Filtering by Tag: high school football
Dr. Koutures Reviews New Mexico Concussion Return to Play Case
The mere fact that a return to play decision ended up in court is in itself a big shame.And that shame is definitely rooted in a lack of preparation and breakdowns in communication leading to an oversimplified attempt to make a complex decision.
Less Football Practice Contact Time May Mean Less Concussions
In the evolving discussion regarding the impact of limited high school contact football practice time on concussion risk, findings from the University of Wisconsin suggest that less contact practices may indeed result in less football-related concussions.
Photo courtesy: http://www.ocregister.com/articles/orange-681360-park-last.html
The state of Wisconsin was one year ahead of California in mandating contact practice time restrictions. Starting with the 2014 high school fall season, the Wisconsin Interscholastic Athletic Association (WIAA) prohibited contact in practice for the first week and limited full contact to 75 minutes per week for week 2, with 60 maximum minutes per week for week three and beyond. These limits are more restrictive than in California where two 90 minute contact practice sessions are allowed per week during the high school football season, thought the definitions of full contact are similar (game speed drills/situations where full tackles are made at competitive pace and players are taken to the ground).
- Click here for related posts on California High School Football Contact Practice limitations.
Licensed Athletic Trainers at several Wisconsin high schools recorded incidence and severity for each sport-related concussion, and compared the two years previous to the rule change (2081 players) with data from the first year of the new limitations (945 players).
Significant findings included
· The rate of sport-related concussion sustained in practice was more than twice as high in the two seasons prior to the rule change
· There was no change in the rate of concussion suffered in games pre and post-rule change
· There was no difference in the severity of concussion (defined as average days lost from football activity) pre (13 days lost) and post-rule change (14 days lost)
· Tackling was the primary mechanism of injury in 46% of sport-related concussions
· Years of football playing experience did not affect the incidence of sport-related concussion in the first year of the new limitations
The authors concluded that limitations on contact during high school football practice may be one effective measure to reduce the incidence of sport-related concussion
How might this relate to California?
This is a well-constructed and much needed initial evaluation on the outcomes of contact practice reductions in high school football, with subsequent years of analysis now being anticipated to see if the above findings hold true over multiple seasons.
The maximum allowed football contact times in Wisconsin are about 42% of the maximal time currently allowed in California, so one may wonder if that increased contact time may make direct extrapolations between the states more difficult. This is where a similar study after the 2015 California high school season is vital to measure the outcomes here in this state.
I was greatly impressed with the finding that there was no change in game-based concussion rate and that the years of previous playing experience not affecting the incidence of new concussion as two potentially landmark outcomes for the future of football safety. Coherent arguments have been voiced that lack of appropriate contact practice time might increase risk for inexperienced or under-prepared players, especially in game time situations. This was particularly voiced for freshman players with no previous tackle football experience. I eagerly await future studies to see if these outcomes are consistent and robust.
The lack of change in severity (again, measured in days lost) brings up a couple of thoughts. The initial reaction might be a bit of disappointment, in that reduction of cumulative head impacts in practice should perhaps lead to a lower burden of injury with a concussive blow and hopefully a quicker recovery. One may not want to try and read much into using number of days lost as a strong measure of severity, for standard return-to-play protocols often mandate a minimum of 8-10 days off from full activity which could influence the return time possibly more than symptoms and other measures of severity.
One important subject not analyzed in this study was the incidence of non-concussion injury rates before and after the practice contact limits were enacted. Concerns have been issued over under-prepared players not confident in tackling techniques or changes in technique (hitting opponent lower in body, for example) both possibly contributing to less concussions, but more shoulder, elbow, knee, leg and other musculoskeletal injuries.
Curious if any groups in California are interested or have proposed a similar analysis of our first year with the high school football practice limitations?
Listen to Dr. Koutures Speak on Football Safety: High School Football America Radio Show
Thanks and appreciation to Jeff Fisher from High School Football America for the focus on football safety during his July 30, 2015 radio broadcast. A must listen for any high school football player, parent, coach, or fan who wants to learn more about:
- Contact practice limitations
- Concussion signs, symptoms, and return to school and football
- Helmets and limits to their protective abilities
- Heat Illness prevention tips
- Appropriate fluids before, during and after football activities
- Injury reduction techniques
To listen to the podcast, click here (my portion starts at 58:45)
Are there any other high school football sports medicine topics you would like to see covered during a future podcast? Email me (chris@dockoutures.com) or contact Jeff at jeff@highschoolfootballamerica.com
Initial Thoughts:CA Limits Contact Practice, Mandates 7 Day Minimum Return after Concussion
California Assembly Bill 2127 authored by Assembly Member Ken Cooley (D-Rancho Cordova) has been passed by both legislative houses and now awaits the likely signature of Governor Jerry Brown. The date of implementation is uncertain at this time, but the following changes are certain to come to high school football in the Golden State:
- All high school football teams (public, private and charter) would be limited to no more than 2 full-contact practices per week during the pre-season and regular season.
- The full contact portion of each practice cannot exceed 90 minutes per day
- Full-contact practices are prohibited during the off-season
- “Full-contact practice” means a practice where drills or live action is conducted that involves collisions at game speed, where players execute tackles and other activity that is typical of an actual tackle football game
In addition to the contact practice limitations, the bill would further provide that, if a licensed health care provider determines that the athlete sustained a concussion or a head injury, the athlete is required to complete a graduated return-to-play protocol of no less than 7 days in duration under the supervision of a licensed health care provider. This stipulation is an extension of previous California legislative mandates passed in 2011 and 2012 that require:
- Immediate removal for the remainder of the day of any high school athlete suspected of having a concussion
- Prohibit the return of the athlete to that activity until he or she is evaluated by, and receives written clearance from a licensed health care provider
- Each year, a concussion and head injury information sheet must be signed and returned by athletes and parent/guardian
- Concussion education must now be part of required first aid training of every high school coach
Upon initial review of this legislation, l commend efforts to reduce concussive injuries and rushed returns to play after concussion, and also realize that many teams at all levels of football have already made live contact limitations. I also realize that there are several unanswered questions and controversies to share:
- The current scientific literature does not have a sufficient body of evidence to declare with certainty the precise risks and benefits of live contact limitations in football. The thought that reducing cumulative sub-concussive head impacts is indeed commendable, but the counter-result of potentially having athletes participate in game situations without adequate exposure of didactic hitting instruction has not been fully studied. Ideally, live contact football limitations would have the same injury reduction outcomes as seen with ice hockey checking limitations. Raising the age of initiating checking actually reduced injuries at all levels, thus countering the argument that early and more frequent exposure to checking was important to reduce injuries in older athletes. However, these proposed checking limitations were debated (and probably still questioned in some circles) for years until good studies were done that provided a sufficient supporting evidence base. It is sensible to think that less live contact overall reduces cumulative risk, but would be more appealing to eventually have good science to further support this contention.
- Is this global reduction on contact practice equally beneficial for all levels of high school football? Does maybe the freshman team with several members playing tackle football for the first time need more live contact versus the varsity program with more experienced athletes? Again, I have no numbers or science to support this statement, but do have to wonder.
- Could teams try to maximize the 90 minute sessions of live contact with more drills or hitting repetitions? Is that increased exposure better or worse than spreading it out over more days?
- I do wonder if the tackling limits will encourage the expansion of football camps and other training programs outside the formal high school environment that will allow greater exposure to live contact tackling drills and instruction? If players, parents, and coaches are concerned about receiving sufficient instruction, will they look elsewhere and if so, will those venues have appropriate coaching along with proper medical support (especially Certified Athletic Trainers) and referral mechanisms?
- How do other medical professionals who routinely manage concussed patients feel about the mandatory 7 day minimum return progression? Don't think that anyone out there is ever excited to speed a player's return to play (in fact, we might actually appreciate having "the law" force us to slow down eager players), but one unintended consequence might be the challenge of even more players and families reluctant to present for medical evaluation with the knowledge that they will be required miss the next game. On the other hand, will it possibly increase demand for immediate post-concussive evaluation to "start the clock" as quickly as possible for the small subset of concussed athletes who truly become symptom free within 24-48 hours of injury?
- The bill urges the California Interscholastic Federation to work in consultation with the American Academy of Pediatrics and American Medical Society for Sports Medicine to adopt rules and protocols for developing the return to play progression. I am a member of both organizations, and can state that they are populated by caring and scientifically rigorous members who strive for the best safety interests of children and adolescent athletes. I implore my colleagues in these groups to rigorously evaluation these new mandates in hopes of developing more evidence-based answers to the queries and uncertainties raised above.
What do you think about the live contact tackling limitations? Do you also have any thoughts about the minimum 7 day return progression after a concussion? Very curious to hear from football players, parents, coaches, school administrators and fellow medical professionals.