By DAVID STEINKRAUS
Journal Times | Posted: Tuesday, September 11, 2007 12:00 am
It is the season of crisp fall days and cheerleaders, last-minute touchdowns and fumbled balls. For young people on the gridiron it is a more important season: injury season.
In what is apparently the first study of its kind, a group of researchers in Columbus, Ohio, compared injury rates between collegiate and high school football players and found that the game is much more serious for the younger players. Lessons from this study resonate in Racine County, too.
What the Ohio group found is that while college players have a greater rate of injury, high school players experience a higher proportion of severe injuries such as concussions and broken bones.
"For example," said lead researcher R. Dawn Comstock, "in the high school athletes we see the majority of the injuries occur during the tackle so the positions that are most commonly injured are the running backs and the linebackers, the people being tackled and the people doing the tackling. One of our recommendations at the high school level is for coaches to ensure that the younger athletes particularly are very competent in their tackling technique and that they're physically capable of performing a tackle correctly, or receiving a tackle correctly, before they're allowed to play in their first game. You know, by the time they get to college they know this stuff, but at the high school level the coaches can still make a big difference." Comstock holds a doctorate in public health epidemiology, is an assistant professor in the Ohio State University colleges of medicine and public health, and is a researcher at the Center for Injury Research and Policy at Columbus Children's Hospital. Her group published its work recently in the American Journal of Sports Medicine.
Before her group began collecting information on high school athletes a few years ago, she said, there was no system for that, and all recommendations about caring for high school athletes were derived from college data. Yet high school athletes are not simply miniature versions of their college counterparts. "We know that high school athletes are not skeletally mature yet, particularly the boys in that group."
Their brains are also still developing, which makes the consequences of a concussion that much more likely to have long-term consequences.
Brains and knees
On the field, trainers see a lot of ankle and knee injuries, said Lynn Swindall, 33, a certified athletic trainer for All Saints and one of the people who work with area schools. "Additionally we have a lot of concussion we deal with unfortunately as well."
Concussion is the most attention-getting injury because of the possibility of lifelong consequences, said Dr. Todd Barnhardt, 42, an orthopedic surgeon with Wheaton Franciscan All Saints in Racine. The NFL is re-evaluating its treatment of concussion right now, he said, and is rethinking guidelines on when players can return to the field because research suggests a change in players' cognitive abilities even during a season in which they suffer a concussion.
Precisely why concussions are a problem is unclear. One hypothesis, although not backed by any solid research, is that there is some brain difference between college and high school athletes, Comstock said. Typically the cause is head-to-head or head-to-ground contact, said Michael Carter, 33, an All Saints trainer and site supervisor in rehabilitation services. A dry, hard playing field may have some bearing, especially at younger ages when players are still learning how to tackle properly, he said.
Equipment fit may play a role. Trainers try to take precautions, and check gear for damage weekly, but at the high school level they're very busy, Swindall said. She worked for some time at Northwestern University where there was a person just to look after equipment. And when you look at manufacturers' Internet sites, Comstock said, you will find 14- or 16-step procedures for making sure that a helmet is properly seated on the head.
"I was kind of surprised at the concussion end of it down here," Barnhardt said. He spent some years helping in Milwaukee schools where those injuries were not as common. In Racine he now works at Park football games.
In Milwaukee, players were smaller in part because the number of drop-outs necessitated the use of younger teens, he said. Here squads are larger, there is more interest in games, and the players are bigger. But he sees another factor.
Some players, he said, want to make the bone-jarring, knock-him-unconscious hit which are common fare on ESPN highlight shows. "To some degree the art of tackling, and the practice of tackling, has degraded over time," said Barnhardt, a former high school football players himself. "Now it's trying to get the big hit, and that's where you're going to get into trouble. That's what the NFL is trying to crack down on." Where coaches have a role, he said, is to stress that the point of a tackle is to wrap up the opposing player and get him on the ground, not in a hospital.
In another paper due to be published in December, Comstock said, her team examines concussions in nine sports and does a comparison with college athletics. That study found a greater proportion of injury due to concussion in high school athletes, although college players had a greater rate of concussion, she said. That work also found that those who returned to play before fully recovering had a greater risk of injury, a particular concern because of the risk of long-term consequences.
Surprises
The greater frequency of severe injuries did surprise her team, Comstock said. Barnhardt wasn't surprised - not if you know how those injuries occur, he said.
More injuries occurred in games than in practices, which didn't really surprise anyone because the intensity is that much greater in games. Also, Comstock said, in practices players don't spend as much time at risk; they may be watch films or spend only 30 minutes on blocking versus an hour doing that during a game.
It may also be that players are not taking their practices seriously enough, said Carmelo Tenuta, president and CEO of Sports Physical Therapy & Rehab Specialists of Racine and Kenosha. "It didn't surprise me that knee injuries were more common." As children get older, their throwing strength increases so naturally there are more running plays in junior and high schools, and that exposes those joints to danger, he said. Those joints are very susceptible to injury, and there's not much that can be done to protect them, Comstock said.
Why do the severity of injuries drop in colleges? It may be better technique, or less reliance on running games, or it may be that players injured in high school, and high school players who have had several concussions, opt out of college sports.
Although the data collection is still in its infancy, Comstock said, the hope is that it can guide improvements, that as coaches, trainers, and physicians make changes, the results will or won't show up in the injury data. Injuries shouldn't be accepted, she said.
"They're thought of as just part of the game or the price you have to pay to play," she said. "We know that's not true." As has happened with motor vehicle accident records, where analysis drives the development of safety equipment and collision resistance, athletic injury information can be used to increase safety, she said.
Barnhardt cautioned against expecting too much from safety efforts. Changes in coaching or equipment may help, he said, but the nature of football can't be changed. "You can make gains but you're never going to prevent all of these violent injuries, especially the violent injuries - concussions, knee, ligament injuries. It is a violent sport, it's a collisions ports, and part of that is people are going to get hurt no matter how we try to prevent it."
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