A computer’s analysis of football injuries JOHN C. JOHNSON, MD AND MERRILL A. RITTER, MD
Annually,
injuries plague the nation’s from grade school’ to the professional ranks. Not only are games lost but players are often left with disabilities. There are many articles relating to the number and type of injuries associated with football
teams
football. These articles, however,
are
either
retrospective or prospective analyses involving multiple schools and questionnaires so that the degree of injury follow-up and control are not available. In an curb such injuries, an analysis has been made of all injuries incurred by a midwest Big Ten football team during the 1973 football season. The results provide a reasonable means to decrease the number and severity of injuries commonly incurred by this football team.
personal attempt
ally supervised and tabulated by the senior author. Two variable analyses of all parameters were applied. These results were then surveyed for significance. Computer services were provided by the I.U.P.U.I. Computing Facilities.
to
METHODS
All members of the Indiana University
varsity football squad at (Bloomington, Indiana) were given a questionnaire’ to elicit data pertaining to physical characteristics, uniform components worn and positions played. For each injury, during all practice sessions, drills, scrimmages and games, the player involved and the team’s trainer completed an injury report describing in detail the type of injury and the playing conditions under which the injury occurred. All the injuries and treatment methods were person-
RESULTS
The
analysis of all data collected is too vast duplicate in these pages and many of the parameters surveyed proved to be of no significance in causing or preventing football injuries. However, the analysis of the following data may be beneficial to curbing injuries. to
General
One hundred and eighteen members of the Indiana Universityfootball squad incurred a total of 207 injuries during the 1973 season. Table I lists the percentage breakdown of players by offensive and defensive positions and may be helpful in affirming the significance of the statements made with regard to individual player group injuries to follow. Table II summarized the significant injury types occurring to the major body regions of all players and also points out the re-injury rate in the case of shoulder, knee and ankle injuries. The following describe the data felt significant for a particular player group. Offensive
Dr. John C. Johnson is Resident, Department of Family Practice, Methodist Hospital, Indianapolis, Indiana. Dr. Merrill A. Ritter is Associate Professor, Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana. 168
Split-Ends
Of all ankle injuries occurring to offensive players, 23.8 per cent were incurred by split-ends. All of the players either wrap (8.4%) or tape (91.6%) their ankles. Fortyone and seven tenths per cent of all split-end
occurred to ankles with the majority classified as either first-degree sprains (30.7%) or first-degree strains (23%). These ankle injuries occurred most frequently to players being tackled (43%) or being blocked, ie, shoulder blocking (43%). Fifty per cent of these injuries occurred during a varsity game with 66 per cent of the injuries occurring during the third and fourth quarters to players who had greater than fifteen minutes of playing time (mean of thirty
injuries
TABLE I
Player Profile by Positions
minutes) prior to injury. Of the remaining ankle injuries (50%) which did not occur during a varsity game, 40 per cent occurred prior to the first game and accounted for 67 per cent of all split-end injuries prior to the first game. Offensive Quarterbacks
Quarterbacks sustained
100 per cent of all rib injuries, all of which were classified as contusions. In addition, 28.6 per cent of all groin injuries (contusions and strains), 25 per cent of all hamstring injuries (firstdegree strains) and 25 per cent of all thigh injuries (contusions and first-degree strains) occurring to offensive players were incurred by quarterbacks. Twenty per cent of all offensive contusion injuries were sustained by quarterbacks with 41.2 per cent of all quarterback injuries classified as contusions. Offensive Tailbacks
Nine and one half per cent of all offensive ankle injuries (100 per cent first-degree sprains) were incurred by tailbacks. Sixtyseven per cent of all tailback injuries were first-degree ankle sprains with 75 per cent of these injuries resulting in time lost from games or practice sessions. Defensive Ends
per cent of all defensive thigh injuries and 40 per cent of all defensive groin injuries were incurred by defensive ends. Fifty-six
Sixty
TABLE 2 ~
Injury Profile of Body
Regions
--.-------
--
169
and three tenths per cent of defensive end injuries occurred during running plays. Sixty-seven per cent of all defensive end injuries were the result of &dquo;crack-back&dquo; blocking. Forty-two per cent of defensive end injuries occurred during a game, usually in the second quarter (42%), and primanly to players with fifteen to thirty minutes of game time elapsed at the time of
injury (71.4%). Defensive Tackles
Seventy-five per cent of defensive foot (not ankle) injuries occurred to defensive tackles with the majority being contusions. Fifty per cent of all injuries incurred by defensive tackles were sustained during group drills. Seventy-seven and eight tenths per cent of tackle injuries occurring during games or scrimmages occurred on running plays with 50 per cent sustained during the act of shoulder blocking. Defensive Half-
or
Corner Backs
Forty-six and two tenths per cent of all defensive shoulder injuries and 50 per cent of all defensive hamstring injuries occurred to halfbacks. Thirty-eight and two tenths per cent of defensive injuries incurred during a game, occurred to defensive halfbacks with 56.5 per cent occurring during running plays and 82.4 per cent occurring while the player was in the act of tackling. Fifty per cent of all defensive tackling injuries were sustained by halfbacks. Analysis of injuries sustained by other groups of players were not felt to be significant.
DISCUSSION The above data leads to the following theoretical means of reducing or eliminating injuries. Ankle injuries to offensive splitends and tailbacks, a major problem for these two groups, may be decreased by better pre-season conditioning and perhaps by retaping or rewrapping ankles after fifteen to thirty minutes of playing time (i.e. at halftime). Quarterbacks could best be aided by additional and more efficacious padding of the ribs (primarily) and thighs. Additional hamstring conditioning should also be of value to quarterbacks, as should be the case 170
for defensive halfbacks, a second group plagued by an inordinate number of ham-
string injuries. Defensive end injuries could be reduced 67 per cent with the elimination of &dquo;crackback&dquo; blocking from varsity football. Fatigue may also be a factor in defensive end injuries with 7.4 per cent of game injuries occurring after fifteen to thirty minutes of playing time for the injured player. Defensive tackle injuries could be greatly reduced with more substantial footwear. Padding for the dorsum of the foot with a heavy material (i.e. leather) or metal plate should be of value in reducing the large number of defensive foot injuries. From Table 2 it can be seen that more effective padding would theoretically eliminate injuries to ribs, upper arms, elbows, hands and hips, and would reduce shoulder (30%) and thigh (54.5%) injuries for all players. Finally, knee, ankle and shoulder injuries should be carefully evaluated to prevent re-injury,-a major source of trauma to these regions.
CONCLUSION
StanislasI of Poland (1677-1766) thought that &dquo;Science when well digested is nothing but good sense and reason&dquo;’. By analyzing the conditions under which athletic injuries occur, many can, theoretically, either be eliminated or reduced in severity. Relatively simple and inexpensive changes in conditioning programs and equipment will hopefully reduce the injury rate at Indiana University during the 1974 football season. To evaluate this hypothesis, our data retrieving forms have been changed to include all our
equipment. References 1. Roser LA, Clawsen DK, Football Injuries in the Very Young Athletes: Clin. Ortho. Rel. Res., 69: 219-223, Mar-Apr., 1970. 2. The 1970 Intercollegiate Tackle Football Injury Surveillance Report, prepared for The Joint Commission on Competitive Safeguards and Medical Aspects of Sports; Gary L. Martin and Samuel I. Fuenning, University Health Center; Donald F. Costella and Jose Inguanzo, University Computing Center, University of Nebraska. 3. Stauss MB (Editor), Familiar Medical Quotations. Little, Brown and Co., 1968.
DISCUSSION Dr. James E. Nixon:
Philadelphia, Pennsyl-
vania : There are some important considerations not brought out in this paper that might very well be emphasized to generate needed attention and additional research. These are: ( 1 ) the obvious physical differences in various individuals on a football team; (2) the highly specialized nature of the tasks carried out by these individuals whose performance involves changing patterns of play (eg, the offensive player who suddenly becomes a defensive player); and (3) the design of general equipment to meet the requirements of those highly specialized tasks (eg, interior lineman’s face mask vs. quarterback’s face mask; lineman’s shoulder pads vs. quarterback’s shoulder pads). It is to be noted, in the paper, that a number of injuries apparently occurred prior to the beginning of the season. Not infrequently, the fields used at this time are different than those played upon during the season. In addition to the environmental factors involved (ie, practice field vs. home-game field), there is the psychological factor in the difference between playing to &dquo;make the
team&dquo; and playing to &dquo;defeat an opponent.&dquo; I believe that the methodology of the present study, ie, data collection and presentation, is in need of clarification and that the abovementioned parameters of injury production should have, in some way, been included. Nonetheless, the raw data itself appears to be useful; the population mass certainly seems adequate to enable generalization. Such data tend to focus attention on an important area of medical concern.
Author’s Reply: I certainly appreciate Dr. Nixon’s comments regarding those &dquo;parameters of injury production&dquo; not covered in the present paper.I should point out that the paper is basically a preliminary study. Most of the 1974 data are still in the hands of computer programmers and will soon be processed. This data was collected by means of questionnaires filled out by all players, trainers and physicians involved in the study. When this data has been processed, we plan to
second,
comprehensive player profiles, injury reports and equipment reports.
complete
a
more
paper which will include
171
Annually,
injuries plague the nation’s from grade school’ to the professional ranks. Not only are games lost but players are often left with disabilities. There are many articles relating to the number and type of injuries associated with football
teams
football. These articles, however,
are
either
retrospective or prospective analyses involving multiple schools and questionnaires so that the degree of injury follow-up and control are not available. In an curb such injuries, an analysis has been made of all injuries incurred by a midwest Big Ten football team during the 1973 football season. The results provide a reasonable means to decrease the number and severity of injuries commonly incurred by this football team.
personal attempt
ally supervised and tabulated by the senior author. Two variable analyses of all parameters were applied. These results were then surveyed for significance. Computer services were provided by the I.U.P.U.I. Computing Facilities.
to
METHODS
All members of the Indiana University
varsity football squad at (Bloomington, Indiana) were given a questionnaire’ to elicit data pertaining to physical characteristics, uniform components worn and positions played. For each injury, during all practice sessions, drills, scrimmages and games, the player involved and the team’s trainer completed an injury report describing in detail the type of injury and the playing conditions under which the injury occurred. All the injuries and treatment methods were person-
RESULTS
The
analysis of all data collected is too vast duplicate in these pages and many of the parameters surveyed proved to be of no significance in causing or preventing football injuries. However, the analysis of the following data may be beneficial to curbing injuries. to
General
One hundred and eighteen members of the Indiana Universityfootball squad incurred a total of 207 injuries during the 1973 season. Table I lists the percentage breakdown of players by offensive and defensive positions and may be helpful in affirming the significance of the statements made with regard to individual player group injuries to follow. Table II summarized the significant injury types occurring to the major body regions of all players and also points out the re-injury rate in the case of shoulder, knee and ankle injuries. The following describe the data felt significant for a particular player group. Offensive
Dr. John C. Johnson is Resident, Department of Family Practice, Methodist Hospital, Indianapolis, Indiana. Dr. Merrill A. Ritter is Associate Professor, Department of Orthopedics, Indiana University School of Medicine, Indianapolis, Indiana. 168
Split-Ends
Of all ankle injuries occurring to offensive players, 23.8 per cent were incurred by split-ends. All of the players either wrap (8.4%) or tape (91.6%) their ankles. Fortyone and seven tenths per cent of all split-end
occurred to ankles with the majority classified as either first-degree sprains (30.7%) or first-degree strains (23%). These ankle injuries occurred most frequently to players being tackled (43%) or being blocked, ie, shoulder blocking (43%). Fifty per cent of these injuries occurred during a varsity game with 66 per cent of the injuries occurring during the third and fourth quarters to players who had greater than fifteen minutes of playing time (mean of thirty
injuries
TABLE I
Player Profile by Positions
minutes) prior to injury. Of the remaining ankle injuries (50%) which did not occur during a varsity game, 40 per cent occurred prior to the first game and accounted for 67 per cent of all split-end injuries prior to the first game. Offensive Quarterbacks
Quarterbacks sustained
100 per cent of all rib injuries, all of which were classified as contusions. In addition, 28.6 per cent of all groin injuries (contusions and strains), 25 per cent of all hamstring injuries (firstdegree strains) and 25 per cent of all thigh injuries (contusions and first-degree strains) occurring to offensive players were incurred by quarterbacks. Twenty per cent of all offensive contusion injuries were sustained by quarterbacks with 41.2 per cent of all quarterback injuries classified as contusions. Offensive Tailbacks
Nine and one half per cent of all offensive ankle injuries (100 per cent first-degree sprains) were incurred by tailbacks. Sixtyseven per cent of all tailback injuries were first-degree ankle sprains with 75 per cent of these injuries resulting in time lost from games or practice sessions. Defensive Ends
per cent of all defensive thigh injuries and 40 per cent of all defensive groin injuries were incurred by defensive ends. Fifty-six
Sixty
TABLE 2 ~
Injury Profile of Body
Regions
--.-------
--
169
and three tenths per cent of defensive end injuries occurred during running plays. Sixty-seven per cent of all defensive end injuries were the result of &dquo;crack-back&dquo; blocking. Forty-two per cent of defensive end injuries occurred during a game, usually in the second quarter (42%), and primanly to players with fifteen to thirty minutes of game time elapsed at the time of
injury (71.4%). Defensive Tackles
Seventy-five per cent of defensive foot (not ankle) injuries occurred to defensive tackles with the majority being contusions. Fifty per cent of all injuries incurred by defensive tackles were sustained during group drills. Seventy-seven and eight tenths per cent of tackle injuries occurring during games or scrimmages occurred on running plays with 50 per cent sustained during the act of shoulder blocking. Defensive Half-
or
Corner Backs
Forty-six and two tenths per cent of all defensive shoulder injuries and 50 per cent of all defensive hamstring injuries occurred to halfbacks. Thirty-eight and two tenths per cent of defensive injuries incurred during a game, occurred to defensive halfbacks with 56.5 per cent occurring during running plays and 82.4 per cent occurring while the player was in the act of tackling. Fifty per cent of all defensive tackling injuries were sustained by halfbacks. Analysis of injuries sustained by other groups of players were not felt to be significant.
DISCUSSION The above data leads to the following theoretical means of reducing or eliminating injuries. Ankle injuries to offensive splitends and tailbacks, a major problem for these two groups, may be decreased by better pre-season conditioning and perhaps by retaping or rewrapping ankles after fifteen to thirty minutes of playing time (i.e. at halftime). Quarterbacks could best be aided by additional and more efficacious padding of the ribs (primarily) and thighs. Additional hamstring conditioning should also be of value to quarterbacks, as should be the case 170
for defensive halfbacks, a second group plagued by an inordinate number of ham-
string injuries. Defensive end injuries could be reduced 67 per cent with the elimination of &dquo;crackback&dquo; blocking from varsity football. Fatigue may also be a factor in defensive end injuries with 7.4 per cent of game injuries occurring after fifteen to thirty minutes of playing time for the injured player. Defensive tackle injuries could be greatly reduced with more substantial footwear. Padding for the dorsum of the foot with a heavy material (i.e. leather) or metal plate should be of value in reducing the large number of defensive foot injuries. From Table 2 it can be seen that more effective padding would theoretically eliminate injuries to ribs, upper arms, elbows, hands and hips, and would reduce shoulder (30%) and thigh (54.5%) injuries for all players. Finally, knee, ankle and shoulder injuries should be carefully evaluated to prevent re-injury,-a major source of trauma to these regions.
CONCLUSION
StanislasI of Poland (1677-1766) thought that &dquo;Science when well digested is nothing but good sense and reason&dquo;’. By analyzing the conditions under which athletic injuries occur, many can, theoretically, either be eliminated or reduced in severity. Relatively simple and inexpensive changes in conditioning programs and equipment will hopefully reduce the injury rate at Indiana University during the 1974 football season. To evaluate this hypothesis, our data retrieving forms have been changed to include all our
equipment. References 1. Roser LA, Clawsen DK, Football Injuries in the Very Young Athletes: Clin. Ortho. Rel. Res., 69: 219-223, Mar-Apr., 1970. 2. The 1970 Intercollegiate Tackle Football Injury Surveillance Report, prepared for The Joint Commission on Competitive Safeguards and Medical Aspects of Sports; Gary L. Martin and Samuel I. Fuenning, University Health Center; Donald F. Costella and Jose Inguanzo, University Computing Center, University of Nebraska. 3. Stauss MB (Editor), Familiar Medical Quotations. Little, Brown and Co., 1968.
DISCUSSION Dr. James E. Nixon:
Philadelphia, Pennsyl-
vania : There are some important considerations not brought out in this paper that might very well be emphasized to generate needed attention and additional research. These are: ( 1 ) the obvious physical differences in various individuals on a football team; (2) the highly specialized nature of the tasks carried out by these individuals whose performance involves changing patterns of play (eg, the offensive player who suddenly becomes a defensive player); and (3) the design of general equipment to meet the requirements of those highly specialized tasks (eg, interior lineman’s face mask vs. quarterback’s face mask; lineman’s shoulder pads vs. quarterback’s shoulder pads). It is to be noted, in the paper, that a number of injuries apparently occurred prior to the beginning of the season. Not infrequently, the fields used at this time are different than those played upon during the season. In addition to the environmental factors involved (ie, practice field vs. home-game field), there is the psychological factor in the difference between playing to &dquo;make the
team&dquo; and playing to &dquo;defeat an opponent.&dquo; I believe that the methodology of the present study, ie, data collection and presentation, is in need of clarification and that the abovementioned parameters of injury production should have, in some way, been included. Nonetheless, the raw data itself appears to be useful; the population mass certainly seems adequate to enable generalization. Such data tend to focus attention on an important area of medical concern.
Author’s Reply: I certainly appreciate Dr. Nixon’s comments regarding those &dquo;parameters of injury production&dquo; not covered in the present paper.I should point out that the paper is basically a preliminary study. Most of the 1974 data are still in the hands of computer programmers and will soon be processed. This data was collected by means of questionnaires filled out by all players, trainers and physicians involved in the study. When this data has been processed, we plan to
second,
comprehensive player profiles, injury reports and equipment reports.
complete
a
more
paper which will include
171
