo DC, Kawata K. Drill Intensity and Head Impact Exposure in Adolescent Football. Pediatrics 2022; 150:189733. [PMID: 36226553 PMCID: PMC9675985 DOI: 10.1542/peds.2022-057725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to examine head-impact exposure by intensity level and position group, and to test the hypothesis that there would be an increase in cumulative head-impact exposure between drill intensities after controlling for duration in each level with air recording the lowest frequency and magnitude and live recording the highest: air < bags < control < thud < live. METHODS We conducted a prospective, multisite study in 1 season with players from 3 high school football teams (n = 74). Each player wore a sensor-installed mouthguard, which monitored head-impact frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Practice drills and games were categorized by level of contact. RESULTS A total of 7312 impacts were recorded with a median of 67 (interquartile range:128) impacts per player. After controlling for duration, increases in head-impact outcomes by level of contact were observed (air < bags = control < thud = live). Live drills had higher cumulative head-impact frequency (45.4 ± 53.0 hits) and magnitude (PLA: 766.3 ± 932.9 g; PRA: 48.9 ± 61.3 kilorad/s2) per player than other levels (P < .0001). In comparison, air drills had the lowest cumulative frequency (4.2 ± 6.9 hits) and magnitude (PLA: 68.0 ± 121.6 g; PRA: 6.4 ± 13.2 kilorad/s2). CONCLUSIONS These data support the levels-of-contact system as a practical approach to limiting head-impact exposure in tackle football. Our findings are clinically important, because data have begun to suggest the relationship between chronic head-impact exposure and decline in brain health. Since head-impact exposure was influenced by levels of contact, regulation of the duration of certain drill intensities (eg, thud, live) may associate with reduced head-impact exposure in high school football.
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Affiliation(s)
- Kyle A. Kercher
- Department of Kinesiology, Indiana University, Bloomington, Indiana
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology School of Education, Indiana University, Bloomington, Indiana
| | - Jonathan T. Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington, Indiana,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana
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11
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Factors associated with U.S. adults’ willingness to allow teenagers to play tackle football. PLoS One 2022; 17:e0273229. [PMID: 36070282 PMCID: PMC9451093 DOI: 10.1371/journal.pone.0273229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/02/2022] [Indexed: 11/19/2022] Open
Abstract
Little is known about the individual factors, such as knowledge and attitudes (i.e., football safety knowledge, football attitudes), related to adults’ willingness to allow adolescents to participate in tackle football. To address this gap, this study examined the extent to which football safety knowledge and attitudes toward head injury risk are associated with adults’ willingness to allow teenage boys to play high school tackle football. Data were obtained from an internet-based survey of a nationally representative sample of U.S. adults aged 18 to 93 years (n = 1,018). We conducted multilevel linear regression modelling to examine independent effects of the football safety knowledge- and attitude-based predictors. Our analyses revealed that knowledge of football safety measures, along with four of the five attitude-based variables were significantly associated with adults’ willingness to allow teenagers to participate in tackle football, over and above demographic factors. This study provides the first nationally representative examination of willingness to allow tackle football participation while extending our understanding of the gap between policy, public perception, and behavior present in U.S. high school football. These results point to promising directions for stakeholders aiming to increase tackle football participation as an increased understanding of the factors associated with participation may help inform effective policymaking, intervention design, and parental decision making.
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12
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Stephen SJ, Hasman L, Goldenberg M, Merchant-Borna K, Kawata K, Mannix R, Bazarian JJ. Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review. J Head Trauma Rehabil 2022; 37:318-325. [PMID: 35293363 DOI: 10.1097/htr.0000000000000767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function. METHODS A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure. RESULTS Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate ( n = 23) or high school ( n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history. CONCLUSION The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.
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Affiliation(s)
- Steve J Stephen
- University of Rochester, Rochester, New York (Mr Stephen, Mss Hasman, Goldenberg, and Mr Merchant-Borna, and Dr Bazarian); Indiana University, Bloomington (Dr Kawata); and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Mannix)
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13
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Career Head Impact Exposure Profile of Canadian University Football Players. J Appl Biomech 2022; 38:47-57. [PMID: 35045388 DOI: 10.1123/jab.2020-0228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022]
Abstract
This study quantified head impact exposures for Canadian university football players over their varsity career. Participants included 63 players from one team that participated in a minimum of 3 seasons between 2013 and 2018. A total of 127,192 head impacts were recorded from 258 practices and 65 games. The mean (SD) number of career impacts across all positions was 2023.1 (1296.4), with an average of 37.1 (20.3) impacts per game and 7.4 (4.4) impacts per practice. The number of head impacts that players experienced during their careers increased proportionally to the number of athletic exposures (P < .001, r = .57). Linebackers and defensive and offensive linemen experienced significantly more head impacts than defensive backs, quarterbacks, and wide receivers (P ≤ .014). Seniority did not significantly affect the number of head impacts a player experienced. Mean linear acceleration increased with years of seniority within defensive backs and offensive linemen (P ≤ .01). Rotational velocity increased with years of seniority within defensive backs, defensive and offensive linemen, running backs, and wide receivers (P < .05). These data characterize career metrics of head impact exposure for Canadian university football players and provide insights to reduce head impacts through rule modifications and contact regulations.
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14
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Wang T, Kenny R, Wu LC. Head Impact Sensor Triggering Bias Introduced by Linear Acceleration Thresholding. Ann Biomed Eng 2021; 49:3189-3199. [PMID: 34622314 DOI: 10.1007/s10439-021-02868-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Contact sports players frequently sustain head impacts, most of which are mild impacts exhibiting 10-30 g peak head center-of-gravity (CG) linear acceleration. Wearable head impact sensors are commonly used to measure exposure and typically detect impacts using a linear acceleration threshold. However, linear acceleration across the head can substantially vary during 6-degree-of-freedom motion, leading to triggering biases that depend on sensor location and impact condition. We conducted an analytical investigation with impact characteristics extracted from on-field American football and soccer data. We assumed typical mouthguard sensor locations and evaluated whether simulated multi-directional impacts would trigger recording based on per-axis or resultant acceleration thresholding. Across 1387 impact directions, a 10g peak CG linear acceleration impact would trigger at only 24.7% and 31.8% of directions based on a 10 g per-axis and resultant acceleration threshold, respectively. Anterior impact locations had lower trigger rates and even a 30 g impact would not trigger recording in some directions. Such triggering biases also varied by sensor location and linear-rotational head kinematics coupling. Our results show that linear acceleration-based impact triggering could lead to considerable bias in head impact exposure measurements. We propose a set of recommendations to consider for sensor manufacturers and researchers to mitigate this potential exposure measurement bias.
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Affiliation(s)
- Timothy Wang
- Department of Mechanical Engineering, The University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Rebecca Kenny
- Faculty of Medicine, The University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, Canada
| | - Lyndia C Wu
- Department of Mechanical Engineering, The University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
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Sarmiento K, Waltzman D, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies. Am J Sports Med 2021; 49:2218-2226. [PMID: 33999722 PMCID: PMC8335321 DOI: 10.1177/03635465211011754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. PURPOSE To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods. RESULTS For impacts ≥10g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games. CONCLUSION This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
- Address correspondence to Kelly Sarmiento, MPH, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Hwy, NE, MS S106-09, Atlanta, GA 30341, USA ()
| | - Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | - Xinjian Zhang
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | - Lara DePadilla
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, Atlanta, Georgia, USA
| | - Marcie-Jo Kresnow
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | | | - David Jones
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Ravi Goyal
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Matthew J. Breiding
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
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Waltzman D, Sarmiento K, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Head Impact Exposures Among Youth Tackle and Flag American Football Athletes. Sports Health 2021; 13:454-462. [PMID: 33618557 PMCID: PMC8404728 DOI: 10.1177/1941738121992324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis: Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. Study Design: Cohort study. Level of Evidence: Level 4. Methods: Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. Results: There were 186,239 head impacts recorded during the study. Tackle football athletes sustained 14.67 (95% CI 9.75-21.95) times more head impacts during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15g (17.95-18.34) and 52.55g (51.06-54.09) for a tackle football athlete and 16.84g (15.57-18.21) and 33.51g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40g) per athletic exposure compared with a flag football athlete. Conclusion: This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. Clinical Relevance: These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.
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Affiliation(s)
- Dana Waltzman
- Dana Waltzman, PhD, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341 ()
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Macy JT, Kercher K, Steinfeldt JA, Kawata K. Fewer US Adolescents Playing Football and Public Health: A Review of Measures to Improve Safety and an Analysis of Gaps in the Literature. Public Health Rep 2021; 136:562-574. [PMID: 33602026 DOI: 10.1177/0033354920976553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Physical activity during adolescence is associated with positive health outcomes, yet only 26% of US middle and high school students report daily physical activity. Moreover, the number of high school students playing a sport is declining, with the largest decline in football. One reason for this decline in playing football may be increased attention to the risk of head injury. For public health, the decline is alarming because football offers a physical activity opportunity for millions of young people every year. In response, efforts have been made to institute measures to enhance the safety of football. The objective of this topical review was to review these measures and the data supporting their effectiveness. We conducted a search of scientific literature supplemented by a web search to identify safety measures. We used the Indiana University library electronic database, PubMed, and web browser searches with specific search terms. In addition to peer-reviewed studies, we searched news stories and reports from sport-related organizations. We summarized the measures and evaluations of effectiveness and categorized the measures by type (game rules, practice guidelines, equipment innovations, strategic initiatives) and target age group (elementary/middle school, high school, college, professional). We found that attempts are being made to improve the safety of football at all levels. However, many measures lack scientific evidence to support their effectiveness. Therefore, researchers need to systematically evaluate safety measures. By implementing evidence-based interventions, we can balance the public health risk of playing football versus the public health risk of continued declines in participation.
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Affiliation(s)
- Jonathan T Macy
- 1771 Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Kyle Kercher
- 1771 Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Jesse A Steinfeldt
- Department of Counseling Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
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