Data Driven Policy: Does Limiting Practice Time Reduce Injuries?

The California Interscholastic Federation (CIF) is the governing body for all high school sports in the state.  Every state has their own version of CIF, established to maintain oversight while “promoting equity, quality, character and academic development”.  The National Federation of High Schools (NFHS) maintains governance on national level for all high school sports.

Lately, concerns for athlete safety, particularly concussions, has compelled state athletic associations to develop policy aimed at reducing injuries.  One recent example, CIF Bylaw 506, limits practice hours for a single team to 18/week and 4/day.  Further, “Double day practices shall not be held on consecutive days” and “Must include a minimum of three (3) hours rest in between practices”.

These efforts mirror NFL policy on the number of contact practices allowed over a season.  A recently enacted California law (AB 2127) limits high school football teams to a maximum of two full-contact practices in a single week.  This bill takes effect for 2015 football season, but many schools have begun adopting its intent this year.

Developing and implementing policy reform is a challenging process, particularly when the science and the data are deficient.  We have seen all 50 states pass head-injury legislation over the past 5 years, but how do we know which laws serve their intended purpose, protecting our young athletes?  How can we monitor the effectiveness of these policies… and perhaps reform the reforms as quality injury data is gathered?

If you’ve read our blog, you know our cause, making informed, data-driven decisions using the latest information on athletic injuries.  In that effort, we decided to examine the effect of CIF’s recent policy update.  From a random sample of 13 California high schools, we compared football injury rates for the month of August 2013 to August 2014.

While the numbers of sprains and strains were unchanged, InjureFree’s data shows a 50% reduction of the total number of head injuries.  Without knowing specifics of which schools have pre-emptively reduced full contact practices, we assume that any reduction of practice hours has the potential to reduce head injuries.  And while clearly other variables at play, such as player fatigue, concussion education, improved coaching models and so on, what is ultimately clear at this stage is the need for more robust sampling data.

These results lead to more focused questions, and that’s a big step in the right direction.  It’s these very questions, and the process of evaluating solutions to them that’ll lead to a deeper understanding of each school’s safety environment.  This type of evaluation should be an integral part of sports safety protocol, from NFHS to state athletic associations to individual school athletic departments, as a way to accelerate and improve children’s safety.

In the case of CIF, the recent policy changes have shown a positive impact on the number of head injuries sustained at 13 of the state’s football teams.  Whether these results are coincidental, time and further data will reveal, but the preliminary outcomes support the decision to pass AB 2172.

Now, if California can just pass AB 1890 and no longer be the last state in the NATION not recognizing athletic trainers as “licensed health care providers,” we’ll really be creating safer playing environments for our kids.

The Impact Of Helmets: A Case Study

No hiding it: Concussions and their long-term effects are in the spotlight. Although they’ve been
a concern for sport’s governing bodies since 1933, with the high profile NFL settlement and today’s sue-first culture… the topic can no longer be disregarded.

We’re learning more everyday about the effects of the injury on the brain, including Chronic Traumatic Encephalopathy (CTE), but there’s still much work to be done.  The complexity of the human brain is one of science’s final frontiers.  So we find ourselves engaged in great debate, as science slowly discovers new details, where parents and caregivers are demanding new strategies and safeguards.

In just five years all 50 states passed legislation regarding head injuries, making it one of the fastest adopted policies in US history. Not since the institution of seat belt laws has public safety been so uniformly agreed upon.  This legislation has set guidelines for administrators to create safer environments, but is often unfunded and leaves out implementation details.

In addition to state and federal policy, we continue to educate athletes about the latest, most effective practices for lowering concussion risk, targeting the millions of children playing contact sports each year.

Naturally, there are many questions and much uncertainty over what ultimately influences concussion rates.   Is it tackling technique?  Is neck strength a culprit?  Is age a factor?  Do helmet types make a difference?

On this last question we have some clarity.  Helmets do nothing to prevent concussions. Moreover, they can actually be the cause of head injuries!  An improperly fit helmet increases the risk for concussions.  Think about how ineffective and dangerous cleats would be if they weren’t laced.  It’s the same concept for helmet fitting.

In a case study performed at a single high school, an athletic trainer (using the InjureFree reporting platform) recorded injuries within the freshman, junior varsity and varsity football teams.  During the first three weeks of practice, eight (8) concussions were reported, within a population of 150 athletes, drawing the attention of team administrators.

Using collected data, it was identified that all eight concussions were sustained using parent-bought helmets, rather than school-issued. While the public school district supplied all necessary equipment, parents were given the choice to purchase their own helmets; similar to most schools throughout the US.  This discovery provided valuable information to district officials who feared possible lawsuits. 

The summer preceding this case, the death of NFL Hall of Famer Junior Seau, who suffered CTE as a result of repeated head trauma, and the media’s focus on his condition, caused parents to react by purchasing “top-rated” football helmets for their children.  While these proactive attempts to protect children are commendable, in this case the sporting goods store helmets were not properly fitted.  There are no policies requiring salespeople to be trained to properly fit helmets, so these eight students ended up playing with poorly sized equipment.

After identifying a potential catalyst for concussion “epidemic”, an email alert was triggered by InjureFree to the parents of football players notifying them to “see the athletic trainer if your son is not using a school issued helmet,” and fitting adjustments were made.  During the remaining 12 weeks of the football season only two concussions were reported, both during game play.

This case study is a terrific reminder for all athletes to check for proper fitting of equipment every time they suit up.  We don’t drive on flat tires and we don’t fly with icy airplane wings.  So why would be we allow athletes to play without ensuring all protective equipment is working properly?

Athletic Trainers For Everyone!

It's a fact:  Having an athletic trainer at athletic practices and games improves the medical care athletes receive.

While our InjureFree software is currently gathering statistical data to support this concept, let’s discuss the empirical evidence.

#1 - ATs are considered health care providers.  Similar to a school nurse, ATs are educated and trained to identify and treat athletic related injuries.  The medical field created this profession to specifically address athletic injuries, it makes sense putting them to work. Neither coaches, nor parents, nor officials are sufficiently qualified.

#2 - Certified ATs, or ATCs, need to complete continuing education credits to maintain their credential.   They are continually studying the latest methods, policies and technologies for athletic injury management.  In an environment of part-time coaches, parent volunteers, and per diem officials, ATs are uniquely suited to manage a huge range of injury care issues, from on-field assessment/treatment, to state and federal regulatory compliance, to overall risk management coordination.

#3 - ATs are teachers too.  While coaches help athletes improve their athletic skills, ATs help athletes learn about their bodies and proper maintenance of these incredible machines, lessons that prevent injury and allow informed participation.  For young athletes, accessing the right information and applying it correctly is an important part of the developmental process.

So how do teams pay for this vital service?

While a full-time high school AT costs $35,000 - $60,000/yr, hourly rates can be as low as $25/hr.  Services like ATvantage provide athletic trainers to high schools and youth sports teams for season long coverage for $8,000 - $15,000.

Consider this.  A youth football season (including 10 hr/wk practice, 8 hr Saturday game coverage, over 14 weeks) would require ~250 hrs of AT service.  At $50/hr… coverage would cost $12,500.  If a youth football club has 500 athletes, that’s $25 per player.  Less than a single doctor’s office copay!  

So how do you approach administrators to make your pitch?

In addition to what we’ve discussed, when proposing to increase spending, it helps having numbers to inform decisions and support necessary changes.  Take a look at the graphic below.

The infographic displays statistics collected during a case study completed within a single 2,200 student high school.  Using our InjureFree web-based software, 80 athletic related injuries were reported by the athletic trainer during the entire school year.  Of those 80 injuries, 27 required additional medical services.  When national averages (for medical services) were applied, the resulting price tag was $102,950.

Who paid that bill?  

The parents of the student athletes, the family’s insurance providers, and the school's insurance policy.  Since this was a public school, local taxpayers contributed as well.

The school in this case study employed an athletic trainer.   Imagine the bill had athletes visited doctors instead of the AT.  If parents aren't convinced an athletic trainer is a sound investment, check back in a few months and we'll have a statistical comparison of injury rates for teams with and without an AT.