High School Football Athletes Research Articles

Pupillary changes after clinically asymptomatic high-acceleration head impacts in high school football athletes.

Previous studies have shown that clinically asymptomatic high-acceleration head impacts (HHIs) may be associated with neuronal and axonal injury, as measured by advanced imaging and biomarkers. Unfortunately, these methods of measurement are time-consuming, invasive, and costly. A quick noninvasive measurement tool is needed to aid studies of head injury and its biological impact. Quantitative pupillometry is a potential objective, rapid, noninvasive measurement tool that may be used to assess the neurological effects of HHIs. In this study, the authors investigated the effect of HHIs on pupillary metrics, as measured using a pupillometer, in the absence of a diagnosed concussion. A prospective observational cohort study involving 18 high school football athletes was performed. These athletes were monitored for both the frequency and magnitude of head impacts that they sustained throughout a playing season by using the Head Impact Telemetry System. An HHI was defined as an impact exceeding 95g linear acceleration and 3760 rad/sec2 rotational acceleration. Pupillary assessments were performed at baseline, midseason, after occurrence of an HHI, and at the end of the season by using the NeurOptics NPi-200 pupillometer. The Sport Concussion Assessment Tool, 5th Edition (SCAT5), was also used at each time point. Comparisons of data obtained at the various time points were calculated using a repeated-measures analysis of variance and a t-test. Seven athletes sustained HHIs without a related diagnosed concussion. Following these HHIs, the athletes demonstrated decreases in pupil dilation velocity (mean difference 0.139 mm/sec; p = 0.048), percent change in pupil diameter (mean difference 3.643%; p = 0.002), and maximum constriction velocity (mean difference 0.744 mm/sec; p = 0.010), compared to measurements obtained at the athletes' own midseason evaluations. No significant changes occurred between the SCAT5 subtest scores calculated at midseason and those after a high impact, although the effect sizes (Cohen's d) on individual components ranged from 0.41 to 0.65. Measurable changes in pupil response were demonstrated following an HHI. These results suggest that clinically asymptomatic HHIs may affect brain reflex pathways, reflecting a biological injury previously seen when more invasive methods were applied.

Effect of a New Rule Limiting Full Contact Practice on the Incidence of Sport-Related Concussion in High School Football Players

Background: Sport-related concussion (SRC) has been associated with cognitive impairment, depression, and chronic traumatic encephalopathy. American football is the most popular sport among males in the United States and has one of the highest concussion rates among high school sports. Measured head impacts and concussions are approximately 4 times more common in contact practices compared with noncontact practices. The Wisconsin Interscholastic Athletic Association passed new rules defining and limiting contact during practice before the 2014 football season. Purpose: To determine if the SRC rate is lower after a rule change that limited the amount and duration of full-contact activities during high school football practice sessions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 2081 high school football athletes enrolled and participated in the study in 2012-2013 (before the rule change), and 945 players participated in the study in 2014 (after the rule change). Players self-reported previous concussion and demographic information. Athletic trainers recorded athlete exposures (AEs), concussion incidence, and days lost for each SRC. Chi-square tests were used to compare the incidence of SRC in prerule 2012-2013 seasons with the incidence in the postrule 2014 season. Wilcoxon rank sum tests were used to determine differences in days lost because of SRC. Results: A total of 67 players (7.1%) sustained 70 SRCs in 2014. The overall rate of SRC per 1000 AEs was 1.28 in 2014 as compared with 1.58 in 2012-2013 (P = .139). The rate of SRC sustained overall in practice was significantly lower (P = .003) after the rule change in 2014 (15 SRCs, 0.33 per 1000 AEs) as compared with prerule 2012-2013 (86 SRCs, 0.76 per 1000 AEs). There was no difference (P = .999) in the rate of SRC sustained in games before (5.81 per 1000 AEs) and after (5.74 per 1000 AEs) the rule change. There was no difference (P = .967) in days lost from SRC before (13 days lost [interquartile range, 10-18]) and after (14 days lost [interquartile range, 10-16]) the rule change. Conclusion: The rate of SRC sustained in high school football practice decreased by 57% after a rule change limiting the amount and duration of full-contact activities, with no change in competition concussion rate. Limitations on contact during high school football practice may be one effective measure to reduce the incidence of SRC.

Epidemiology of Cervical Muscle Strains in Collegiate and High School Football Athletes, 2011-2012 Through 2013-2014 Academic Years.

Cervical muscle strains are an often-overlooked injury, with neck- and spine-related research typically focusing on spinal cord and vertebral injuries. To examine the rates and distributions of cervical muscle strains in collegiate and high school football athletes. Descriptive epidemiology study. Collegiate and high school football teams. The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) collected data from collegiate football athletes. The High School National Athletic Treatment, Injury and Outcomes Network (HS NATION) and High School Reporting Information Online (HS RIO) collected data from high school football athletes. Data from the 2011-2012 through 2013-2014 academic years were used. Athletic trainers collected injury and exposure data for football players. Injury counts, injury rates per 10 000 athlete-exposures (AEs), and injury rate ratios with 95% confidence intervals (CIs) were calculated. The NCAA-ISP reported 49 cervical muscle strains (rate = 0.96/10 000 AEs), of which 28 (57.1%) were TL (time loss; rate = 0.55/10 000 AEs). High School NATION reported 184 cervical muscle strains (rate = 1.66/10 000 AEs), of which 33 (17.9%) were TL injuries (rate = 0.30/10 000 AEs). The HS RIO, which collects only TL injuries, reported 120 TL cervical muscle strains (rate = 0.51/10 000 AEs). The overall injury rate was lower in the NCAA-ISP than in HS NATION (injury rate ratio = 0.58; 95% CI = 0.42, 0.79); when restricted to TL injuries, the overall injury rate was higher in the NCAA-ISP (injury rate ratio = 1.83; 95% CI = 1.11, 3.03). No differences were found when comparing TL injuries in HS RIO and the NCAA-ISP. Cervical muscle-strain rates were higher during competitions than during practices across all 3 surveillance systems for all injuries. Most cervical muscle strains were due to player contact (NCAA-ISP = 85.7%, HS NATION = 78.8%, HS RIO = 85.8%). The incidence of cervical muscle strains in football players was low compared with other injuries. Nonetheless, identifying and implementing interventions, particularly those aimed at reducing unsafe player contact, are essential to further decrease the risk of injury and associated adverse outcomes.

Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure.

Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction.

Resting-state functional connectivity after concussion is associated with clinical recovery.

There has been a recent call for longitudinal imaging studies to better characterize the time course of physiological recovery following sport-related concussion (SRC) and its relationship with clinical recovery. To address this, we evaluated changes to resting-state functional connectivity (rs-FC) of the whole-brain network following SRC and explored associations between rs-FC and measures of clinical outcome. High school and collegiate football athletes were enrolled during preseason. Athletes that suffered SRC (N = 62) were assessed across the acute (within 48 hr) and sub-acute (days 8, 15, and 45) phases. Matched football athletes without concussion served as controls (N = 60) and participated in similar visits. Multi-band resting-state fMRI was used to assess whole-brain rs-FC at each visit using network-based statistic and average nodal strength from regions of interest defined using a common whole-brain parcellation. Concussed athletes had elevated symptoms, psychological distress, and oculomotor, balance, and memory deficits at 48 hr postconcussion relative to controls, with diminished yet significant elevations in symptoms and psychological distress at 8 days. Both rs-FC analyses showed that concussed athletes had a global increase in connectivity at 8 days postconcussion relative to controls, with no differences at the 48-hr, 15-day, or 45-day visits. Further analysis revealed the group effect at the 8-day visit was driven by the large minority of concussed athletes still symptomatic at their visit; asymptomatic concussed athletes did not differ from controls. Findings from this large-scale, prospective study suggest whole-brain rs-FC alterations following SRC are delayed in onset but associated with the presence of self-reported symptoms.

Olympic lifting vs. traditional lifting methods for North American high school football players

A stronger emphasis has been placed on increasing strength, power, size, and speed for today’s football player. The key to obtaining these abilities and skills are accomplished in the weight room. There are various types of lifting methods when it comes to resistance training (RT) for football. Two types of lifting styles that are often used for high school football weight training programs are the traditional lifting or core training programs and Olympic style lifting. It is thought that Olympic lifts help to increase power, which is something that can be transferred onto the playing field and help improve overall performance. This study compared two different styles of RT (traditional vs. Olympic) in North American High School football athletes in order to determine if one RT protocol was superior at improving measures of speed, strength, and power. Forty male, high school football players ranging from 14 to 18 years old participated in an eight week, off-season, early morning football resistance training program. Each participant was randomly selected into either the traditional resistance protocol (TR: n = 20) or Four Quarters protocol (FQ: n = 20) experimental groups. The players each had the same weight lifting/conditioning routine, however, twice a week the FQ group performed an Olympic lift variation and the TR group performed a dead lift. Pre- and post-assessment scores were obtained and compared in the 1-RM squat, 1-RM power clean, vertical jump (VJ) and 9.14 meter sprint. Pre- post- scores were compared with in each group with a dependent t-test. A gain score was also calculated for each dependent variable (post-pre score) and compared between the experimental groups with an independent t-tests (p≤0.05). Both groups made improvements in pre to post assessments in the 1-RM squat, 1-RM power clean, and VJ (p<0.05). The gain scores for the 1-RM squat, 1-RM power clean were significantly greater for the FQ group (p<0.05). Neither group improved 9.14 meter sprint times (p>0.05). The results of this study are consistent with those found in previous literature demonstrating that increases in both the 1-RM squat and 1-RM power clean are better achieved using an Olympic lift variations when compared to using a traditional lifting method. Resistance training programs for athletes are designed with the goal of improving physical performance on the field of play. The results of this study suggest that improvements in muscular strength and power as measured by the 1-RM squat and 1-RM power clean are best achieved with a RT protocol that includes the Olympic lift variation of the power clean.

202 Pupillary Changes After Nonconcussive High-Acceleration Head Impacts in High-School Football Athletes

202 Pupillary Changes After Nonconcussive High-Acceleration Head Impacts in High-School Football Athletes

Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes.

This prospective observational cohort study of high-school football athletes was performed to determine if high-acceleration head impacts (HHIs) that do not result in clinically diagnosed concussion still lead to increases in serum levels of biomarkers indicating traumatic brain injury (TBI) in asymptomatic athletes and to determine the longitudinal profile of these biomarkers over the course of the football season. Sixteen varsity high-school football athletes underwent baseline neurocognitive testing and blood sampling for the biomarkers tau, ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), and spectrin breakdown products (SBDPs). All athletes wore helmet-based accelerometers to measure and record head impact data during all practices and games. At various time points during the season, 6 of these athletes met the criteria for HHI (linear acceleration > 95g and rotational acceleration > 3760 rad/sec2); in these athletes a second blood sample was drawn at the end of the athletic event during which the HHI occurred. Five athletes who did not meet the criteria for HHI underwent repeat blood sampling following the final game of the season. In a separate analysis, all athletes who did not receive a diagnosis of concussion during the season (n = 12) underwent repeat neurocognitive testing and blood sampling after the end of the season. Total tau levels increased 492.6% ± 109.8% from baseline to postsession values in athletes who received an HHI, compared with 164% ± 35% in athletes who did not receive an HHI (p = 0.03). Similarly, UCH-L1 levels increased 738.2% ± 163.3% in athletes following an HHI, compared with 237.7% ± 71.9% in athletes in whom there was no HHI (p = 0.03). At the end of the season, researchers found that tau levels had increased 0.6 ± 0.2 pg/ml (p = 0.003) and UCH-L1 levels had increased 144.3 ± 56 pg/ml (p = 0.002). No significant elevations in serum NF-L, GFAP, or SBDPs were seen between baseline and end-of-athletic event or end-of-season sampling (for all, p > 0.05). In this pilot study on asymptomatic football athletes, an HHI was associated with increased markers of neuronal (UCH-L1) and axonal (tau) injury when compared with values in control athletes. These same markers were also increased in nonconcussed athletes following the football season.

Factors related to return to play after knee injury in high school football athletes

PurposeAmerican football is played by over 1 million high school athletes in the United States, and knee injuries are the third most common injury. The purpose of this study is to identify factors that influence return to play after knee injuries in high school football athletes and whether return to play differs for varsity and nonvarsity football players. MethodsWe used academic year 2006–2007 through 2009–2010 data from the National High School Sports-Related Injury Surveillance Study. Polytomous logistic regression was used to assess factors influencing return to play. ResultsThirty-one percent returned to play in more than 3 weeks or not at all. After adjusting for injury severity, a difference in time to return to play persisted for injuries occurring in the regular or postseason compared to pre-season (OR 0.5, CI: 0.3-0.9), and injuries occurring to varsity players compared with nonvarsity players (OR 0.7, CI: 0.4-1.0). ConclusionsTime in season, method of injury assessment, and the need for surgery were the main predictors of return to play for football athletes. As more factors were influential for varsity athletes than nonvarsity athletes, future studies should separate the groups of athletes to better identify their specific factors for time to return.

Baseline Visual Measures in High School Football Players With and Without Previous Concussion

Visual impairments are common following sport-related concussion and may negatively affect athlete performance and safety if unresolved. PURPOSE: To examine differences in baseline visual assessment measures in high school football players with and without previous concussion. A secondary purpose was to examine the correlations between these asessments. METHODS: High school varsity football players (n=64, n=24 with concussion history) from a single high school (mean age=15.6±1.3 years) were enrolled in the study. Participants completed the following assessments prior to the start of the competitive football season: 1) three near-point of convergence (NPC) trials, 2) vision and sensory performance testing via the Senaptec Sensory Station, and 3) a demographic questionnaire. The independent variable was previous concussion history (with vs. without). Primary outcomes were average NPC across three trials (measured in centimeters) and the Senaptec Sensory Station scores for: visual clarity, contrast sensitivity, depth perception, near-far quickness, perception span, multiple object tracking, and hand-reaction time. Independent samples t-tests were used to examine differences in visual assessments between those with and without previous concussion. Pearson correlations examined relationships between all Senaptec Sensory Station and mean NPC measures. Alpha level was set to P < 0.05 a priori. RESULTS: Over half (62.5%) of those who reported a concussion history indicated that their most recent concussion was within the last year. There was no significant effect of concussion history on any of the visual assessment measures. There was a significant, but clinically insignificant correlation between mean NPC and binocular visual clarity (r=0.26; P=0.03). No other significant correlations among the visual assessment measures were identified (P < 0.05). CONCLUSION: High school football athletes, regardless of concussion history, exhibit similar baseline clinical and performance visual measures. Our data suggest that NPC and binocular visual clarity, while statistically correlated are clinically independent of one another and both worthy of evaluation in assessing concussion.

Predicting Concussion Incidence from Baseline Data in High School and Collegiate Football Athletes

Predicting Concussion Incidence from Baseline Data in High School and Collegiate Football Athletes

No Seasonal Changes in Cognitive Functioning Among High School Football Athletes: Implementation of a Novel Electrophysiological Measure and Standard Clinical Measures.

To evaluate neuroelectric and cognitive function relative to a season of football participation. Cognitive and neuroelectric function declines are hypothesized to be present in football athletes. Observational. Athletic fields and research laboratory. Seventy-seven high school athletes (15.9 + 0.9 years, 178.6 + 7.2 cm, 74.4 + 14.7 kg, and 0.8 + 0.8 self-reported concussions) participating in football (n = 46) and noncontact sports (n = 31). All athletes completed preseason, midseason, and postseason assessments of cognitive and neuroelectric function, self-reported symptoms, and quality of life. All athletes participated in their respective sports without intervention, while head impact exposure in football athletes was tracked using the Head Impact Telemetry System. Cognitive performance was based on Cogstate computerized cognitive assessment tool processing speed, attention, learning, working memory speed, and working memory accuracy scores. ElMindA brain network activation amplitude, synchronization, timing and connectivity brain network activation scores demarcated neuroelectric performance. Quality of life was assessed on the Health Behavior Inventory and Satisfaction with Life Scale and symptoms on the SCAT3 inventory. Football and control sport athletes did not show declines in cognitive or neuroelectric function, quality-of-life measures, or symptom reports across a season of sport participation. These findings refute the notion that routine football participation places athletes at risk for acute cognitive declines. The lack of impairment may be associated with no association with head impacts and cognitive function, increased physical activity offsetting any declines, and/or test sensitivity. How these findings are associated with long-term cognitive function is unknown.

In Search of a Five-Star: The Centrality of Body Discourses in the Scouting of High School Football Players

This study explores how high school football athletes’ bodies are constructed within the context of contemporary scouting regimes. Deploying a quantitative approach, we analyze 6600 scouting reports on a total of 1650 high school football athletes available online from four high-profile media outlets which offer ‘expert’ analyses of athletes’ body characteristics, performance, and estimated potential. The findings indicate that subjective measurements of the athlete’s body are the best predictors of hierarchical classification. The findings also indicate that objective measurements do not seem to predict the subjective assessment of those very athletic bodies. We argue that the evaluation of high school football athletes by so-called expert analysts is remarkably arbitrary, and thus call into question the very practice of football scouting that has become so dominant and influential. ‘Scouts’ promote a system of scrutiny that contributes the reification of hegemonic relations between the observers and the observed.

The Epidemiology of Overuse Conditions in Youth Football and High School Football Players.

High-intensity sport training at the youth level has led to increased concern for overuse conditions. Few researchers have examined overuse conditions in youth sports. To examine the rates, risks, and distributions of overuse conditions between youth and high school football players. Descriptive epidemiologic study. Youth and high school football teams. The Youth Football Safety Study (YFSS) investigated youth football athletes from age 5 to 14 years. The National Athletic Treatment, Injury and Outcomes Network (NATION) focused on high school football athletes 14 to 18 years old. The YFSS data consisted of 210 team-seasons, and the NATION data consisted of 138 team-seasons. Athletic trainers collected football injury and exposure data during the 2012 and 2013 seasons. Injury rates, risks, and distributions were calculated, with injury rate ratios, risk ratios, and injury proportion ratios with 95% confidence intervals (CIs) comparing youth and high school football players. The YFSS reported 1488 injuries, of which 53 (3.6%) were overuse conditions. The NATION reported 12 013 injuries, of which 339 (2.8%) were overuse conditions. The overuse condition rate did not differ between high school and youth football (3.93 versus 3.72/10 000 athlete-exposures; injury rate ratio = 1.06; 95% CI = 0.79, 1.41). However, the 1-season risk of overuse condition was higher in high school than in youth football players (2.66% versus 1.05%; risk ratio = 2.53; 95% CI = 1.84, 3.47). Compared with high school football players, youth football players had greater proportions of overuse conditions that were nontime loss (ie, <24 hours participation-restriction time; 83.0% versus 67.0%; injury proportion ratio = 1.24; 95% CI = 1.07, 1.43) and affecting the lower extremity (92.5% versus 62.5%; injury proportion ratio = 1.48; 95% CI = 1.32, 1.65). Overuse conditions may not present a primary concern in youth and high school football players. However, differences existed between the 2 levels of competition. Although additional research on the incidence of overuse conditions across all youth and high school sports is needed, these findings may highlight the need for programming that is specific to competition level.

A Prospective Evaluation on the Effects of One High School Football Season on Neurocognitive Test Scores in High School Football Athletes

Subconcussive head impacts do not result in outward signs of neurological dysfunction, however they may have an effect on neurocognitive function. Limited research has indicated that negative changes in neurocognitive function occurs in high school football athletes as a result of one season of football. The purpose of this study was to prospectively evaluate the effects of one season of high school football on neurocognitive test scores. Results revealed a significant group and time interaction effect (p &lt; .001) for the Verbal Memory composite score of the ImPACT test. Further analysis revealed a significant difference in the Verbal Memory score between groups at postseason (p &lt; .01), with the football group scoring lower than the low contact group. It appears that one season of high school football may have a negative effect on the Verbal Memory composite score of the ImPACT test in high school football athletes.

Individual Impact Magnitude vs. Cumulative Magnitude for Estimating Concussion Odds.

Helmeted impact devices have allowed researchers to investigate the biomechanics of head impacts in vivo. While increased impact magnitude has been associated with greater concussion risk, a definitive concussive threshold has not been established. It is likely that concussion risk is not determined by a single impact itself, but a host of predisposing factors. These factors may include genetics, fatigue, and/or prior head impact exposure. The objective of the current paper is to investigate the association between cumulative head impact magnitude and concussion risk. It is hypothesized that increased cumulative magnitudes will be associated with greater concussion risk. This retrospective analysis included participants that were recruited from regional high-schools in Illinois and Michigan from 2007 to 2014 as part of an ongoing study on concussion biomechanics. Across seven seasons, 185 high school football athletes were instrumented with the Head Impact Telemetry system. Out of 185 athletes, 31 (17%) sustained a concussion, with two athletes sustaining two concussions over the study period, yielding 33 concussive events. The system recorded 78,204 impacts for all concussed players. Linear acceleration, rotational acceleration, and head impact telemetry severity profile (HITsp) magnitudes were summed within five timeframes: the day of injury, three days prior to injury, seven days prior to injury, 30days prior to injury, and prior in-season exposure. Logistic regressions were modeled to explain concussive events based on the singular linear acceleration, rotational acceleration, and HITsp event along with the calculated summations over time. Linear acceleration, rotational acceleration, and HITsp all produced significant models estimating concussion (p<0.05). The strongest estimators of a concussive impact were the linear acceleration (OR=1.040, p<0.05), rotational acceleration (OR=1.001, p<0.05), and HITsp (OR=1.003, p<0.05) for the singular impact rather than any of the cumulative magnitude calculations. Moreover, no cumulative count measure was significant for linear or rotational acceleration. Results from this investigation support the growing literature indicating cumulative magnitude is not related to concussion likelihood. Cumulative magnitude is a simplistic measure of the total exposure sustained by a player over a given period. However, this measure is limited as it assumes the brain is a static structure unable to undergo self-repair. Future research should consider how biological recovery between impacts may influence concussion risk.

Concussion Symptoms and Return to Play Time in Youth, High School, and College American Football Athletes: Kerr ZY, Zuckerman SL, Wasserman EB, et al. JAMA Pediatrics. 2016;170:647-653

Concussion Symptoms and Return to Play Time in Youth, High School, and College American Football Athletes: Kerr ZY, Zuckerman SL, Wasserman EB, et al. JAMA Pediatrics. 2016;170:647-653

High School Football Players' Knowledge and Attitudes About Concussions.

To assess high school (HS) football players' knowledge of concussions and to determine whether increased knowledge is correlated with better attitudes toward reporting concussion symptoms and abstaining from play. Two survey tools were used to assess athletes' knowledge and attitudes about concussions. Surveys collected information about demographics, knowledge about concussions, and attitudes about playing sports after a concussion. All athletes present completed one of the 2 surveys. A knowledge and attitude score for each survey was calculated. Frequencies and mean values were used to characterize the population; regression analysis, analysis of variance, and t tests were used to look for associations. A football camp for HS athletes in the Cincinnati area. Male HS football players from competitive football programs in the Cincinnati area. None. Scores on knowledge and attitude sections; responses to individual questions. One hundred twenty (100%) athletes were enrolled although not every athlete responded to every question. Thirty (25%) reported history of a concussion; 82 (70%) reported receiving prior concussion education. More than 75% correctly recognized all concussion symptoms that were asked, except "feeling in a fog" [n = 63 (53%)]. One hundred nine (92%) recognized a risk of serious injury if they return to play too quickly. Sixty-four (54%) athletes would report symptoms of a concussion to their coach; 62 (53%) would continue to play with a headache from an injury. There was no association between knowledge score and attitude score (P = 0.08). Despite having knowledge about the symptoms and danger of concussions, many HS football athletes in our sample did not have a positive attitude toward reporting symptoms or abstaining from play after a concussion. Physicians should be aware that young athletes may not report concussion symptoms.

Injury History Predicts Musculoskeletal Lower Extremity Injury Risk in High School Athletes

Previous musculoskeletal (MSK) injury history is thought to predispose athletes to increased risk of lower extremity (LE) injury. PURPOSE: Determine if including injury history on a pre-participation examination (PPE) will improve the ability to predict MSK LE injury risk in high school athletes. METHODS: Prior to the start of their respective sports seasons, 3,587 high school football, soccer, basketball and lacrosse athletes (m/f= 2,271/1,316, 15.6±1.2 y, 1.73±0.07 m, 69.3±15.5 kg) completed a functional performance assessment as part of the ongoing functional pre-participation physical evaluation (FPPE) project. Certified Athletic Trainers (ATCs) using the national surveillance tool, High School Reporting Information Online (RIO), collected LE injury data (n=406 injuries reported) across 2 years. An injury was defined as requiring medical care from a physician or ATC and resulting in at least one day lost from athletic participation. Injury history was self-reported on state mandated PPE forms. Binary logistic regression with a two block entry design was used to determine if assessing injury history significantly improved a LE injury risk prediction model. A model was developed by entering age, height, weight, gender, sport, single leg anterior reach (SLAR) asymmetry, and single leg hop (SLHOP) asymmetry into block one using forward conditional selection. A variable indicating a history of injury was added to the model in block two to determine if it significantly improved the model developed in block one. Alpha level was set a priori at p<0.05. RESULTS: The initial model best predicting injury included age, height, weight, gender, sport, and SLHOP asymmetry greater than 20% (Χ2 = 90.301, df = 8, p < 0.001). Adding history of injury significantly improved the model (Χ2 change= 30.528, df = 1, p < 0.001). Additionally, when incorporated into the model created in block one, the odds of suffering a LE injury during the study period were 1.98 times greater for individuals with a history of injury (OR = 1.98, 95% CI = 1.56, 2.50, p < 0.001). CONCLUSION: Including injury history may significantly improve the ability to predict adolescent athletes’ MSK injury risk.

Does Visual Performance Influence Head Impact Severity Among High School Football Athletes?

To compare the odds of sustaining moderate and severe head impacts, rather than mild, between high school football players with high and low visual performance. Prospective quasi-experimental. Clinical Research Center/On-field. Thirty-seven high school varsity football players. Athletes completed the Nike SPARQ Sensory Station visual assessment before the season. Head impact biomechanics were captured at all practices and games using the Head Impact Telemetry System. Each player was classified as either a high or low performer using a median split for each of the following visual performance measures: visual clarity, contrast sensitivity, depth perception, near-far quickness, target capture, perception span, eye-hand coordination, go/no go, and reaction time. We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures. Players with better near-far quickness had increased odds of sustaining moderate [odds ratios (ORs), 1.27; 95% confidence intervals (CIs), 1.04-1.56] and severe head impacts (OR, 1.45; 95% CI, 1.05-2.01) as measured by Head Impact Technology severity profile. High and low performers were at equal odds on all other measures. Better visual performance did not reduce the odds of sustaining higher magnitude head impacts. Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players. Further research is needed to determine whether visual performance influences concussion risk. Based on our results, we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts.