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    Concussion Location not Linked to Clinical Outcomes but Points to Need for Safer Tackling in HS Football

    A new study on concussions in high school football has found that the location of the impact on the head may not have much to do with clinical outcomes, but it could have a lot to say about the need for safer tackling.

    A recently published article in Pediatrics describes efforts to examine whether the location of a concussion—front, back, side, or top of head—was linked to the number or prevalence of symptoms, symptom resolution, and return-to-play times for high school football players. Authors write that much like studies that found no links between neuropsychological function and impact location, their study of 1,975 concussion incidents "suggest[s] that impact location is likely of little use in predicting clinical outcomes."

    Researchers used data from the National High School Sports-Related Injury Surveillance System, High School Reporting Information Online (RIO), a system based on reports from high school athletic trainers over 5 seasons, from 2008 to 2013. The reports include data on impact location, symptomology, and symptom resolution.

    The only factor that did seem to be influenced by the location of the concussion was related to loss of consciousness, which was experienced at twice the rate (8.8%) of concussed players sustaining top-of-the-head impacts compared with all other areas (3.5%).

    The findings underscore the need to emphasize "heads up" tackling, authors write, given that 70.7% of all concussions caused by player-to-player collisions were the result of head-to-head contact. "Concussions from top-of-the-head impacts, and the resulting risks associated with such impacts, may be reduced by enforcing rules prohibiting players from leading with their head," authors write. "Players must never initiate contact with the helmet or make contact while head-down."

    Among other findings in the study:

    • Nearly 10% of all concussions from a player-to-player impact were reported as recurrent concussions, with 23.1% of those recurrent injuries taking place within the same academic year. Recurrence was not related to impact location.
    • Players with recurrent concussions due to side-of-head and top-of-head impacts reported more symptoms than players with new concussions from contact in those areas.
    • Players with recurrent concussions generally had longer symptom resolution and return-to-play times.
    • Player-to-player concussions were sustained most frequently by linebackers (17%), running backs (15.2%), and defensive tackles (9.5%).
    • Back-of-the-head concussions were the type most frequently sustained by quarterbacks, at 2.4 times the rate of other locations.

    Concussion prevention and management—particularly in youth sports—has been a particular focus of APTA over recent years, and APTA continues to educate policymakers on how physical therapists are qualified to detect and manage concussions. For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage. Find more resources on the Traumatic Brain Injury webpage, and direct patients to the Physical Therapist's Guide to Concussion, located on APTA's MoveForwardPT.com consumer website.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


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