Association of Use of a Mobile Tackling Dummy During College Football Practice With Reduced Sport-Related Concussion: Results of a Pilot Investigation.

Background: Considering the multifaceted consequences of improperly managed sport-related concussions (SRCs) in American football, identifying efficacious prevention measures for enhancing player safety is crucial. Purpose: To investigate the association of primary prevention measures (no-tackle practices and using a mobile tackling dummy in practice) with the frequency of SRCs within college football programs in the United States. Study Design: Descriptive epidemiology study. Methods: In this pilot study, we analyzed the frequency of new SRCs recorded during various settings (total, in preseason, in season, in practice, and game) across 14 seasons (2007-2019 and 2021) for Dartmouth College and across 7 seasons (2013-2019) for the 7 other teams in the Ivy League men's athletic football conference. Trends between seasons and the number of SRCs sustained were examined using correlations and basic descriptive statistics. We also examined SRC frequency in relation to primary prevention measures (no-tackle practices, use of mobile tackling dummies during practice) in the Dartmouth College football program, and we compared SRCs with regard to the no-tackle practice policy in the other Ivy League teams. Results: There was a statistically significant reduction in the number of SRCs over the seasons studied, with the strongest finding observed for Dartmouth College in-game SRCs (r = -0.52; P = .029). Relatedly, the strongest between-season effect was seen for the Dartmouth College practice policy on in-game SRCs (η2 = 0.510; P = .01). The use of mobile tackling dummies was found to be independently associated (adjusting for no-tackle practice) with a lower number total (ß = -0.53; P = .049), in-season (ß = -0.63; P = .023), and in-game (ß = -0.79; P = .003) SRCs. While seasons with the no-tackle practice were not meaningfully associated with SRCs for Dartmouth College, stronger trends were observed in the other Ivy League teams, such that seasons with this policy were associated with lower SRC prevalence. Conclusion: Our data indicate that the use of the mobile tackling dummy in practice was related to the reduced number of SRCs sustained at multiple settings during the football season. To a lesser extent, the no-tackle practice policy was also associated with a reduced number of SRCs.

Bone modification of the college american football player: longitudinal study / Modificaciones óseas del jugador de futbol americano universitario: estudio longitudinal

The purpose of this study was to know the bone changes of college football (FA)players. A total of 39 male FA players participated, ranging in age from 18 to 25 years old. They were grouped according to each playing position they play in the team such as: Linemen (n = 15), players of great skills (n = 7), players of skill (n = 13) and quarterbacks (n = 4). For the assessment of BMD (g/cm2) a Double X-ray Bone Densitometry (DXA) was used. The results of this study showed a significant decrease (p<.05) of BMD in head and legs, in contrast, the CMO showed an increase in legs, however, in the pelvic region showed a significant decrease (p<.05). In conclusion, significant changes were found for BMD and CMO in the head, leg and pelvis regions in college AF players over a one-year span of competition (AU)

El propósito de este estudio fue conocer los cambios óseos de los jugadores de futbol americano (FA) universitario. Participaron un total de 39 jugadores de FA masculino, con rangos de edad de 18 a 25 años. Se agruparon acorde a cada posición de juego que desempeñan en el equipo como: Linieros (n=15), jugadores de grandes habilidades (n=7), jugadores de habilidad (n=13) y mariscales de campo (n=4). Para la valoración de DMO (g/cm2) se utilizó un Densitometría Ósea Doble de Rayos X (DXA). Los resultados de este estudio mostraron una disminución significativa (p<.05) de DMO en cabeza y piernas, en cambio, el CMO mostró un aumento en piernas, sin embargo, en la región de pelvis mostro una disminución significativa (p<.05). En conclusión, se encontraron cambios significativos para la DMO y CMO en las regiones de cabeza, piernas y pelvis en los jugadores de FA universitario en un lapso de un año de competencia (AU)

Down, set, spread: The association between college football and COVID-19.

OBJECTIVES: Before the Fall 2020 semester, college presidents and the NCAA made decisions about playing college football. The current study aims to examine the association between college football games and COVID-19 infections at universities. PARTICIPANTS: More than 1,800 college campuses nationwide from The New York Times database on COVID-19 cases on college campuses. METHODS: Random effects negative binomial regression is used to analyze the association between college football games, membership to college football organizations, and COVID-19 cases at the universities studied. RESULTS: The number of football games played was significantly associated with higher COVID-19 cases at the universities studied. Membership to certain college football organizations was also significantly associated with higher COVID-19 cases, particularly FBS and Power Five conferences. CONCLUSIONS: These findings provide a baseline for subsequent analyses across other sports and advocates for continued assessment of protocols that ensure the safety and well-being of student-athletes, fans, and university communities.

Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project.

BACKGROUND: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the "Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project." The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project. METHODS: The targeted sample and sample size was 240 male participants, ages 45-74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined. RESULTS: Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021. CONCLUSIONS: Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE. TRIAL REGISTRATION: NCT02798185.

Longitudinal alteration of cortical thickness and volume in high-impact sports.

Collegiate football athletes are subject to repeated head impacts. The purpose of this study was to determine whether this exposure can lead to changes in brain structure. This prospective cohort study was conducted with up to 4 years of follow-up on 63 football (high-impact) and 34 volleyball (control) male collegiate athletes with a total of 315 MRI scans (after exclusions: football n â€‹= â€‹50, volleyball n â€‹= â€‹24, total scans â€‹= â€‹273) using high-resolution structural imaging. Volumetric and cortical thickness estimates were derived using FreeSurfer 5.3's longitudinal pipeline. A linear mixed-effects model assessed the effect of group (football vs. volleyball), time from baseline MRI, and the interaction between group and time. We confirmed an expected developmental decrement in cortical thickness and volume in our cohort (p â€‹< â€‹.001). Superimposed on this, total cortical gray matter volume (p â€‹= â€‹.03) and cortical thickness within the left hemisphere (p â€‹= â€‹.04) showed a group by time interaction, indicating less age-related volume reduction and thinning in football compared to volleyball athletes. At the regional level, sport by time interactions on thickness and volume were identified in the left orbitofrontal (p â€‹= â€‹.001), superior temporal (p â€‹= â€‹.001), and postcentral regions (p â€‹< â€‹.001). Additional cortical thickness interactions were found in the left temporal pole (p â€‹= â€‹.003) and cuneus (p â€‹= â€‹.005). At the regional level, we also found main effects of sport in football athletes characterized by reduced volume in the right hippocampus (p â€‹= â€‹.003), right superior parietal cortical gray (p â€‹< â€‹.001) and white matter (p â€‹< â€‹.001), and increased volume of the left pallidum (p â€‹= â€‹.002). Within football, cortical thickness was higher with greater years of prior play (left hemisphere p â€‹= â€‹.013, right hemisphere p â€‹= â€‹.005), and any history of concussion was associated with less cortical thinning (left hemisphere p â€‹= â€‹.010, right hemisphere p â€‹= â€‹.011). Additionally, both position-associated concussion risk (p â€‹= â€‹.002) and SCAT scores (p â€‹= â€‹.023) were associated with less of the expected volume decrement of deep gray structures. This prospective longitudinal study comparing football and volleyball athletes shows divergent age-related trajectories of cortical thinning, possibly reflecting an impact-related alteration of normal cortical development. This warrants future research into the underlying mechanisms of impacts to the head on cortical maturation.

Global and region-specific patient-reported outcomes pre and post a division I football season.

OBJECTIVE: Determine the change in global and region-specific PROMs among athletes from one NCAA Division I football team during one season. DESIGN: Prospective cross-sectional study. SETTING: Athletic training facility. PATIENTS OR OTHER PARTICIPANTS: Fifty-three Division I collegiate football athletes (n = 54) were eligible (20.1 ± 1.4 years, 187.7 ± 8.3 cm, and 113.5 ± 25.6 kg) for analyses. Participants completed five PROMs (Disablement in the Physically Active Scale [DPA], Epworth Sleep Score [ESS], Headache Impact Test [Hit-6], Disabilities of the Arm, Shoulder, and Hand [DASH], and the Lower Extremity Functional Scale [LEFS]) before the season and the same five PROMs after the season. MAIN OUTCOME MEASURES: A multivariate repeated measure analysis of variance (ANOVA) was conducted for all dependent variables. Alpha level was set at ɑ = 0.05. RESULTS: The overall multivariate repeated measures ANOVA was significant for time (p = 0.01). Follow up one-way ANOVA's indicated the DPA (p < 0.01, mean decrease/worse of 6.6 points) and LEFS (p = 0.01, mean decrease/worse of 4.1 points) were statistically significant between time points. CONCLUSION: Division I football can be detrimental to the physical, mental, and emotional health of the athletes. From these data, global and one region-specific PROM decreased over one season in one NCAA Division I football team.

Effects of Protective American Football Headgear on Peripheral Vision Reaction Time and Visual Target Detection in Division I NCAA Football Players.

The purpose of this study was to examine the effects of protective football headgear on peripheral vision reaction time and visual target detection. Twenty-five Division I NCAA football players (age = 20.5 yrs ± 0.9, height = 185.9 cm ± 6.8, body mass = 99.2 kg ± 19.2, BMI = 29.6 ± 4.5) participated. In a crossover counterbalanced study design, subjects participated in one visit with three conditions: Baseline (BL) without headgear, helmet only (HO), helmet with an eye shield (HE). Subjects completed a 1-min peripheral vision reaction time test for each condition separated by 3-min recovery periods. Tests were administered using a 64 light Dynavision D2 Visuomotor board. Target detection (total hit score) was higher during BL than HO (p < 0.001) and HE (p < 0.001). Average (p < 0.001), peak (p < 0.001), minimum (p < 0.001), and median (p < 0.001) peripheral reaction times were faster during BL than HO and HE. No significant differences were observed for any measures between HO and HE conditions (p > 0.05). Findings indicate that protective football headgear impaired reaction time to peripheral visual stimuli. The addition of an eye shield to the helmet had a small non-significant effect on reaction time and target detection. These results may hold important implications in helmet design and player safety.

Echocardiographic measurements of aortic root diameter (ARD) in collegiate football Athletes at pre-participation evaluation.

BACKGROUND: Some remodelling of the aortic root may be expected to occur with exercise but can already vary due to different body sizes, compositions and genetic predispositions. Attributing the cause of borderline aortic root diameter (ARD) values to either physiological or pathological conditions in American college football athletes is difficult as there is very limited normal reference values in this population. Body surface area (BSA) specific norms are thought to be useful in other cardiac measurements of football athletes. METHODS: A retrospective cohort review of pre-participation examination (PPE) transthoracic echocardiogram data from collegiate football athletes was performed. ARD was analysed by field position (linemen, n=137; non-linemen, n=238), race (black, n=216; white, n=158) and BSA for predictive value and associations. Values were compared with non-athlete norms, and collegiate football athlete-specific normal tables were created. RESULTS: Only 2.7% of football athletes had ARD measurements above normal non-athlete reference values and the mean athlete ARD values were lower than non-athlete values. No athletes had an aortic root >40 mm or were disqualified due to underlying cardiac pathology. Univariate analyses indicated linemen position and increasing BSA was associated with larger values for ARD. BSA outperformed race in predicting ARD. Normal tables were created for ARD stratified by BSA group classification (low, average and high BSA). Proposed clinical cut-offs for normal and abnormal values are reported for raw echocardiograph metrics and their BSA indexed scores. CONCLUSIONS: Non-athlete reference values for ARD appear applicable for defining upper limits of normal for most collegiate football athletes. BSA-specific normal values may be helpful in interpreting results for athletes that exceed non-athlete norms.

Impact of Anterior Cruciate Ligament Reconstruction on NCAA FBS Football Players: Return to Play and Performance Vary by Position.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are devastating for college football players. Although the change in functional performance of National Collegiate Athletic Association (NCAA) football players after reconstruction has been shown to be negligible, studies have failed to analyze the statistical performance of these players upon their return. PURPOSE/HYPOTHESIS: The purpose of this study was to quantify the impact of ACL reconstruction on the statistical performance of collegiate football players. We hypothesized that statistical performance would vary by position and that running backs, wide receivers, and defensive backs, compared with preinjury and controls, would experience the largest decline in performance after returning from ACL reconstruction. STUDY DESIGN: Descriptive epidemiology study. METHODS: NCAA Football Bowl Subdivision (FBS) football players who experienced ACL tears between the years 2010 and 2015 were identified. The rates of return to play after surgery were determined for each position. Preinjury and postoperative performance statistics of each running back, receiver, defensive lineman, linebacker, and defensive back who met inclusion criteria were compared. A t-test analysis was used to compare the performance changes experienced by these players versus the performance changes of matched controls. RESULTS: A total of 349 players were identified. Only 63.64% of eligible offensive linemen returned to play. Upon return, running backs experienced significant performance decreases compared with controls in carries (mean ± SD, -2.4 ± 2.7 vs 2.8 ± 1.6; P = .003), yards (-12.3 ± 15.5 vs 13.8 ± 7.8; P = .006), and receptions (-0.22 ± 0.32 vs 0.32 ± 0.23; P = .011) per game. Receivers displayed significant performance decreases compared with controls in number of touchdowns (-0.019 ± 0.110 vs 0.18 ± 0.06; P = .004), receptions (-0.11 ± 0.79 vs 1.2 ± 0.4; P = .004), and yards (-3.2 ± 10.6 vs 18.6 ± 5.4; P = .0009) per game. Linebackers demonstrated less improvement than controls in tackles for loss (0.007 ± 0.115 vs 0.31 ± 0.11; P = .0003) and sacks (0.001 ± 0.061 vs 0.10 ± 0.06; P = .026). CONCLUSION: Although offensive linemen were the least likely to return to play, running backs and receivers returned to play at a lower level of performance. The performance of defensive players was less affected by ACL reconstruction.

Recurrent Anterior Cruciate Ligament Tears in the National Football League: A Case-Control Study.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common in American football players. The risk of subsequent ACL reinjury to either the ipsilateral or the contralateral knee in National Football League (NFL) draftees with a history of successful ACL reconstruction before entering the NFL remains unknown. HYPOTHESIS: NFL athletes with a history of successful ACL reconstruction before being drafted will likely demonstrate increased risk of subsequent ACL injury when compared with a control cohort consisting of players of similar positions and draft class. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Detailed orthopaedic evaluations of NFL Combine participants from 2006 to 2012 were obtained to identify players entering the NFL draft with a history of successful ACL reconstruction. A control cohort was created in a 2:1 ratio, consisting of players matched by position and draft class. RESULTS: Of the 2016 players invited to the NFL Combine during the study period, 100 met the inclusion criteria. A total of 26 subsequent ACL reinjuries (12 ipsilateral, 14 contralateral) occurred in 25 players (25%) while playing in the NFL, with injuries occurring at a mean of 22.1 months after the NFL draft. In comparison, 18 of the 200 (9%) carefully matched cohort players without history of prior ACL injury sustained a new ACL injury during this time period (P < .001). CONCLUSION: NFL athletes with a history of successful ACL reconstruction before being drafted into the NFL have a significantly higher rate of subsequent ACL reinjury while playing in the NFL when compared with a carefully matched cohort of players without a history of prior ACL injury.

Identifying the Influence of Opponent Ranking and Game Characteristics on Alcohol-Related Stadium Ejections.

Sporting events in the U.S., particularly college football games, provide an opportunity for high-risk alcohol consumption that can result in alcohol-related consequences and associated public safety issues. Policy implication and predicting alcohol-related misconduct at college football games has become a concern for university administrators. To address this issue, we explored the extent to which the profile of a game or opponent-whether that be operationalized by classification (e.g., in-state opponent, conference opponent) or opponent quality (e.g., top-25 status, ranking average)-influences the reported stadium ejections of a college football venue, and whether these associations existed beyond the influence of several noteworthy covariates (e.g., time of kickoff, attendance, temperature). We suggest that time of kickoff and opponent quality measures predicted increases of ejections from college football stadiums. We conclude by discussing policy implications for college athletic departments and university stakeholders.

Epidemiology of Football Injuries in the National Collegiate Athletic Association, 2004-2005 to 2008-2009.

BACKGROUND: Research has found that injury rates in football are higher in competition than during practice. However, there is little research on the association between injury rates and type of football practices and how these specific rates compare with those in competitions. PURPOSE: This study utilized data from the National Collegiate Athletic Association Injury Surveillance System (NCAA ISS) to describe men's collegiate football practice injuries (academic years 2004-2005 to 2008-2009) in 4 event types: competitions, scrimmages, regular practices, and walkthroughs. STUDY DESIGN: Descriptive epidemiological study. METHODS: Football data during the 2004-2005 to 2008-2009 academic years were analyzed. Annually, an average of 60 men's football programs provided data (9.7% of all universities sponsoring football). Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (RRs), 95% CIs, and injury proportions were reported. RESULTS: The NCAA ISS captured 18,075 football injuries. Most injuries were reported in regular practices (55.9%), followed by competitions (38.8%), scrimmages (4.4%), and walkthroughs (0.8%). Most AEs were reported in regular practices (77.6%), followed by walkthroughs (11.5%), competitions (8.6%), and scrimmages (2.3%). The highest injury rate was found in competitions (36.94/1000 AEs), followed by scrimmages (15.7/1000 AEs), regular practices (5.9/1000 AEs), and walkthroughs (0.6/1000 AEs). These rates were all significantly different from one another. Distributions of injury location and diagnoses were similar across all 4 event types, with most injuries occurring at the lower extremity (56.0%) and consisting of sprains and strains (50.6%). However, injury mechanisms varied. The proportion of injuries due to player contact was greatest in scrimmages (66.8%), followed by regular practices (48.5%) and walkthroughs (34.9%); in contrast, the proportion of injuries due to noncontact/overuse was greatest in walkthroughs (41.7%), followed by regular practices (35.6%) and scrimmages (21.9%). CONCLUSION: Injury rates were the highest in competitions but then varied by the type of practice event, with higher practice injury rates reported in scrimmage. In addition, greater proportions of injuries were reported in regular practices, and greater proportions of exposures were reported in regular practices and walkthroughs. Efforts to minimize injury in all types of practice events are essential to mitigating injury incidence related to both contact and noncontact.

Ethanol Values During College Football Season: University Policy Change and Emergency Department Blood Ethanol Values From 2006 Through 2014.

BACKGROUND: Tailgating is popular at many college football games. However, it is known to contribute to binge drinking and alcohol intoxication, which are common public health challenges. OBJECTIVE: To use laboratory data to measure changes in plasma ethanol levels observed in a large state university emergency department after a series of reforms were enacted to reduce binge drinking. METHODS: We performed a retrospective chart review on all serum ethanol levels measured at the University of Iowa Hospitals and Clinics on weekends from 2006 through 2014. Data were analyzed by multivariable logistic regression after controlling for significant covariates. RESULTS: A total of 5437 patients had ethanol levels recorded on weekends. After the implementation of policy changes, there was a significant reduction in the adjusted odds ratio (AOR) of ethanol values reported in the severe intoxication range (≥240 mg/dL; AOR = 0.77; 95% confidence interval [CI], 0.64-0.92). CONCLUSION: The policy changes implemented in 2009 in an attempt to reduce binge drinking are associated with a decreased likelihood of an ethanol result being in the severe intoxication range.

Emerging data on the incidence of concussion in football practice at all levels of amateur play.

There has been increasing concern, particularly in the US, about potential long-term neurological deterioration syndromes seen in the US football players. Recurrent concussions are a potential area of concern. The authors of this paper have used data bases from three levels of amateur US football to identify the rate and risk of concussion injury in both football games and practice at the youth, high school, and college levels. This information is very important initial data around concussion rates at these levels.