January 23, 2017 • FootballSports Medicine & Nutrition

Reducing the risk of football injuries, including concussions

Millions of youths and adolescent athletes participate in various levels of amateur sports each year in the United States with thousands more playing at intercollegiate levels. Despite increasing media attention and the best efforts of media and training staffs, injuries are still occurring at high rates, especially in collision sports such as football.

Injuries are considered an inevitable part of the game, but staff at The Micheli Center for Sports Injury Prevention (Massachusetts) are making strides to change mentality and approach through community education and individualized training. Located on the Waltham campus of Boston Children’s Hospital, The Micheli Center applies the latest evidence-based research in an effort to lower the risk of injuries across all sports and fitness activities, including football.


Football is a violent game with the highest rates of concussions across organized sports, despite ever increasing numbers of media reports and regulatory changes from youth leagues all the way to the NFL. Disrupting the normal function of the brain, concussions cannot be seen on a MRI or X-ray, but they remain extremely disruptive to an individual’s athletic and academic performance.

Several risk factors have been associated with suffering a concussion, including having previous concussion history, age, game versus practices, athletic environment, level of play and body mass index. Newer research suggests that modifiable factors such as neck strength, reaction time, peripheral vision and core strength also may play a role in concussion risk.

With so many factors playing a role in concussions, prevention must be multi-factorial as well. Proper equipment fitting is paramount in football because of the negative effects of oversized and undersized helmets. For example, if the helmet is too large in terms of mass or has an inappropriate sized facemask, this greatly increases the required strength for the neck and upper back to resist damaging forces.

Exercise training can also have a profound effect on concussion risk. To know what exercises to begin with, basic range of motion and strength measurements for the neck and upper back muscles should be taken. Exercises should start with isometric strengthening and progress to include dynamic strengthening movements when appropriate.

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Concussions in football happen through dynamic movements, whether because of direct contact with another player, contact with the ground or object, or whiplash motion without any contact to the head. Baseline objective measurements need to include core strength, reaction time and peripheral vision to get a clearer picture of what that individual needs.

Exercise programs should incorporate all aspects, without taking up too much time. For instance, an individual could perform isometric neck strengthening, single leg balance, front and side planks, single leg bridges, resisted lateral walks, reaction time drills, and peripheral vision training within a 30-minute session. Hitting all of these points of emphasis could significantly decrease the risk of concussion.

ACL injuries

ACL injuries are not as common in football when compared to other sports, but far too many athletes still suffer this injury. Typically described as preventing forward movement of the shin bone in relation to the thigh, the ACL also plays a significant role in preventing rotational forces, which is why so many football players injure their ACL without contact while cutting or pivoting. ACL injuries are more preventable, but it takes an appropriate injury prevention program.

Many studies describe ACL injury prevention programs, and additional research will shed more light on effective practices. The best programs emphasize key musculature, which includes strength development of the hamstrings, hips, core and an increase in overall flexibility. Some research suggests narrowing the gap between hamstring strength to quadriceps strength, known as the hamstring:quadriceps ratio. Athletes who can achieve a ratio of 0.60 or higher are said to reduce their overall risk of ACL injury, specifically non-contact.

The hamstring muscles work in conjunction with the quadriceps muscles to provide enhanced stability to the knee joint and lessen the stress on the ligaments. Additionally, adding in plyometric and balance training can positively enhance an athlete’s neuromuscular control (i.e. the overall ability for muscles to automatically provide joint stability) without the athlete having to think about it.

Ankle sprains

Ankle sprains remain one of the most common injuries in all sports. These injuries usually occur when the ankle twists inward, stretching the ligaments on the outside part of the ankle, leading to significant swelling and inability to continue playing. It’s relatively easy to decrease risk of an ankle sprain, compared to concussions or ACL injuries.

The easiest way to lower your risk of ankle sprains is to wear a well-fitting ankle brace. These braces range from very rigid to sleeves, but lace-up versions have the benefit of adjustment during play to desired tightness. Rigid ankle braces can be even more effective but many athletes complain about it limiting motion, even though many studies have shown this not to be the case.

Exercises can be a very effective means to decrease ankle sprain risk, with an emphasis on balance and strengthening the peroneal muscles of the lower leg and ankle. These muscles turn the foot outwards. That resists inward motion and limits the amount of force absorbed by the ligaments.

Single leg balance exercises starting on flat ground and progressing to unstable surfaces train these muscles reflexively, being more functional to the athlete long-term. Peripheral and reaction training drills again can help athletes prepare for game situations, allowing them to adjust and not have their ankle end up in a compromising position.

Despite the vast number of injuries, football remains extremely popular with many benefits. With proper injury prevention exercises and guidance, teams and individuals can maximize their ability to stay on the field and limit the risk of injuries.

Corey Dawkins is the practice administration manager at The Micheli Center for Sports Injury Prevention in Massachusetts. Learn more at www.themichelicenter.com.

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