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Young Footballers’ Injuries More Common at Small Schools

Doubled risk compared with football teams from large schools

By Randy Dotinga, Contributing Writer, MedPage Today

SAN DIEGO — Size matters when it comes to risk of injuries in youth football, researchers said here — the size of the school fielding the team, that is.

Players from small schools faced more than double the risk of injury -- including concussion — than those on the largest teams, said Lauren Pierpoint, a graduate student at the University of Colorado Denver, speaking at the American Public Health Association annual meeting.

While the findings aren’t conclusive, they raise questions about whether schools should take action to make teams larger, Pierpoint said. She suggested that officials may wish to boost team size by consolidating teams from various schools, “especially if participation in football keeps declining.”

Football is the most popular high school sport, although a University of Colorado professor’s analysis suggests that participation has dipped markedly since 1998, possibly because of a public focus on concussions and safety. When it comes to concussions, research has suggested that football is the riskiest or among the riskiest high-school sports.

For the new study, Pierpoint and colleagues tracked high-school football concussion data from the High School Reporting Information online database for the school years 2005-2006 to 2016-2017. As part of this program, athletic trainers logged in weekly to report injuries and exposures to risk.

The data encompassed 711 schools and nearly 34,000 injuries, including 7,023 concussions.

The researchers didn't have roster sizes for teams, and instead used “athletic exposures,” a measurement of how often athletes were exposed to play in practice or games, to estimate the sizes of the teams. “We assumed lower athletic exposures translated to teams with fewer athletes,” Pierpoint said.

The smallest teams — those in the 10th percentile — had an estimated relative risk of injury that was 2.5 times higher than those in largest teams (90th percentile), and the higher risk of concussion was nearly identical (RR=2.35). Results were similar when the researchers adjusted the definitions of smallest and largest teams. “No matter what, if you’re a smaller school compared to a larger school, you have a larger rate of injury,” Pierpoint said.

Players faced a higher risk of both injury and concussion in competition versus practice.

Pierpoint cautioned that the study doesn’t take into account the time that players spent on the field, although players on smaller teams may play more if they end up on both offense and defense.

She said the findings suggest that schools may want to consider alternatives to the current system that allows small teams. One idea, she said, is to hold competitions based on team size rather than school enrollments. Limitations on full-contact practices may also be helpful, and time should be allowed for athletes to rest and recover, she added.

In an interview, neurologist and concussion researcher James M. Noble, MD, CPH, of Columbia University Medical Center in New York City, said the explanation for the discrepancy may be more complicated than players on smaller teams facing higher risk because they spend less time on the bench.

“Is an athlete on a smaller squad more likely to be physically outmatched by their opponent, player for player, and thus more likely to be injured?’ Noble asked. “Might there be different strategies employed in practice and competition between smaller and larger squads? Might there be different practice habits, training, or coaching? Does this translate to differences in skill levels and tackling techniques?”

There are other possibilities too, he continued: “Does a larger squad have a larger budget for more coaches, better training, a dedicated tackling coach, or even different equipment?”

​Please note: The information on this website is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

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