Injury Rates Remained Elevated in the Second National Football League Season After the Onset of the COVID-19 Pandemic

Abstract

The purpose of this study is to compare the injury incidence of the 2018-2019 and 2020 National Football League (NFL) seasons with the 2021 season. Publicly released NFL weekly injury reports were queried to identify players listed as "out" or placed on injured reserve (IR) for at least one game in the 2018-2021 seasons. Injuries were then categorized into upper extremity, lower extremity, spine/core, and head. Incidence per 1,000 athlete exposures were calculated for each season and proportions of injuries by position were calculated separately for the 2018-2019, 2020, and 2021 cohorts. Incidence rate ratios (IRR) were used to compare injury rates. Overall injury incidence in the 2021 NFL season increased compared to the pre-COVID-19 seasons (2018-2019) in all anatomical zones except for the upper extremity. [28.70 vs. 23.09 per 1,000 exposures, IRR 1.24 (95% CI: 1.14-1.36); p< 0.001]. The injury rate remained elevated and further increased in 2021 compared to the 2020 season for all anatomical zones other than the spine/core [28.70 vs. 21.64 per 1,000 exposures, IRR 1.33 (1.19-1.47); p< 0.001]. No significant difference existed during the early season (weeks 1-4); however, injury rates after week 4 increased in 2021 compared to both the 2018-2019 and 2020 seasons. The injury incidence in the 2021 season remained elevated and increased further compared to both the 2018-2019 and 2020 seasons. Traumatic injuries resulting in missed games increased despite return to a more traditional season since the beginning of the COVID-19 pandemic. The injury rates significantly increased in mid- to late season. III, cross-sectional study.