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Head Impact Exposure in Youth Football: High School Ages 14 to 18 Years and Cumulative Impact Analysis

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Abstract

Sports-related concussion is the most common athletic head injury with football having the highest rate among high school athletes. Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level. Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16,502 head impacts were collected over the course of the season. Biomechanical data were analyzed by team and by player. The median impact for each player ranged from 15.2 to 27.0 g with an average value of 21.7 (±2.4) g. The 95th percentile impact for each player ranged from 38.8 to 72.9 g with an average value of 56.4 (±10.5) g. Next, an impact exposure metric utilizing concussion injury risk curves was created to quantify cumulative exposure for each participating player over the course of the season. Impacts were weighted according to the associated risk due to linear acceleration and rotational acceleration alone, as well as the combined probability (CP) of injury associated with both. These risks were summed over the course of a season to generate risk weighted cumulative exposure. The impact frequency was found to be greater during games compared to practices with an average number of impacts per session of 15.5 and 9.4, respectively. However, the median cumulative risk weighted exposure based on combined probability was found to be greater for practices vs. games. These data will provide a metric that may be used to better understand the cumulative effects of repetitive head impacts, injury mechanisms, and head impact exposure of athletes in football.

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Acknowledgments

The authors would like to thank the Reagan High School, especially Ashley Lake, ATC (Reagan High School), Corbin Ratcliffe, Lauren Smith and the football program. Thank you to Elizabeth Lillie and all those who contributed to the study development. Special thanks to the Childress Institute for Pediatric Trauma at Wake Forest Baptist Medical Center for providing support for this study.

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Authors and Affiliations

  1. Virginia Tech—Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, 27157, USA

    Jillian E. Urban, Elizabeth M. Davenport, Adam J. Golman & Joel D. Stitzel

  2. Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA

    Jillian E. Urban, Elizabeth M. Davenport, Adam J. Golman, Joseph A. Maldjian, Christopher T. Whitlow, Alexander K. Powers & Joel D. Stitzel

  3. Department of Radiology (Neuroradiology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Joseph A. Maldjian & Christopher T. Whitlow

  4. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Alexander K. Powers

  5. Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Christopher T. Whitlow

  6. Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Alexander K. Powers & Joel D. Stitzel

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  1. Jillian E. Urban
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Correspondence to Joel D. Stitzel.

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Associate Editor Peter E. McHugh oversaw the review of this article.

Appendix

Appendix

See appendix Tables A1, A2, A3, and A4.

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Urban, J.E., Davenport, E.M., Golman, A.J. et al. Head Impact Exposure in Youth Football: High School Ages 14 to 18 Years and Cumulative Impact Analysis. Ann Biomed Eng 41, 2474–2487 (2013). https://doi.org/10.1007/s10439-013-0861-z

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  • DOI: https://doi.org/10.1007/s10439-013-0861-z

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