High School Football Athletes Research Articles

Prevalence Of Game-Related Hip Pointers Between High School And Collegiate Football Athletes

Prevalence Of Game-Related Hip Pointers Between High School And Collegiate Football Athletes

On-Field Evaluation of Mouthpiece-and-Helmet-Mounted Sensor Data from Head Kinematics in Football

PurposeWearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system.MethodsData was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes.ResultsA total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively.ConclusionIf the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.

Acute psychological symptom profiles in high school football players following sport-related concussion.

In a cohort of high school football athletes, the authors sought to 1) describe the proportion of those with acute psychological symptoms postconcussion, 2) determine predictors of more acute psychological symptoms postconcussion, and 3) determine if acute psychological symptoms impact recovery. A retrospective cohort study of high school football athletes (14-18 years of age) who sustained a sport-related concussion between November 2017 and April 2022 and presented to a multidisciplinary concussion center was performed. Based on their Post-Concussion Symptom Scale (PCSS) scores at the initial clinic visit, their total psychological symptom cluster score was calculated by summing their scores for the four affective symptoms (irritability, sadness, nervousness, and feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score to the total initial PCSS score. Primary outcomes included time to return to learn (RTL), symptom resolution, and return to play (RTP). Uni- and multivariable regression analyses were performed controlling for demographic factors, learning disabilities, attention-deficit/hyperactivity disorder, and personal and/or family history of psychological diagnoses and migraine. A total of 195 male football players (mean age 16.2 ± 1.2 years) were included in the study. About one-third of the sample (n = 70, 35.9%) reported at least one psychological symptom. Of these 70 athletes, their psychological symptom scores were 1 (10.3%), 2 (7.7%), and ≥ 3 (17.9%). Irritability was the most endorsed psychological symptom (25.1%), followed by nervousness (15.9%), feeling more emotional (12.8%), and sadness (11.8%). The multivariable regression model showed that a positive psychological history (B = 2.66, 95% CI 0.74-4.58, p = 0.007) and family psychological history (B = 2.43, 95% CI 0.98-3.88, p = 0.001) were significant predictors of a higher psychological symptom cluster score. Multivariable linear regression analysis showed that a higher psychological symptom cluster score was associated with a longer time to RTP (B = 1.22, 95% CI 0.17-2.264, p = 0.023) but not with time to symptom resolution or RTL. The psychological symptom ratio was not a significant predictor. In a cohort of male football players, 36% reported at least one psychological symptom, with irritability being most commonly reported. Athletes with a personal and/or family history of psychological disorders experienced more acute psychological symptoms following a sport-related concussion. A higher psychological symptom cluster score was associated with delayed time to RTP but not time to RTL or symptom resolution.

Do Sport-Related Concussions Later in the Season Take Longer to Recover From?

In a cohort of high-school football athletes with sport-related concussion (SRC), we sought to investigate the role of seasonality, defined as time of injury during a season, on recovery. Retrospective cohort study. Regional sport concussion center. High-school football athletes ages 14 to 19 -years old who sustained an SRC from 11, 2017 to 04, 2022. Athletes were divided into 3 groups based on seasonality: early, middle, and late season. The primary outcomes were initial Post-Concussion Symptom Scale score and recovery, as defined by time to return-to-learn (RTL), symptom resolution, and return-to-play (RTP). Descriptive statistics, analysis-of-variance, t tests, and multivariable regressions were performed. Of our cohort of 273 high-school football players who sustained an SRC, 97 (35.5%) sustained an SRC during early season, 107 (39.2%) during middle season, and 69 (25.3%) during late season. Compared with late-season concussions, early-season concussions took less days to symptom resolution (early = 11.5 ± 12.9 vs late = 25.5 ± 27.0, P = 0.03), but no differences were found in days to RTL (early = 5.3 ± 4.8 vs late = 7.2 ± 15.8, P = 0.51) and RTP (early = 13.5 ± 11.8 vs late = 23.0 ± 22.8, P = 0.08). Seasonality was not a significant predictor for any recovery metric in multivariable regressions. Sport-related concussions occurring in the early third of the season took significantly less time to symptom resolution than those occurring in the later third of the season; however, this was not statistically significant in multivariable analyses. No association was observed between seasonality and time to RTL and RTP. A trend of worse recovery with concussions later in the season may be present.

Goal Setting and Parental Participation in a piloted High School Football Sports Nutrition Education Program

Introduction: There is a lack of research on how parental involvement in an adolescent athlete’s sports nutrition program can impact an athlete’s adherence to nutrition related goals. Thus, this investigation aimed to examine the difference in the high school football athlete’s adherence to self-identified dietary goals in relation to parental involvement in the program. Methods: A total of 25 high school football athletes and 25 parents participated in a six week-long WAVE sports nutrition education program. 64% of participants (athletes & parents) completed the 12-week post follow up (n=32). Athletes and parents completed sports nutrition knowledge questionnaires and food frequency questionnaires. Additionally, parents completed self-efficacy questionnaires to rank their confidence in preparing healthy meals and cooking. Results: There were significant changes in parents' sports nutrition knowledge scores from initial to the 12-week follow up (p<0.001) The parents’ self-efficacy around choosing and preparing healthy food options also increased from initial to the 12-week follow up (p=0.004). No significant difference was found between parent’s attendance and the athlete’s adherence to long-term goals. Conclusions: The increase in parent's overall sports nutrition knowledge and self-efficacy around preparing and cooking healthy foods did not significantly affect athlete’s adherence to their self-identified goals.

Changes in resting state networks in high school football athletes across a single season.

The aim of this pilot cohort study was to examine changes in the organization of resting-state brain networks in high school football athletes and its relationship to exposure to on-field head impacts over the course of a single season. Seventeen male high school football players underwent functional magnetic resonance imaging and computerized neurocognitive testing (CNS Vital Signs) before the start of contact practices and again after the conclusion of the season. The players were equipped with helmet accelerometer systems (Head Impact Telemetry System) to record head impacts in practices and games. Graph theory analysis was applied to study intranetwork local efficiency and strength of connectivity within six anatomically defined brain networks. We observed a significant decrease in the local efficiency (-24.9 ± 51.4%, r = 0.7, p < 0.01) and strength (-14.5 ± 26.8%, r = 0.5, p < 0.01) of functional connectivity within the frontal lobe resting-state network and strength within the parietal lobe resting-state network (-7.5 ± 17.3%, r = 0.1, p < 0.01), as well as a concomitant increase in the local efficiency (+55.0 +/- 59.8%, r = 0.5, p < 0.01) and strength (+47.4 +/- 47.3%, r = 0.5, p < 0.01) within the mediotemporal networks. These alterations in network organization were associated with changes in performance on verbal memory (p < 0.05) and executive function (p < 0.05). We did not observe a significant relationship between the frequency or cumulative magnitude of impacts sustained during the season and neurocognitive or imaging outcomes (p > 0.05). Our findings suggest the efficiency and strength of resting-state networks are altered across a season of high school football, but the association of exposure levels to subconcussive impacts is unclear. The efficiency of resting-state networks is dynamic in high school football athletes; such changes may be related to impacts sustained during the season, though further study is needed.

Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law.

A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football. To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries. Descriptive epidemiology study. Level 4. We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011). During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study. Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs. SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.

Shoulder, upper arm and elbow injuries in high school men’s American football

ABSTRACT In order to reduce shoulder, upper arm and elbow injury rates in American football, identifying injury risk factors and any underlying associations is needed. No prior study has done such characterization at the high school level. A descriptive epidemiology study was performed using data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) from the years 2011/12 to 2013/14 on high school football athletes. Four hundred and sixty total injuries were found in the dataset. Acromioclavicular (AC) sprains had the highest incidence of all injuries (0.060 injuries per 1000 exposures). Fractures lead to the greatest time lost (42.24 days). Most injuries occurred in older athletes (juniors and seniors, 30% and 32%, respectively), were related to tackling (31%), and in running back and linebacker positions (15% each). Orthopaedic surgeons and other sports medicine specialists can use these findings to educate players, coaches and families about injury risks and for improving injury prevention guidelines.

Associations Between Personal Traits And Head Impact Frequency And Force Among High School Football Athletes

Associations Between Personal Traits And Head Impact Frequency And Force Among High School Football Athletes

Poster 116: Traumatic Brain Injury in High School and College American Football Athletes, 2002-2019: Increasing Risk of Injury and Fatality

Objectives:A prior report revealed an average of 7.2 (0.67 per 100,000 participants) traumatic brain injuries (TBI) per year in high school (HS) and college football players from 1989 through 2002. Our goal is to update the profile of TBI in HS and college football players and evaluate the efficacy of state laws implemented to reduce brain injuries.Methods:We retrospectively reviewed 17 academic years (July 2002 through June 2019) of TBIs catalogued by the National Registry of Catastrophic Sports Injuries (NRCSI). Descriptive statistics were collected using Excel and SPSS. The incidence of TBI was compared with the prior 13-year period. In addition, the incidence of TBI was assessed at the HS level during the pre (2002-2009[BB3] [BI([4] [BI([5] ), transitional (2009-2014), and post (2014-2019) universal adoption time periods of the Lystedt laws. Multinomial logistic regression analyses were performed to determine the odds of TBI based on level of play, Lystedt law adoption eras, and position played.Results:During the study period, there was a total of 177 TBIs (10.4 per year, 0.82 per 100,000 participants): 164 (92.7%, 0.81 per 100,000, 9.65 per year) in HS athletes and 13 (6.6%, 0.96 per 100,000, 0.76 per year) in college athletes. The risk of TBI at the HS level was significantly higher than at the college level (1.99: 95% CI, 1.137-3.517, P<0.0001). Compared to the prior 13-year period, the risk of TBI during the study period was 1.29 (95% CI, 1.004-1.656, P=0.047) with a greater increase at the college (4.40: 95% CI, 0.993-19.5, P=0.051) than the HS level (1.22: 95% CI, 0.946-1.577, P=0.124). There were 51 fatalities (3 per year, 0.24 per 100,000 participants) with a risk of 1.63 (95% CI: 0.65-4.11, P = 0.3) at the college (n=5, 0.29 per year, 0.36/100,000) compared with the HS (n=46, 2.71 per year, 0.22 per 100,000) levels. The risk of a fatality in the current study compared with the prior study was 4.32 (95% CI: 2.05-9.09, P= 0.0001) with higher risks at both the HS (5.17, 95% CI: 2.21-12.1, P =0.0002) and college (1.8, 95% CI: 0.35-9.3, P = 0.48) levels. The incidence of TBI in HS increased significantly from the pre (0.57 per 100,000) to the transitional (0.78 per 100,000, OR = 4.7, P<0.001), and from the transitional to the post universal adoption (1.17 per 100,000, OR = 13.7, P<0.0001) eras of the Lystedt law. The most common positions among HS and college athletes suffering TBI were linebacker (26, 22.6%) and running back (20, 17.4%), and defensive back (16, 13.9%).Conclusions:The incidence of TBI has increased 29% during the 2002-2019 period compared to the prior 13-year period with a 440% and 22% rise in college and HS cases, respectively. The risk of fatality increased 432% compared to the prior 13-year period with an increase of 517% and 180% at the HS and college levels, respectively. The increased incidence of TBI at the HS level has occurred despite implementation of the Lystedt laws. Further research is necessary to determine the risk factors for TBI in order to develop prevention strategies.Figure 3B.Incidence Rates During Lystedt Law Adoption Eras

Avenues for Sport-Related Concussion Prevention in High School Football: Effect of Limiting Collision Practices.

Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices. To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons. Retrospective cohort study. Michigan high school football. High school (9th-12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events. Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015-2016 through 2019-2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season. A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017-2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018-2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019-2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015-2016. We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015-2016.

Baseline Aerobic Fitness in High School and College Football Players: Critical for Prescribing Safe Exercise Regimens

Nontraumatic fatalities occur on a regular basis in high school (HS) and college football athletes, primarily in obese linemen performing high-intensity exercise. One contributing factor to these deaths may be a mismatch between baseline aerobic (cardiorespiratory) fitness and exercise regimens. There is a wide range of aerobic fitness in HS and college football players. Body mass index (BMI) is a safe and simple method for estimating baseline aerobic fitness. Retrospective cohort study. Level 3. A retrospective review was performed on 79 HS football athletes who had VO2Peak (mL·kg-1·min-1) measured during the offseason. Multivariate regression analysis was used to determine if BMI (obese, overweight, and normal; kg/m2), position played (linemen vs other), year in school (freshmen vs other), and/or race (African American vs White) were risk factors for poor aerobic fitness. A separate cohort of 135 (48 HS; 87 college) football athletes performed a 6-minute run test to determine speed (miles/min), extrapolate VO2Max, and calculate reference values for suggested upper threshold safe starting speeds (85% of maximum) for aerobic training based on BMI. The relationship between BMI and VO2Peak was assessed. The exercise regimens (speeds) of 2 collegiate football fatalities from the public domain were used to predict their VO2Max values. Mean VO2Peak (mL·kg-1·min-1) was 38.5 ± 8.6 (range 19.1-60.6); when grouped by BMI, low scores (<40) were found in 87.5% of obese (32.4 ± 7.7), 47.8% of overweight (40.8 ± 7.6), and 45.2% of normal (41.4 ± 7.8) athletes. VO2Peak was significantly lower in linemen (32.8 ± 6.4; P = 0.007) compared with nonlineman (41.8 ± 7.9), and in obese players (by BMI; 32.4; P = 0.019) compared with nonobese players (41.4 ± 7.6), but did not differ by age, year in school, or race. Means for speed (min/mile) and extrapolated VO2Max (mL·kg-1·min-1) for the 6-minute run test by BMI groups were both significantly different (P = 0.001) for normal (7.0 ± 0.6; 51.1 ± 2.6), overweight (7.6 ± 0.8; 46.5 ± 3.2), and obese (8.9 ± 1.5; 36.8 ± 5.9) athletes. There was a significant negative correlation (r = -0.551; P = 0.001; R2 = 0.304) between VO2Peak and BMI. Safe starting speed recommendations for running 1 mile range from 7.3 to 12.1 min/mile for BMIs 20 to 40 kg/m2 for HS and college athletes. For the 2 fatalities (mean, BMI of 36.5 kg/m2) repetitive sprint speeds were 49 and 89% higher than our safe starting speeds for their BMI. A large spectrum of baseline aerobic fitness was noted in HS and college football players. Obese players and linemen had statistically lower baseline aerobic fitness, a major risk factor for possible heat illness. BMI is an acceptable surrogate for VO2Peak and can be employed to develop safe training regimens without the need for a maximum fitness test, which can place the athlete at risk for a medical event. Knowledge of BMI provides an estimate of baseline aerobic fitness and a foundation for prescribing safe, individualized exercise regimens.

Identifying Factors Associated with Head Impact Kinematics and Brain Strain in High School American Football via Instrumented Mouthguards.

Repeated head impact exposure and concussions are common in American football. Identifying the factors associated with high magnitude impacts aids in informing sport policy changes, improvements to protective equipment, and better understanding of the brain's response to mechanical loading. Recently, the Stanford Instrumented Mouthguard (MiG2.0) has seen several improvements in its accuracy in measuring head kinematics and its ability to correctly differentiate between true head impact events and false positives. Using this device, the present study sought to identify factors (e.g., player position, helmet model, direction of head acceleration, etc.) that are associated with head impact kinematics and brain strain in high school American football athletes. 116 athletes were monitored over a total of 888 athlete exposures. 602 total impacts were captured and verified by the MiG2.0's validated impact detection algorithm. Peak values of linear acceleration, angular velocity, and angular acceleration were obtained from the mouthguard kinematics. The kinematics were also entered into a previously developed finite element model of the human brain to compute the 95th percentile maximum principal strain. Overall, impacts were (mean ± SD) 34.0 ± 24.3 g for peak linear acceleration, 22.2 ± 15.4 rad/s for peak angular velocity, 2979.4 ± 3030.4 rad/s2 for peak angular acceleration, and 0.262 ± 0.241 for 95th percentile maximum principal strain. Statistical analyses revealed that impacts resulting in Forward head accelerations had higher magnitudes of peak kinematics and brain strain than Lateral or Rearward impacts and that athletes in skill positions sustained impacts of greater magnitude than athletes in line positions. 95th percentile maximum principal strain was significantly lower in the observed cohort of high school football athletes than previous reports of collegiate football athletes. No differences in impact magnitude were observed in athletes with or without previous concussion history, in athletes wearing different helmet models, or in junior varsity or varsity athletes. This study presents novel information on head acceleration events and their resulting brain strain in high school American football from our advanced, validated method of measuring head kinematics via instrumented mouthguard technology.

High School Sports-Related Concussion and the Effect of a Jugular Vein Compression Collar: A Prospective Longitudinal Investigation of Neuroimaging and Neurofunctional Outcomes.

Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes. We aimed to quantify the alterations in white matter (WM) microstructure and global network organization, and the decrements in behavioral and cognitive outcomes from pre-season to post-concussion in youth athletes who experienced SRC. We also aimed to evaluate whether wearing a jugular compression neck collar, a device designed to mitigate brain "slosh" injury, would mitigate the pre-season to post-concussion alterations in neuroimaging, behavioral, and cognitive outcomes. A total of 488 high school football and soccer athletes (14-18 years old) were prospectively enrolled and assigned to the non-collar group (n = 237) or the collar group (n = 251). The outcomes of the study were the pre-season to post-concussion neuroimaging, behavioral, and cognitive alterations. Forty-six participants (non-collar: n = 24; collar: n = 22) were diagnosed with a SRC during the season. Forty of these 46 athletes (non-collar: n = 20; collar: n = 20) completed neuroimaging assessment. Significant pre-season to post-concussion alterations in WM microstructural integrity and brain network organization were found in these athletes (corrected p < 0.05). The alterations were significantly reduced in collar-wearing athletes compared to non-collar-wearing athletes (corrected p < 0.05). Concussion and collar main effects were identified for some of the behavioral and cognitive outcomes, but no collar by SRC interaction effects were observed in any outcomes. In summary, young athletes exhibited significant WM microstructural and network organizational, and cognitive alterations following SRC. The use of the jugular vein compression collar showed promising evidence to reduce these alterations in high school contact sport athletes.

Identifying Risk Factors For Head Impact Exposure In High School Football Using A Validated Instrumented Mouthguard

Head impact sensor technology is evolving, and recent advances include the design and validation of instrumented mouthguards that accurately measure head impact kinematics. The use of such devices, in conjunction with video-based impact detection algorithms, can be useful in elucidating the true nature of head impact exposure in contact sports such as American football. PURPOSE: To characterize patterns of head impact exposure in high school football using a validated instrumented mouthguard sensor. METHODS: High school football athletes (n = 116) wore Stanford instrumented mouthguards (the “MiG2.0”) during practices and games in their 2018 and 2019 Fall seasons. A validated impact detection algorithm made specifically for the MiG2.0 in American football was used to filter out false-positive accelerative events recorded by the MiG2.0 devices. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of verified head impacts were saved for analyses. Helmet model, level of competition (JV or varsity), body mass index (BMI), age, and prior concussion history were also recorded at the beginning of each season for each athlete. RESULTS: 66969 events were recorded by the MiG2.0 sensors across 888 athlete exposures. The impact detection algorithm determined that 713 events were true head impacts. Athletes wearing Riddell Speedflex helmets sustained head impacts of lower PRA than those wearing VICIS Zero1 helmets (p < 0.01). Athletes with a previous concussion history sustained head impacts of lower PLA than those without (p < 0.04). No statistically significant differences were found between peak kinematics of head impacts between athletes of varying age, BMI, or level of competition. Higher number of previous concussions, varsity competition, and higher BMI were associated with more frequent head impacts (p < 0.036). CONCLUSION: The MiG2.0 instrumented mouthguard sensor, when used with a validated impact detection algorithm, is an effective tool for characterizing head impact exposure in high school football. In our cohort, concussion history and helmet model affected the severity of head impacts sustained by athletes, and the in vivo performance of helmets may differ from previous reports of laboratory helmet testing. Athletes with more football experience may sustain head impacts more frequently.

The Association between Baseline Eye Tracking Performance and Concussion Assessments in High School Football Players.

Concussions are complex injuries that require a multifaceted testing battery. Vision impairments are common after concussion, but it is unknown exactly how eye tracking may be affected after injury and how it is associated with other clinical concussion assessments. This study aimed to (1) examine the relationship between eye tracking performance (BOX score) and other common concussion evaluations, (2) identify if eye tracking adds novel information that augments baseline concussion evaluations, and (3) examine the effect of age, concussion history, and attention-deficit/hyperactivity disorder on eye tracking and other ophthalmological measures. A total of 102 male high school football athletes (age, 16.0 years; 95% confidence interval, 15.8 to 16.2 years) completed a series of visual and neurocognitive tests during their pre-season baseline assessment. The main outcome measures were BOX score, near point of convergence (NPC) distance, binocular accommodative amplitude (BAA) distance, Standardized Assessment of Concussion score, and Immediate Post-Concussion Assessment and Cognitive Testing composite scores. BOX score was not significantly associated with symptoms, Standardized Assessment of Concussion score, NPC distance, BAA distance, or any Immediate Post-Concussion Assessment and Cognitive Testing composite scores. Age, concussion history, attention-deficit/hyperactivity disorder, and number of prior years playing football were not significantly associated with BOX score or NPC distance, but there was a significant association between concussion history and greater BAA distance (β = 1.60; 95% confidence interval = 0.19 to 3.01; P < .03). The BOX score cutoff of 10 resulted in a 12% false-positive rate. Eye tracking was not significantly associated with the commonly used clinical concussion assessments. These results suggest that an objective eye tracking variable may be a valuable addition to the current concussion battery.

Abstract 16076: Elevated Body Mass Index and Blood Pressure Among Male High-School American Style Football Athletes

Introduction: The impact of American Style Football (ASF) participation on cardiovascular health is unclear. Early-life weight gain among ASF athletes is common and is associated with risk of multiple later-life health afflictions. Despite the popularity of ASF participation among the youth, a rigorous comparison of the cardiovascular health profiles between ASF and non-ASF athletes at the high-school level has not been undertaken. We performed an observational cross-sectional study comparing the body mass index and blood pressures of ASF and non-ASF high-school athletes. Methods: Between October 2012 to November 2018 we performed voluntary cardiac screens including height, weight and blood pressure among predominantly high-school students. Inclusion criteria included the following: male sex; &gt;10 hours of exercise per week; single-sport athlete; age &gt;14 years old. Of the 6973 young individuals who underwent screening, 508 athletes were included in the analyzed data. Results: ASF athletes represented 18% of all high-school athletes. The mean age of ASF and non-ASF athletes was 18.5 and 18.0 years, respectively. BMI was higher in ASF athletes compared to non-ASF participating athletes (26.9 vs 21.2 p&lt;0.0001). There was a higher prevalence of class I and class II obesity among ASF athletes (class I obesity: 15% vs 1%; class II obesity: 10% vs 1%, p&lt;0.0001 for each). ASF athletes had an increased systolic (SBP) and diastolic blood pressure (DBP) compared to non-ASF participating athletes (SBP: 121 vs 114 p&lt;0.0001; DBP: 73 vs 70 p=0.0028). Among all athletes, there was a positive correlation between blood pressure and BMI (SBP: R=0.4149, DBP: R=0.2076, p&lt;0.0001 for each). Conclusions: High-school athletes that participate in ASF have a higher BMI, prevalence of obesity and blood pressure compared to their non-ASF counterparts. It is important to screen young ASF athletes for obesity and hypertension in order to optimize cardiovascular health at an early age.

Postactivation Potentiation Effect of Heavy Sled Towing on Subsequent Sprints.

Williams, JJ, Heron, R, Spradley, B, and Saracino, P. Postactivation potentiation effect of heavy sled towing on subsequent sprints. J Strength Cond Res 35(5): 1229-1233, 2021-Recent research supports heavy sled towing as a tool used to improve subsequent sprints as part of postactivation potentiation (PAP) protocols. The purpose of this study was to examine the effect of heavy sled towing using a velocity decrement (Vdec) on subsequent unloaded sprinting in high school football (soccer) athletes sprinting on artificial turf. A sled load equating to a 40-50% Vdec range was used (66-70% body mass). Fifteen (n = 9 boys and n = 6 girls) high school football players volunteered for this study. The sled-towing intervention consisted of a dynamic warm-up, 3 submaximal sprint efforts (50, 75, and 95%), and 3 maximum speed 15-m sled sprints, separated by 2-minute rests, of which the fastest time was recorded for analysis. Peak preintervention 15-m baseline sprint times were compared with peak post sled-towing 15-m sprint times using a paired samples t-test. Thirteen of 15 athletes ran faster peak post sled-towing sprint times than peak preintervention baseline sprint times (9 boys and 4 girls). On average, peak post sled-towing sprint times (2.60 ± 0.10 seconds) were 0.10 seconds faster (p < 0.0001; Cohen's d = 0.92) than peak preintervention baseline sprint times (2.70 ± 0.09 seconds). This research established that sled-towing protocols using loads corresponding to Vdec of 40-50% significantly improved subsequent sprints in high school football (soccer) athletes running on artificial turf.

Age Of First Exposure Influences Cerebrovascular Reactivity In High School Football Athletes

Late-life physiological and clinical impairments are associated with age of first exposure (AFE) to tackle football. There is a dearth of literature describing how AFE may influence physiological outcomes in current high school football athletes. Cerebrovascular reactivity (CVR) measures the cerebral blood flow response to variations in carbon dioxide partial pressures. Understanding how AFE affects cerebrovascular function in high school athletes may offer insight into potential long-term deficits following cumulative head impact exposure. PURPOSE: To investigate how the age at which high school football athletes began playing tackle football influences baseline CVR. METHODS: High school football athletes [n=29; age=15.8 ± 1.1 yrs; height=175.8 ± 8.1cm; mass=75.1 ± 12.6kg] self-reported AFE (median AFE=13 years old, range=5-15). Transcranial Doppler (TCD) ultrasound was used to assess middle cerebral artery velocity (MCAv) prior to beginning the competitive season. Baseline MCAv was collected for 2 minutes. Changes in MCAv were measured in response to 5 breath-holding trials (20s breath-hold/40s rest) and 5 hyperventilation trials (20s hyperventilation/40s rest). We employed separate mixed effects models with quadratic mean structures to assess group differences in MCAv response to breath-holding and hyperventilation tasks. RESULTS: The AFE significantly predicted CVR during breath-holding (F1,1709=5.27, p=0.02) and hyperventilation (F1,1709=4.08, p=0.04). One-year increases in AFE were associated with a 0.69% reduction in average CVR response during breath-holding and a 0.58% increase in average CVR during hyperventilation. CONCLUSIONS: Though AFE is associated with CVR in high school football players, the underlying mechanisms driving the observed results are unclear. The effect of cumulative head impact exposure at the high school level is understudied despite long-term neurophysiological deficits reported in retired professional football players. Studying neurophysiological responses in young football players may provide important insights into addressing cerebrovascular function and other late-life physiological health in athletes.

THE EFFECTS OF INTERNAL JUGULAR VEIN COMPRESSION FOR PRESERVING WHITE MATTER INTEGRITY IN HIGH SCHOOL FOOTBALL PLAYERS COMPARISON OF HIGH VS LOW

Background:Repetitive head impacts experienced during competitive sports contribute to neurologic changes over the course of a season. Internal jugular vein compression, by means of an externally worn neck collar device has shown efficacy in mitigating white matter (WM) alterations following repeated head impact exposure. However, its relative effectiveness in high versus low head impact exposures is unknown.Hypothesis/Purpose:The purpose of this study was to investigate the effectiveness of an externally worn neck collar device in limiting WM alterations over a season of high school football in players who receive high and low cumulative head impact exposures over 90 g.Methods:213 male high-school football athletes were prospectively assigned to two study groups: a control group (non-collar; n=106) and an experimental group who wore the jugular vein compression collar during all practices and games (collar; n=107). MRI data was collected from all participants pre- and post-season. Fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) were calculated to assess WM integrity at both time points. Cumulative head impact exposure was monitored by accelerometers attached to each athlete’s left mastoid process during every exposure. Participants were dichotomized into subgroups based on accumulated exposures to hits over 90 g, which divided the entire cohort into four subgroups, using a cut-off of 40 hits : (1) non-collar group (≥40 hits, n=57); (2) collar group (≥40 hits, n=51); (3) non-collar group (<40 hits, n=49); (4) collar group (<40 hits, n=56).Results:As seen in Table 1, in athletes with ≥40 hits, both the non-collar and collar group showed significant pre- to post- season reductions in MD, AD, and/or RD. The non-collar group with ≥40 hits also showed a significant increase in FA, MD, and AD. RD, FA, and MD changes were greater in the non-collar group compared to the control group with ≥40 hits, while AD changes were greater in the collar group compared to the non-collar group with ≥ 40 hits. The non-collar group with <40 hits presented significant pre- to post-season reductions in MD, AD, and RD that were greater than the collar group with < 40 hits (whom did not show pre-to post-season changes).Discussion & Conclusion:The present results provide support for internal jugular vein compression to protect the brain from both low- and high-level repeated head impact exposure. However, less consistent changes were observed for athletes exposed to repeated, high-level head impacts, warranting further investigation.Table 1.Number of WM voxels (1x1x1mm) with significant (p < .05 after correcting for multiple comparisons) pre- to post-season DTI changes and/or significant group difference (red indicates group difference for non-collar group; blue indicates group difference for collar group) for high and low head impact exposure FA ↓ MD↓ AD↓ RD↓ FA↑ MD↑ AD↑ RD↑ #hits ≥ 40 Noncollar,n= 5701390381 702965186110Collar, n=51013313350 0000Grp_diff-011511 24660-#hits <40 Noncollar,n= 4905925956340 0000Collar, n=560000 0000Grp_diff-308627611 ----