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In 2014, high school football adopted a targeting rule prohibiting players from initiating forceful contact above an opponent's shoulders. The goal was to reduce dangerous hits that could result in concussions or worse. Since then, to avoid penalties, football coaches and players have made a conscious effort to avoid contacting the head and neck when tackling. JABSOM students wanted to know if those safety changes were putting players' lower extremities at greater risk.
"We were just thinking as people are avoiding the head and neck, they're going to be tackling lower in the body, so maybe the injury burden might be getting shifted lower in the body," JABSOM student Nolan Tanji said.
Tanji and fellow JABSOM students Cameron Nishida, Philip Lee and Sasha Rovinsky's hypothesis was simple: if players were tackling lower, injuries to the lower extremities might increase.
After pouring through thousands of injuries, they concluded there was no increase in lower extremity injuries.
"It was really surprising," Tanji said. "It was something that was the complete 180 from what we were expecting before analyzing the data."
The research team analyzed high school football injuries involving athletes ages 14 to 18 using a national database containing emergency department data from more than 100 hospitals across the country. The study compared injuries from the five years before the targeting rule with the five years after it took effect.
"We went through every single entry, which was more than 14,000 entries," Tanji said. "Individually going through them and looking at how these injuries happened, what exactly happened during the tackle."
Tanji estimates that process took three or four months of nearly daily work.
The results showed 7,315 lower-extremity injury cases during the five years before the targeting rule and 5,611 during the five years afterward. When researchers used those cases to estimate national totals, the number dropped from about 242,000 injuries to 193,000.
The study's central finding was clear: lower-extremity injuries did not increase after the targeting rule took effect. There were some important details within the encouraging overall trend. Knee injuries represented a slightly larger share of lower-extremity injuries after the rule took effect, and the proportion involving collisions between players also increased. Nishida says those findings warrant additional study.
The researchers cannot say the targeting rule caused the overall decline in lower-extremity injuries. Other changes in football during the same period, including increased attention to training, injury prevention, and improvements in equipment technology, may have contributed.
The database also included only injuries treated in emergency departments, so it did not capture athletes treated at urgent care centers, doctors' offices, or elsewhere. Researchers also could not identify which positions the injured athletes played. Those limitations are important to the study authors, who stop short of calling football a safe sport.
"It's not completely safe," Tanji said, "but, you know, it's looking promising for the future in terms of injuries in football."
KHON recently featured the JABSOM student research. Watch the segment here: