Influence of Extrinsic Risk Factors on National Football League Injury Rates

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Abstract

Background:

The risk of injury associated with American football is significant, with recent reports indicating that football has one of the highest rates of all-cause injury, including concussion, of all major sports. There are limited studies examining risk factors for injuries in the National Football League (NFL).

Purpose:

To identify risk factors for NFL concussions and musculoskeletal injuries.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Injury report data were collected prospectively for each week over the 2012-2013 and 2013-2014 regular seasons for all 32 teams. Poisson regression models were used to identify the relationship between predetermined variables and the risk of the 5 most frequent injuries (knee, ankle, hamstring, shoulder, and concussion).

Results:

A total of 480 games or 960 team games (TGs) from the 2012-2013 and 2013-2014 regular seasons were included in this study. A trend to an increasing risk of concussion and TG ankle injury with decreasing mean game-day temperature was observed. The risk of TG concussion (incidence rate ratio [IRR], 2.16; 95% CI, 1.35-3.45; P = .001) and TG ankle injury (IRR, 1.48; 95% CI, 1.10-1.98; P = .01) was significantly greater for TGs played at a mean game-day temperature of ≤9.7°C (≤49.5°F) compared with a mean game-day temperature of ≥21.0°C (≥69.8°F). The risk of TG shoulder injury was significantly increased for TGs played on grass surfaces (IRR, 1.36; 95% CI, 1.02-1.81; P = .038) compared with synthetic surfaces. The risk of TG injury was not associated with time in season, altitude, time zone change prior to game, or distance traveled to a game.

Conclusion:

This study evaluated extrinsic risk factors for injury in the NFL. A hazardous association was identified for risk of concussion and ankle injury with colder game-day temperature. Further research should be conducted to substantiate this relationship and its potential implication for injury prevention initiatives.

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Most cited references 26

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Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.

W van Mechelen, H. Hlobil, H Kemper (1992)

Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the 'sequence of prevention'. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step. In this review some aspects of the first and second step of the sequence of prevention are discussed. The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of 'sports injury' and 'sports participation'. The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample. Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the 'sequence of prevention' the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model.(ABSTRACT TRUNCATED AT 400 WORDS)

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Evidence based prevention of hamstring injuries in sport.

Juliana Petersen, P Hölmich (2005)

A common soft tissue injury in sports involving sprinting and jumping is the hamstring strain. A major problem with hamstring strains is the high incidence of reinjury. Muscle injuries can be classified as direct or indirect and are typically grouped into three categories according to severity. A number of potential risk factors have been proposed for hamstring strains. Only a few are evidence based and some are mainly based on theoretical assumptions. There is a lack of clinical research on the effectiveness of rehabilitation programmes for hamstring strains. Although the initial treatment of rest, ice, compression, and elevation is accepted for muscle strains, no consensus exists for their rehabilitation. Not much evidence based research has been carried out on prevention of hamstring strain. To our knowledge only two prospective studies have so far been published. As the injuries are common in football and other sports involving sprinting and jumping, there is a need for further research preferably in the form of randomised controlled trials.

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A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup.

M Hägglund, J Ekstrand, Patricia M. Walden (2004)

To investigate the correlation between exposure of footballers in European clubs to match play in the months before the World Cup 2002 and their injuries and performances during that World Cup. The team doctors at 11 of the best football clubs in Europe prospectively recorded players' exposure and injuries during the 2001-2002 season (July 2001-May 2002). Sixty five players participated in the World Cup in Korea/Japan (June 2002). During the World Cup, the clubs reported injuries sustained by these players, and their performance was evaluated by three international experts. The number of team matches during the season varied between 40 and 76 for the different countries involved. The individual player had a mean of 36 matches during the season. Top players played more matches, especially during the final period of the season. Players who participated in the World Cup played more matches during the season than those who did not (46 v 33 matches). World Cup players did not show any increased risk of injury during the season. About 29% incurred injuries during the World Cup, and 32% performed below their normal standard. The players who underperformed had played more matches during the 10 weeks before the World Cup than those who performed better than expected (12.5 v 9, p<0.05). Twenty three (60%) of the 38 players who had played more than one match a week before the World Cup incurred injuries or underperformed during the World Cup. There is considerable variation in the number of matches played per season in European professional football leagues. Top level players are obliged to play many matches especially during the final period of the season.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 29 March 2016

Publication date Collection: March 2016

Volume: 4

Issue: 3

Electronic Location Identifier: 2325967116639222

Affiliations

[† ]Department of Family & Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

[‡ ]Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.

[§ ]Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.

[∥ ]Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada.

[5-2325967116639222] Investigation performed at University of Toronto, Toronto, Ontario, Canada

Author notes

[*] [* ]David W. Lawrence, MD, Department of Family & Community Medicine, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada (email: dw.lawrence@ 123456mail.utoronto.ca ).

Article

Publisher ID: 10.1177_2325967116639222

DOI: 10.1177/2325967116639222

PMC ID: 4820027

PubMed ID: 27088102

SO-VID: d66daf74-f9c4-43e6-b1b4-ec699f42b8c3

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Keywords: national football league,nfl,concussion,injury prevention,temperature,epidemiology

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Keywords: national football league, nfl, concussion, injury prevention, temperature, epidemiology

Influence of Extrinsic Risk Factors on National Football League Injury Rates

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IUCN Red List of Ecosystems

Most cited references 26

Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.

Evidence based prevention of hamstring injuries in sport.

A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup.

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