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College football players were more likely to have concussions and head hits during practices and preseason training rather than regular season play, an observational study of National Collegiate Athletic Association (NCAA) Division I players showed.

In six NCAA teams across five pre-pandemic seasons, 72% of concussions and 67% of head impacts occurred during practices, according to Michael McCrea, PhD, of Medical College of Wisconsin in Milwaukee, and co-authors.

Roughly half of all concussions occurred during preseason training, even though preseason training represented just 21% of the whole season. Head impacts in preseason were twice the proportion of regular season head hits, they reported in .

"Our results suggest that targeted prevention strategies in football practice, in both the preseason and regular season, may yield the greatest overall effects toward reducing head impact exposure and concussion incidence without modification to football game play," McCrea said.

"The higher incidence of concussion in the preseason is likely due to several factors, including the total hours and intensity of training, heavy emphasis on full contact drills such as tackling and blocking, and the volume of participants in those activities," he told 木瓜直播.

"Over the course of the season, it's common for football teams to reduce the frequency of full contact drills, thereby also reducing head impact exposure and risk for concussion from full contact activities," he continued. "Still, the overall number of practices -- and the volume of players participating in those drills compared to games -- suggests that reducing full-contact activities in practice could do the greatest good in reducing incidence of head impact exposure and concussion throughout the full football season, not just the preseason."

While many sports have focused on rules, penalties, and equipment to prevent concussions and reduce head hits, "football has seen the greatest gains not by changing how the game is played, but how it is practiced," said Christopher Nowinski, PhD, and Robert Cantu, MD, both of the Concussion Legacy Foundation in Boston, in an .

In 2011, the National Football League (NFL) Players Association collectively bargained for severe contact limits in practice, with 14 full-contact practices allowed during the 17-week season. Since that rule was implemented, only have occurred in practice, the editorialists pointed out. Nearly 40 states now have in high school football.

"High school reforms have been driven by oversight from state athletic associations, state governments, advocates, and educators responsible for the health and safety of minors. In the NFL, reforms have been driven by the players, who can legally organize and collectively bargain," Nowinski and Cantu wrote.

"College football players exist in a regulatory no-man's land," they added. "They have no mechanism through which to organize, they are no longer minors, and they seem to exist outside the influence of professional educators."

The study looked at players from 2015 to 2019 in Division I NCAA football programs participating in the . A total of 658 players with an average age of 19 had helmets with Head Impact Telemetry (HIT) system sensors that measured head impact frequency, location, and magnitude.

Whether a player wore a sensor depended on his level of participation; starters were prioritized over reserves. Over five seasons, sensors recorded 528,684 head impacts, a median of 415 head hits per player per season.

Overall, 68 players had a diagnosed concussion; 48.5% occurred during preseason training (0.059 preseason vs 0.016 regular-season concussions per team per day; mean difference 0.042, 95% CI 0.020-0.060, P=0.001).

Preseason head hits were twice the proportion of regular season impacts (324.9 vs 162.4 impacts per team per day; mean difference 162.6, 95% CI 110.9-214.3, P<0.001). In every season, median head impact exposure was highest in August (146.0 impacts) and lowest in November (80.0 impacts).

Most concussions and head hits occurred during practices: over 5 years, players averaged 262.4 impacts during practices and 137.2 during games.

"As a former college football player and a former team physician, respectively, we find this situation inexcusable," Nowinski and Cantu wrote. "Concussions in games are inevitable, but concussions in practice are preventable. Practices are controlled situations where coaches have almost complete authority over the head impact exposure risks taken by players."

Nowinski and Cantu were especially harsh in their evaluation of the NCAA's efforts to limit concussions. "After an NCAA football player died of a brain injury that occurred in practice, NCAA lawyers' defense to the surviving family's lawsuit was, 'the NCAA denies that it has a legal duty to protect student-athletes,'" the editorialists wrote. And this was from an organization, they noted, .

The findings have significant policy implications, they added. While the advocates reform and issues guidelines, "guidelines are not rules," the editorialists emphasized. "Laudably, McCrea and co-authors call on the NCAA and football conferences to explore policy and rule changes to reduce concussion incidence and head impact exposure and to create robust educational offerings to encourage change from coaches and college administrators."

The HIT system is the most widely used, validated device for measuring head impacts in football, but potential for error exists, McCrea and colleagues noted. The research had other limitations, they added: it did not use live or video surveillance to verify impacts, and not all rostered players wore sensors. The study included only Division I NCAA players; concussion and head impact patterns may be different for other groups.

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