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Injury Patterns in Big Ten Conference Football

John P. Albright, MD^*,, John W. Powell, PhD, ATC, Al Martindale, MS, ATC/L, Robert Black, MS, LAT, ATC^ll, Edward Crowley, LPT, ATC, Paul Schmidt, MS, PT, ATC^¶, Jeff Monroe, MS, ATC, Doug Locy, MA, ATC/L^#, Tory Aggler, ATC/L^**, W. R. Davis, MS, ATC, George Salvaterra, PhD, ATC, Dennis Miller, MS, ATC, PT, Dennis Helwig, LAT^{ll ll}, Stephen Soboroff, MD, Jim Nivens, MD^ll, James Carpenter, MD^¶, Jeff Kovan, DO, Elizabeth Arndt, MD^#, Howard Sweeney, MD^**, John Lombardo, MD, Wayne J. Sebastianelli, MD, Michael Krauss, MD and Greg Landry, MD^{ll ll}

From the University of Iowa Hospitals and Clinics, Iowa City, Iowa, Michigan State University, East Lansing, Michigan, the University of Illinois, Urbana-Champaign, Illinois, ^ll Indiana University, Bloomington, Indiana, the ^¶ University of Michigan, Ann Arbor, Michigan, the ^# University of Minnesota, Minneapolis, Minnesota, ^** Northwestern University, Evanston, Illinois, Ohio State University, Columbus, Ohio, Pennsylvania State University, State College, Pennsylvania, Purdue University, West Lafayette, Indiana, and the ^{ll ll} University of Wisconsin, Madison, Wisconsin

^* Address correspondence to John P. Albright, MD, University of Iowa Hospitals and Clinics, Department of Orthopaedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242-1088.

Background: In 1998, the National Collegiate Athletic Association legislated a decrease in the number of scrimmages and full-contact practices allowed during the spring season.

Hypothesis: A significantly increased risk of injury faced by the same player during the spring versus fall practice sessions does exist, but the National Collegiate Athletic Association regulations will not have the intended effect of reducing injury rates to equal or below those of the fall practice sessions.

Study Design: Retrospectively analyzed, descriptive study of prospectively collected injury surveillance data followed by a prospective, controlled, repeated-measures study after the rule change.

Methods: Phase 1: the Big Ten Conference Sports Injury Surveillance System database was reviewed from spring 1992 through fall 1997 for all reportable injuries. Phase 2: a prospective investigation was instituted from spring 1998 through fall 2000. This protocol was modified to also document updated individual player position descriptions and string as well as exposures for the old fall and spring practice categories (scrimmages, full contact, and limited contact) and the new spring practice designations (full pads with and without tackling, helmets only, spring game, and other scrimmages).

Results: Phase 1: There were 3950 fall injuries and 1007 spring injuries, with 469 of the 1007 attributable to the "spring risk factor." There was a statistically significant increase in injury rate in the spring (19.8) versus fall (10.6). Scrimmages (incidence density ratio = 2.4) and limited-contact practices (incidence density ratio = 2.5) showed more than twice the fall injury rate. Phase 2: There were 1502 fall injuries and 648 spring injuries, with 192 attributable to the spring risk factor. There was a 3-fold increase in injury rate in the spring (incidence density ratio = 3.2). Although the noncontact, helmets-only practices produced the lowest injury rates, the nonspring game scrimmages and the limited-contact practices defined as "practice with pads but without tackling" displayed the highest injury rates. In both spring and fall, nonplayers exhibited the highest injury rates for all string groups.

Conclusions: There was and still is a statistically significant increase in spring practice injury risk. The 1998 rule change resulted in an even greater increase in spring practice injury risk. If the goal is to minimize the number of spring practice injuries, it will be best accomplished by limiting the number of scrimmages and limited-contact sessions.

Key Words: college football • injury rates • practice sessions • seasonal comparisons • spring risk factor • National Collegiate Athletic Association (NCAA) rule changes • incidence density ratios

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