Does the location of impact influence concussion outcomes? Specifically, does the location of impact when two players collide affect concussion severity, number of symptoms, length of absence from sports, and the chance of recurrence?
If you are an athletic trainer or doctor covering a football game, it might be important since you might actually see the players’ heads collide. If you are a pediatrician or family medicine doctor who sees a young athlete after a head-to-head collision, you might suspect that the nature of impact affects his outcome, and potentially, his treatment.
And if you are a high school football player or the coach of a football team, this information might help you implement tackling techniques to avoid certain types of blows to the head.
Concussions in high school football
A new study published in Pediatrics presents data collected from high schools between the 2008-2009 and 2012–2013 high school football seasons. Zachary Y. Kerr and other researchers used injury data gathered by athletic trainers across the United States and entered into the National High School Sports-Related Injury Surveillance system. They specifically studied concussions resulting from player-to-player collisions.
The study’s findings show that the location of impact might not be as important as we might have thought.
• 58.8% of concussions in high school football occurred during competition, while 41.2% occurred during practice.
• About 70% of concussions caused by player-to-player collisions were caused by head-to-head contact. 23% of these concussions were caused by contact with another players body, such as his elbow or knee.
• 44.7% of concussions caused by player-to-player contact involved impact to the front of the head. 22.3% involved the side of the head. 5.7% involve the back of the head. 5.5% impacted the top of the head.
• In terms of position, linebackers suffered the most frequent concussions resulting from player-to-player collisions. Running backs and defensive tackles were the next most likely.
• The nature and location of the impact had no relationship to the number of concussion symptoms the player experienced.
• Only one concussion symptom was associated with the location of the impact – loss of consciousness. More football players who sustained contact involving a top-of-the-head impact experienced loss of consciousness than players who suffered other types of player-to-player collisions.
• The location of impact also had no association with symptom resolution or length of time until return to play.
One area of particular interest in the study was the importance of recurrent concussions.
• In this study of concussions in high school football, 9.6% of the head injuries were recurrent injuries instead of new concussions.
• 23.1% of the recurrent concussions occurred within the same season of the original injury.
• Players who suffered a repeat concussion had a longer duration of symptoms and a longer length of time until they returned to play.
Take home points
As we can see from this data, where the contact occurs might not be all that helpful for healthcare providers. Knowing if a collision between players involved the front, the side, or the top of the head might not change the treatment or decision-making. Since a large percentage of concussions in high school football appear to result from player-to-player collisions, athletic trainers and team doctors should take all such events seriously.
Second, the study confirms the findings of earlier research that suggests recurrent concussions can be serious problems for young athletes. Symptoms like headaches, nausea, dizziness and many others persist much longer after a recurrent concussion. Plus it takes longer to return to sports after repeat concussions. And essentially one in every five players will suffer one in the same season as the first concussion.
Evaluation and management of an athlete’s concussion should be done based on individual findings. This data suggests that athletes who suffer repeat concussions – and the doctors who treat them – should be especially cautious about rushing them back to play.
Are you surprised about the apparent lack of significance of impact location? Do the findings about repeat concussions worry you? If you are a parent of a football player who has suffered a concussion, does the study change your thoughts about his return to sports? Share your thoughts here!
Zachary Y. Kerr, Christy L. Collins, Jason P. Mihalik, Stephen W. Marshall, Kevin
M. Guskiewicz and R. Dawn Comstock. Impact Locations and Concussion Outcomes in High School Football Player-to-Player Collisions. Pediatrics. Published online August 11, 2014.