Football and injuries, the two are inseparable. One of the main reasons people are against football is the risk of injury. Football injury risks include those to the body, neck, and head, and some can be traumatic.

My only football injury was in 7^th grade when I broke my wrist during practice. I was small for my age. I had not yet hit a puberty growth spurt. Going against someone bigger than me in a 1-v-1 drill, and I was attempting to wrap and ‘tackle’ him. This drill was not meant to actually tackle to the ground but just wrap and drive my teammate backwards.

Rather than initiating contact with my shoulder and body, my left arm stayed tucked to my side and my open hand made first contact. This resulted in a compression fracture of my radius—the forearm bone that abuts the wrist bones. My poor tackling technique—and slight timidness—resulted in my injury. Besides debilitating muscle cramps, I was fortunate to never have another injury playing football.

Football may be in the spotlight regarding safety concerns, but many other sports and activities also have injury risks. In this post, we will discuss the following:

• Injury Risks in Life
• Most Recent Traumatic Injury in Pro Football
• Catastrophic Injuries over the Years
• Rule Changes to Decrease Injuries
• Traumatic Injuries in Extreme Sports
• Current Injury Rates in Contact Sports
• Benefits of Youth Sports

Injury Risks in Life

There is a risk for injury in just about everything we do. Sitting too long at work or school can lead to back or neck pain. Walking on the sidewalk can cause a missed step off the curb leading to a sprained ankle. Cooking in the kitchen can result in a burn from the stove, a cut finger from slicing vegetables, or even a concussion from hitting one’s head on an open cabinet door. Yes, I have seen this last one before.

Driving to work or school could also result in a motor vehicle accident that may cause a variety of injuries both mild and severe. In fact, the global rise in concussions and traumatic brain injuries has been contributed to the increased use of motor vehicles.¹

Although there are these risks, people do not avoid sitting at a desk, walking on the sidewalk, cooking in the kitchen, and driving a car. While some of these injuries are rare, others are more common. Some may be mild and others severe.

People weigh the risks and compare them to the benefits of doing the activity. Of course, sitting at a desk is important for one’s education or occupation, which leads to financial security either currently or in the future. Walking on the sidewalk is good exercise and can benefit physical and mental health. Cooking one’s own food is healthier and cheaper than ordering in or going to a restaurant. Plus, people need to eat!

The necessities of life’s activities and the benefits gained outweigh the injury risk associated with those activities. Sports inevitably come with risks as well. While sports are not considered necessary for life, there are many benefits of sports for which millions of young and old participate each year. For these people, the benefits outweigh the risks.

All sports have injury risk with some injuries being more severe than others. Football gets a bad rap due to the possibility of more severe injuries; however, these injuries are very rare. Also, some sports have a higher risk of severe injuries than football.

Most Recent Traumatic Injury in Pro Football

While football is already considered a dangerous game by many, an event early this year further shined light on the potential severe risks of playing football. On Monday Night Football, the Buffalo Bills’ safety, Damar Hamlin, was severely injured. After taking a shoulder to the chest while making a tackle, he stood up but then fell to the turf. He had stopped breathing. He needed fast medical attention, CPR, and defibrillation to resuscitate him.

Then, he was transferred to the University of Cincinnati Medical Hospital, which helped him in the initial recovery before going home to Buffalo. Although Hamlin did not return to football that season, he recovered well considering the condition he was in that Monday night.

Hamlin suffered an injury called commotio cordis.² When a strong blow to the heart occurs within the 15-30-millisecond window before the ventricles are about to contract, it leads to ventricular fibrillation.³ This is much more dangerous than atrial fibrillation causing heart arrhythmia. Ventricular fibrillation causes the heart to stop beating known as cardiac arrest.

Commotio cordis is very rare as there are typically thirty cases per year across the nation. It is even more rare in football as there have only been a handful of documented cases in youth and high school football. In fact, the injury is more likely to occur in baseball, softball, lacrosse, or hockey in which there is a direct blow to the chest from a fast-moving ball or puck.³ These high forces are not common in football especially directly to the chest that is often covered by shoulder pads to diminish the blow.

This recent example is one of the traumatic injuries that can occur in sports like football. Like commotio cordis, some can result in death.

Catastrophic Injuries over the Years

While traumatic injuries can still occur in football, the current game is much safer than it was over a century ago. Between 1900 and 1905, at least forty-five players died nationwide from injuries during college games.⁴ This is about eight players per year in a time when football was only played by a few colleges. In 1906, rule changes were implemented to make the game safer, and the Intercollegiate Athletic Association—later National Collegiate Athletic Association (NCAA)—was formed to govern these rules.

From 1945 to 1999, there were 497 fatalities among football players.⁵ This is nine players per year during a time when the sport was more popular with more participants. Most of the brain-related fatalities occurred between 1965 and 1969 when football helmets had minimal interior padding and players were permitted to slap, hit, and club others directly in the helmet.

From 1990 to 2010, another report showed only 12 fatalities per year among the most participants (over one million high school and thousands of college football players).⁶ Of the 243 deaths, there were twice as many from indirect causes like heart failure and heat illness than direct, blunt trauma like brain injury. Those dying from indirect causes would likely have had these problems in other sports.

For instance, sudden cardiac deaths occur more frequently in male basketball and soccer players than male football players.⁷ One in every 9,000 basketball players die each year from cardiac arrest compared with one in every 23,600 soccer players and 36,000 football players.

In comparison, there are over 40,000 fatalities due to a motor vehicle accident each year in the Untied States. According to the National Security Council, a lifetime risk of dying from a car accident is one in every 93 people.⁸ We don’t think twice about getting in a car to drive to work, so why should we worry about sports?

Rule Changes to Decrease Injuries

Over the years, the National Football League (NFL) has made many rule changes to decrease all types of injuries.⁹ The most notable ones are below:

• 1943- Helmets were made mandatory.
• 1955- The ball became dead immediately if the ball carrier touched the ground with any part of his body except hands or feet while in the grasp of an opponent.
• 1962- Grabbing any player’s face mask became prohibited.
• 1974- Goal posts were moved from the goal line to the end lines to prevent running into them. 
• 1977- To open up the passing game, defenders were permitted to make contact with eligible receivers only once. The head slap was abolished. Offensive linemen were prohibited from thrusting their hands to an opponent’s neck, face, or head.
• 1979- Players on the receiving team were prohibited from blocking below the waist during kickoffs, punts, and field-goal attempts.
• 1980- Further restrictions on contact in the area of the head, neck, and face: directly striking, swinging, or clubbing on the head, neck, or face became a personal foul.
• 2010- Defenseless players were given more protection by preventing blows to the head or neck by a launching opponent on a player who has just completed a catch. Defensive players were no longer allowed to rush directly over a long snapper.
• 2018- Lowering one’s head (except bracing for contact) and initiating contact with the helmet against an opponent became a personal foul pertaining to ALL players on ALL areas on the field. This was termed the Use of Helmet Rule. Kickoffs were modified in multiple ways including preventing ‘high-bouncing’ onside kicks. Touchbacks after a kickoff were moved from the 20- to 25-yard line to encourage touchbacks and prevent collisions on kickoff.

In addition to these rule changes, there have been more recent changes in high school football. These include limiting contact practices during the week, educating players and coaches about concussions and heat illness, pre-screening adolescents for heart abnormalities.

Traumatic Injuries in Extreme Sports

While football still involves traumatic injury risks, there are other less popular sports that are more dangerous. For instance, extreme sports pose great risks. These include airborne sports (Hang-gliding, kiting, parachuting), rock climbing and mountaineering, and skating (Skateboarding, Longboarding, In-line skating).

These extreme sports have all been shown to have increased rates of severe injuries when compared to contact sports such as hockey, football, and soccer.¹⁰ In fact, over an eleven-year period, skating activities were associated with the highest rate of loss of consciousness at scene (27.1%), the highest pre-hospital intubation rate (33.3%), and also the highest in-hospital mortality (15.2%), related to major head injuries.

Furthermore, winter sports like Alpine skiing, snowboarding, and sledding have high rates of traumatic injuries with skiing being more prevalent.¹¹ Equestrian sports can also cause many severe injuries with the most common being head injuries, spinal fractures, and facial fractures due to a fall from a horse or horse kick.¹² Although these sports and activities are less common in the general population, they still pose a higher risk of severe injuries for the participant.

Current Injury Rates in Contact Sports

When studying injuries across sports, the best studies utilize rates based on the number of exposures an athlete has experienced. Exposures are based on practices or competitions for each athlete. Because football has more players on a team, and often more participants in general, than any other sport, mathematically there will be a higher number of injures in football. This shows the importance of using a rating system.

One study compared injuries from 2008 to 2013 sustained in high school boys’ soccer, wrestling, football, ice hockey, and lacrosse. Football had the highest risk of injury and severe injury:¹³

• Football = 3.87 per 1000 athlete exposures
• Ice Hockey = 2.31
• Wrestling = 2.26
• Lacrosse = 2.19
• Soccer = 1.68

The most common injury site was the head/face for all sports except soccer, which was hip/leg. However, the time lost due to injury was highest among wrestling and ice hockey. This may mean that football players were able to recover from their injuries faster.

A severe injury was classified as over 21 days absence, medical disqualification, paralysis, or fatality. The rates for severe injury are below:¹³

• Football = 0.80 per 1000 athlete exposures
• Wrestling = 0.53
• Lacrosse = 0.49
• Ice Hockey = 0.45
• Soccer = 0.31

The most common severe injury site was the knee for all sports except hockey (shoulder). Lastly, football only had 0.27 times higher risk for concussion over ice hockey and 0.67 times over lacrosse; however, football had as high as 2.27- and 2.98-times higher risk of concussion over wrestling and soccer, respectively.¹³

This study shows that football does have higher injury rates than other high school contact sports, but they are not as drastic as many people believe. 

Benefits of Youth Sports

While there are risks of mild and severe injury in all sports, contact sports like football pose greater risks. Often, the benefits of youth sports, especially team sports, outweigh the risks of playing the sport.

Team sport participation influences all aspects of a child’s physical, mental, and social development.¹⁴ Adolescents who participate in organized sports are more likely to meet physical activity standards and excel in fitness tasks. Middle school and high school team sport participants report higher self-esteem, higher life satisfaction, and decreased psychological distress. Team sports especially improve social skills and leadership development.

Football is a team sport that can benefit many types of children. Because no specific skill is needed to succeed, children can choose positions on the field that best suit them. Football offers spots for all children to participate and have fun. Enjoyment will motivate them to continue playing leading to healthier children with strong development and prevent obesity.

Summary

In conclusion, football poses a risk for injury. Every activity in life comes with injury risks, but often the benefits of the activity outweighs the risks. Just as driving a car carries a risk of traumatic injury, playing contact sports also have these risks. At the same time, risks of traumatic injury are very rare in contact sports, especially when comparing them to extreme sports.

Severe injury risk of playing football may be slightly higher than other contact sports, but the discrepancy is not as high as many believe. The same is true for milder injuries as football does carry greater risk than these other sports like hockey, lacrosse, and soccer.

While football may have greater risks, it may provide more benefits by offering positions and playing time for all types of children to succeed.

References

1. Roozenbeek B, Maas AIR, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013; 9:231–6.
2. Quinn, TJ. A cardiologist’s view of what happened to Buffalo Bills safety Damar Hamlin. ESPN. January 4, 2023. Accessed March 12, 2023. 
3. Maron BJ, Link MS. Don’t Forget Commotio Cordis. Am J Cardiol. 2021;156:134-135.
4. Forgrave, Reid. Love, Zac. Algonquin Books of Chapel Hill; 2020.
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8. Odds of Dying – Preventable Deaths. National Security Council Injury Facts. Updated 2021. Accessed March 19, 2023. https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/
9. NFL Health and Safety Related Rules Changes since 2002. NFL Enterprises LLC. Updated 2020. Accessed February 2, 2022. https://www.nfl.com/playerhealthandsafety/equipment-and-innovation/rules-changes/nfl-health-and-safety-related-rules-changes-since-2002
10. Weber CD, Horst K, Nguyen AR, et al. Evaluation of severe and fatal injuries in extreme and contact sports: an international multicenter analysis. Arch Orthop Trauma Surg. 2018;138(7):963-970.
11. Weber CD, Horst K, Lefering R, et al. Major trauma in winter sports: an international trauma database analysis. Eur J Trauma Emerg Surg. 2016;42(6):741-747.
12. Weber CD, Nguyen AR, Lefering R, Hofman M, Hildebrand F, Pape HC. Blunt injuries related to equestrian sports: results from an international prospective trauma database analysis. Int Orthop. 2017;41(10):2105-2112.
13. Hammer E, Brooks MA, Hetzel S, Arakkal A, Comstock RD. Epidemiology of Injuries Sustained in Boys’ High School Contact and Collision Sports, 2008-2009 Through 2012-2013. Orthop J Sports Med. 2020;8(2):2325967120903699.
14. Zuckerman SL, Yengo-Kahn AM, Brett BL, Kuhn AW, Wolfson DI, Kerr ZY. Benefits of team sport participation versus concerns of chronic traumatic encephalopathy: prioritizing the health of our youth. Concussion. 2020;5(2):CNC75.