Survey Tackles Football Concussions

October 18, 2000

The Game

The grace of a receiver catching a long pass.
The power of a running back charging up the middle of the field.
The quickness of a linebacker pouncing on a fumble.

The crushing tackle by a cornerback in the open field.
The punishing block of an offensive lineman.
The quarterback sack behind the line of scrimmage.

These are some of the plays that make up the game of football and illustrate that football is a major contact sport. As a result of this contact, football is also a game of injuries.

The Concussion

One type of injury suffered by football players is a concussion. A concussion is defined as an impact to the head that causes a change in mental status. Changes in mental status include memory problems, dizziness, headaches, confusion, and blurred vision or even loss of consciousness. These symptoms may last a few minutes or many days. Not all people who have concussions lose consciousness.

The Survey

Although football players wear helmets and other protective equipment, many players still suffer concussions. Studies published over the last 20 years indicate that 15-20% of high school football players (200,000-250,000 players) suffer concussions each year. However, because of recent rule changes and better safety equipment, a new study was performed to determine if there were changes in the incidence of concussions in high school and college football players. Researchers at the Sports Medicine Research Laboratory at the University of North Carolina analyzed data from 242 schools and 17,549 football players.

How often do football players suffer concussions?

Researchers found that 888 players (5.1%) had at least one concussion in a season.

Of the 888 players who had one concussion, 131 of them (14.7%) had another concussion the same season.

What are the symptoms suffered by players with concussions?

The most common symptoms of players with concussions were: headaches (86%), dizziness (67%), confusion (59%), disorientation (48%), blurred bision (35.5%), amnesia (27.7%), loss of consciousness (8.9%)

Many headaches (28%) cleared up after 24 hours. However, 10% of the headaches lasted longer than 5 days.

Players who had a second concussion within a year of their first injury had more severe symptoms the second time.

Which players suffer concussions?

High school and college division III players had a higher incidence of concussions than division II and division I (larger schools) players.

Defensive backs, offensive linemen and linebackers were injured more frequently than players in other positions.

Special teams players and wide receivers suffered more severe concussions than other players.

When do players suffer concussions?

Most (59.9%) of the concussions occurred during games rather than during practice.

Concussions occurred when players collided with:

  • Opponents (63.6%)
  • Teammates (16.9%)
  • Ground (10.0%)
  • Equipment (3.8%)

Head contact with artificial turf was more likely to cause concussions than natural grass. Head contact with artificial turf tended to cause more severe concussions than natural grass.

Approximately one-third of the players who suffered a concussion returned to play on the same day they were injured. These players were held out of the game for an average of only 13 minutes.

"Heads Up" on Concussions

This new report reveals that football players suffer fewer concussions compared with those of 20 years ago. The authors provide several possible explanations for this decreased incidence of head injury:

  1. Rule changes: for example, making "spearing" illegal.
  2. Player education: players know about the new rules and about the effects of concussions.
  3. Reduced contact: many teams now practice with less contact.
  4. Brain injury awareness: people are more aware of the dangers involved in returning a player to a game too soon after an injury.

Even though concussions appear to have decreased in the number and severity over the last few years, the overall number of head injuries is still high. Moreover, players who have one concussion are approximately three times more likely to have a second concussion the same season than those players who have not had an injury. Several well-known professional football players (for example, Steve Young and Troy Aikman) have suffered multiple concussions during their careers. Head injuries jeopardize not only football players' careers, but their future health.

Football is a game played by many people at multiple levels (e.g., Pop Warner, high school, college, professional). As with other contact sports, football carries the risk of injury. It is best that players, parents, coaches, trainers and physicians know these risks and that they work to avoid injury so a player can enjoy a long, healthy career off as well as on the girdiron.

Concussions in the National Football League (NFL) - through week 10 of the 2000 season
Source: Seattle Post-Intelligencer, November 7, 2000, page C1
Troy AikmanQuarterbackWeek 1; 9/3/2000Cowboys
Akili SmithQuarterbackWeek 1; 9/3/2000Bengals
Frank WycheckTight EndWeek 4; 9/24/2000Titans
Antonio FreemanWide ReceiverWeek 6; 10/8/2000Packers
Santana DotsonOffensive TackleWeek 6; 10/8/2000Packers
Cletidus HuntDefensive EndWeek 6; 10/8/2000Packers
Brock HuardQuarterbackWeek 8; 10/22/2000Seahawks
Jon KitnaQuarterbackWeek 8; 10/22/2000Seahawks
Chris ChandlerQuarterbackWeek 10; 11/5/2000Falcons
Charlie BatchQuarterbackWeek 10; 11/5/2000Lions

Did you know?

In 1904, US President Theodore Roosevelt threatened to outlaw football after 19 college football players were killed or paralyzed from brain or spinal cord injuries. (Statistic from Maroon et al., Neurosurgery, 47:659-672, 2000.)

Grades of Concussion
From Neurology, 48:581-585, 1997
Grade 1
Symptoms: Transient confusion; inattention, poor concentration; no loss of consciousness; symptoms clear up in less than 15 minutes.

Recommendations: remove from game; examine immediately and at 5 minute intervals; can return to play if symptoms clear up within 15 minutes. If player suffers a second concussion in the same game, the player should not return to play for a week after the symptoms clear up.

Grade 2
Symptoms: Same as Grade 1, but symptoms last longer than 15 minutes.

Recommendations: remove from game and not allow the player back into the game that day; examine frequently; reexamine the following day by a trained person; return to play after one week without symptoms. If a player suffers a second Grade 2 concussion, the athlete should not return to play for at least two weeks without symptoms. A player should not return to play for an entire season if that player has an abnormal brain scan.

Grade 3
Symptoms: ANY (seconds or minutes) loss of consciousness

Recommendations: get player to emergency room; perform immediate neurological examination and at daily intervals. After a brief (seconds) Grade 3 concussion, athletes should not return to play for one week after symptoms have cleared up; after a prolonged (minutes) Grade 3 concussion, athletes should not return to play for two weeks after symptoms have cleared up. If a player suffers a second Grade 3 concussion, the athlete should not return to play for at least one month without symptoms.

Reference and Further Information:

  1. Guskiewicz, K.M., Weaver, N.L., Padua, D.A. and Garrett, Jr., W.E. Epidemiology of concussions in collegiate and high school football players, American Journal of Sports Medicine, 28:643-650, 2000.
  2. High School Sports and Brain Injury from Neuroscience for Kids
  3. What is a Concussion? from the American Academy of Family Physicians
  4. A Bang to the Brain. What We Know About Concussions.

They said it!

"Football isn't a contact sport, it's a collision sport. Dancing is a contact sport."
--- Vince Lombardi, professional football coach (in Sports in America) by J. Michener

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