High School Sports and Brain Injury September 20, 1999 Do you play sports? Perhaps you are on a basketball team? Do you play soccer or football? Volleyball? Baseball or Softball? A study published on September 8, 1999 (Journal of the American Medical Association, Vol. 282, pp. 958-963, 1999) has documented the incidence of traumatic brain injury in high school athletes who play these and other sports. The results may surprise you.

	The authors of the new paper asked 246 athletic trainers in 235 high schools in the United States to keep track of the injuries associated with 10 different sports teams (5 boys' teams and 5 girls' teams). Of the 23,566 injuries reported over the 1995-1997 seasons, 1,219 were classified as mild traumatic brain injuries (MTBIs). From these data, it was estimated that in the US there are 62,816 MTBIs each year in these ten sports. Most people will think of an MTBI as a "concussion": a change in mental status, such as confusion or disorientation, caused by an impact to the head. Such a head injury does NOT have to cause a person to lose consciousness. The sports included in the study were: BOYS GIRLS Baseball Basketball Football Soccer Wrestling Basketball Field Hockey Softball Soccer Volleyball
Can you guess which of the sports had the most MTBIs? Make your predictions then move your mouse over the two boxes below to see which of these sports had the most (#1) and the fewest (#5) MTBIs.

Here are some details about the injuries associated with each of the sports.
	Football 63.4% of all reported MTBIs were related to football. Players did not return to play for an average of three days. The number of MTBIs during games was 11 times higher than during practices. Most injuries were associated with tackling or being tackled. 14.3% of the MTBIs occurred in linebackers; 14.0% in running backs; 13.4% in offensive linemen. Of the 693 different players who suffered an MTBI, 621 players (89.6%) had only 1 MTBI; 65 players (9.4%) had 2 MTBIs; 6 players (0.9%) had 3 MTBIs and 1 player (0.2%) had 4 MTBIs. No deaths were reported.
	Wrestling 10.5% of all reported MTBIs were related to wrestling. The number of MTBIs during matches was 3.1 times higher than during practice. Most MTBIs were suffered during takedowns or attempted takedowns. Wrestlers did not return to the sport for an average of 2 days after an MTBI.
	Basketball 4.2% of all reported MTBIs were related to boys' basketball and 5.2% were related to girls' basketball. MTBIs occurred more often during games than practice: 4.9 times more often in boys' games compared to practice; 6.1 times more often in girls' games compared to practice. Collisions between players accounted for most MTBIs. MTBIs were also suffered by many girls during rebounding. Most game-related MTBIs in boys and girls were suffered by guards. In practice, most MTBIs occurred in forwards. Players did not return to play for an average of 2 days.
	Soccer 5.7% of all reported MTBIs were related to boys' soccer and 6.2% were related to girls' soccer. In boys' soccer, the injury rate was 16.2 times higher during games than during practices; in girls' soccer, it was 14.4 times higher during games than during practices. Forwards and halfbacks suffered most of the MTBIs. Most MTBIs occurred while heading the ball. However, it is unclear if player-to-player, player-to-ball or player-to-ground collisions caused the MTBIs. Players did not return to play for an average of 3 days.
	Baseball and Softball 1.2% of all reported MTBIs were related to boys' baseball; 2.1% were related to girls' softball. Most baseball and softball related MTBIs occurred when players collided with other players, although MTBIs were also sustained by players from collisions with a bat, during sliding and from being hit by a pitch. Baseball players did not return to play for an average of 3 days; softball players did not return to play for an average of 2 days.
	Field Hockey 1.1% of all reported MTBIs were related to girls' field hockey. Games had MTBI rates 14.4 times higher than practices. MTBIs occurred from being hit with a hockey stick, hit with a ball and collsions with other players. Players did not return to play for an average of 3 days.
	Volleyball 0.5% of all reported MTBIs were related to girls' volleyball. MTBIs occurred from being hit with a ball, collisions with other players, and during digging. Players did not return to play for an average of 1 day.

These data show that many high school sports have a significant risk for brain injury. It is especially important to monitor and treat people who suffer MTBIs because injuries to the head may have lasting effects on memory and learning. To prevent injuries: Know the rules of the game. Know the proper technique to play the game. Wear protective safety equipment. Seek immediate medical help if you are injured. JUST DO IT! (but do it safely)

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.)

References and further information: Powell, J.W. and Barber-Foss, K.M. Traumatic brain injury in high school athletes, J. American Medical Association, 282:958-963, 1999. Soccer and the Brain