Safety Decisions in High School Football: Helmets & Funding

Introduction and Background

This paper focuses on one aspect of high school football safety: the issue of higher levels of injury being associated with particular brands of football helmets worn by high school athletes, and the institutional decisions and actions that follow the disclosure of such information. A recent study by Virginia Tech rated helmets worn by professional football players; helmets worn by high school students have not yet been rated by the university. The study compared helmets manufactured by three companies. High ratings were given to the Riddell Speed, the Riddell Revolution, the Riddell Revolution IA, the Schutt Ion 4D, the Schutt DNA, and the Xenith X1. Medium ratings were given to the Schutt Air XP and the Schutt Air Advantage. Players were warned by Virginia Tech not to wear the Riddell VSR4 or the Adams A2000. Notably, no correlation exists between safety and the price of a helmet: the Adams A2000 is the lowest-rated helmet, yet it costs $200, while the four-star-rated Schutt DNA costs $170.

It is important to note that the Riddell VSR4 — the second-lowest-rated helmet — was the most commonly worn helmet in NFL games last season, and is also worn by college and high school football players. The industry and institutions have been reluctant to issue mandates about which helmets their players must wear. Apparently, the NFL has received legal advice that disclosing information about helmets without mandating a particular brand or type reduces their legal risk. With sports broadcasters enthusiastically drawing attention to helmet-to-helmet contact, referees ignoring unnecessary roughness, football practice left largely unregulated, ill-advised coaches demanding nutcracker drills and other cumulatively dangerous training approaches, and pro football players wearing the least safe helmets, young football athletes are exposed to cultural pressure and branding messages that can result in unsafe decisions (Gerberich, 1983; Saunders & Harbaugh, 1984).

Further, academic budgets have been reduced across the nation in response to the residual effects of the 2009 fiscal crisis, and cuts to athletic programs are typically among the first to be implemented. Athletics are highly popular, but also inordinately expensive. Educational institutions are under considerable pressure to make budget cuts in areas believed not to negatively impact students' academic attainment or institutional accreditation.

A diminished sports budget is bound to have some impact on sports activities at an affected institution. The condition of equipment used by student athletes can deteriorate if there is insufficient money for repair or replacement. Coaching staff may not be of high caliber if there is insufficient money to pay for their services. Practice sessions may not be well supervised, or student athletes may be encouraged to perform above their capacity or in ways that are not considered safe (Pollock, 1977). Disincentives may also discourage certified athletic trainers from reporting issues related to under-training, over-training, or pressure to perform (DiScala, 1997; "Excessive physical training," 1991).

The manner and degree to which budget cuts to high school football affect player safety is of fundamental interest in this study. While the research is intended to explore the purchase and maintenance decisions regarding football helmets provided to high school athletes following disclosure of preferred brands and types, the study is also designed to examine the degree to which cultural and traditional forces influence these decisions.

Theoretical Framework and Sports Safety Research

This research is grounded in post-positivist theory, in which science is perceived as a socio-cultural activity as well as a technical (empirical) endeavor. It is, in fact, the socio-cultural context that gives meaning to scientific findings. Any scientific accounts purported to undergird findings related to sports safety research — as presented in this paper — must be understood as explanations put forth by a specific community of scientists situated in a particular place and time.

From the post-positivist position, the theoretical framework can be seen as pragmatism, which represents the ultimate scientific position for linking theory and practice. The approach goes beyond explanation to the application of that explanation in practice. This is fundamentally the reason for conducting research in sports safety: it is not knowledge for knowledge's sake that the researcher pursues, but rather the direct application of research to practice. The purpose of the research is to determine what "safety" in football means and looks like, and then to apply that understanding to the actual practice and playing of the game.

From these definitions of the theoretical framework, the reader is encouraged to review the various official agencies and research bodies charged with constructing the body of knowledge regarding safety in sport, as presented below.

Sports Safety Record-Keeping and Research

Football injuries can cause debilitating harm and are costly to individual players, football teams, and the institutions that host games. Considerable research has been dedicated to sports safety and the incidence of sports injuries, but coordination of the many efforts has been difficult. Unlike the record-keeping that occurs for pandemic health issues or the sophisticated tracking carried out by the Centers for Disease Control and Prevention, information about football injuries at the level of educational institutions tends to be somewhat isolated.

"Not surprisingly, the rising prevalence and expense of sport and exercise injuries have increased the public's attention toward sports injuries. For example, the Centers for Disease Control included sports injuries as an area of focus in its most recent Injury Research Agenda" (Datalys Center, 2011).

Epidemiology and Biostatistics

The advent of digital medical record-keeping has made it possible to collect and analyze information that would once have lain dormant in obscure medical files. At sports medicine clinics associated with universities engaged in medical research and having established teaching hospitals, medical records scrubbed of individual identifying information are being added to immense databases for analysis. The ability to use electronic record-keeping for tracking the causes of injuries and patient outcomes is beginning to reach local levels, as physicians invest in the infrastructure for electronic medical and health care records.

Data Mining and Data Integration

As the digital infrastructure expands and electronic record-keeping becomes more commonplace, the possibility of integrating disparate databases becomes a feasible option. Institutions of higher education and secondary education generally have well-developed technology infrastructures. Through data mining techniques, it has become possible to collect and analyze information from a wide range of sources. A number of organizations now exist to keep records and conduct research on sports safety, as discussed below.

National Operating Committee on Standards for Athletic Equipment

The mission of the National Operating Committee on Standards for Athletic Equipment (NOCSAE) is to commission research that informs the establishment of standards for athletic equipment, and, where possible, to establish those standards. The Committee promotes dissemination of information on research findings related to athletic equipment, injury data, and other associated areas of inquiry. To this end, the Committee collaborates with organizations represented on the NOCSAE Board of Directors and with other entities in the disciplines of sports medicine and athletic medicine.

National High School Sports-Related Injury Surveillance Study

The High School RIO is an internet-based data collection system used in the National High School Sports-Related Injury Surveillance Study, which follows a national sample of U.S. high school athletes. It is currently the only surveillance study of all time-loss injuries within that sample. The study began in the 2005–2006 academic year and has been maintained ever since. It is a high school version of the National Collegiate Athletic Association (NCAA) Injury Surveillance System. Refinements have been made over the years with input from the high school sports community, which includes student athletes, their parents, high school athletic directors, local and state athletic associations and administrators, the National Federation of State High School Associations (NFHS), and pediatric sports medicine clinicians.

National Collegiate Athletic Association Injury Surveillance System

The NCAA Injury Surveillance System offers a program of free participation, training, and system support. The program creates permanent electronic athletic training records, maintains coaches' records, creates individual and team injury reports for insurance purposes, and serves as a resource for decision-making at the school, conference, and Association levels. The database permits customized reports, enabling researchers to compare injury trends across academic years, examine changes in coaching staff, or compare school data to divisional and national trends. Reports can also quantify treatment plans and treatment modalities across different sports programs or schools by sport.

Datalys Center for Sports Injury Research and Prevention

Researchers, sports associations, and the sports medicine community require complete and reliable information about the incidence and outcomes of sports injuries in order to develop more effective prevention and treatment strategies. Complete and reliable data is the foundation for evidence-based programs, rules, education, and policies. The goal is to prevent, mitigate, and treat exercise and sports injuries. The Datalys Center for Sports Injury Research and Prevention translates that information into better prevention outcomes and improved public health and sports medicine practice.

Literature Review

The literature in the area of sports safety tends to take the form of reports-of-injury (ROI) databases and associated reports from formal agencies and organizations. Interest in recreation, exercise, and sports is increasing in the United States, and accordingly, related injuries are also on the rise. Football injuries can cause debilitating harm and are costly to individual players, teams, and hosting institutions. Considerable research has been dedicated to sports safety and the incidence of sports injuries, but coordination of the many efforts has been difficult.

• Children younger than 15 who participate in 29 sports sustain injuries costing more than $49 billion each year (Consumer Products Safety Commission).
• Each year in U.S. school settings, there are approximately 715,000 recreation and sports injuries (CDC Injury Research Agenda).
• High school athletes account for an estimated 500,000 physician visits, 30,000 hospital stays, and 2 million injuries per year (MMWR Weekly).
• 3.65 million emergency room visits each year (1 in 5 visits) result from sports, recreation, or exercise participation (CDC Injury Research Agenda).

Unlike the record-keeping that occurs for pandemic health issues or the sophisticated tracking carried out by the CDC, information about football injuries at the level of educational institutions tends to be somewhat isolated. Under the best of circumstances, sports injuries are increasing. But what happens when the overall environment in which high school sports are played deteriorates — particularly due to a reduction in athletic program budgets? High school football has one of the highest rates of injury of all sports available to secondary students.

Protective gear and equipment is essential to the safety of football players, perhaps especially for secondary students who are young and vulnerable due to their immature brains and a sense of immortality that often leads young people to take inordinate risks. The condition of equipment can deteriorate if there is insufficient money for repair or replacement. When athletic programs experience budget reductions, there is likely to be less money to recruit the highest caliber coaches and certified athletic trainers. Coaching staff may not be focused on the safety of their teams if they are part-time employees or if compensation is too low. Unless football coaches are considered professionals and hired on that basis, they may compromise their team's safety in order to please the school board or parents of student players. If a football coach feels vulnerable to outside forces, they may succumb to the pressure of too many competing objectives. If a coach is too heavily focused on reputation or team standing, practice sessions may not be well supervised and student athletes may be encouraged to perform above their capacity or in ways that are not regarded as safe.

The coach is not alone in this dilemma. Disincentives may discourage certified athletic trainers from reporting issues related to under-training, over-training, or pressure to perform. A certified athletic trainer may be considered a luxury by some secondary schools. In order to protect their position, a certified athletic trainer may feel compelled to demonstrate worth and contribute value to the team in ways that create a chilling effect — discouraging any damper on the gung-ho attitude of coaches who are also hired to generate results. This dynamic is difficult to overcome.

There is a considerable body of data in the literature to substantiate that sports played under certain conditions can result in an increase in the incidence of injuries. The National Center for Catastrophic Sport Injury Research collects and disseminates data on death and permanent disability sports injuries involving the brain and/or spinal cord. Since 1965, this research has been conducted at the University of North Carolina at Chapel Hill. Three annual reports are compiled and made available each year. While the incidence of catastrophic injuries is low on a per-100,000-player basis, the rate of incomplete neurological recovery was 0.39 for every 100,000 participants. Tackling has been associated with 67.8% of catastrophic injuries since 1977. In the 2010 football season, one injury was caused by tackling, two by being tackled, three by tackling on a kick-off, and one during a tackling drill. The researchers at the National Center have expressed that they are not confident in the number of injuries reported with full recovery, and that data collection in 2007, 2008, and 2009 produced the highest number of catastrophic recovery injuries since the study began in 1977. A combined total of incomplete recovery cervical cord and cerebral injuries reaches 459, an average of 13.5 injuries per year over the past 34 years. The rate of incomplete neurological recovery at the college level was 2.66 per 100,000 players, compared with 0.33 per 100,000 for high school and junior high school football. Most catastrophic spinal cord injuries occur in games — in the 2010 season, two such injuries took place in practice while five occurred in games, indicating that football is played more intensely at the game level, particularly at the collegiate level.

The Annual Survey of Catastrophic Football Injuries, for the period from 1977 through 2010, describes the reporting process as follows. Information about a possible catastrophic football injury serves as a catalyst for contact with the player's coach, physician, and athletic director. That contact may be made by telephone, personal letter, or questionnaire. The questionnaire collects demographic data (age, height, weight) and background data (previous injury, accident information, immediate and post-accident treatment, and equipment information) related to the injury. During the 2010 football season, a total of seven cervical cord injuries with incomplete neurological recovery occurred: two at the college level and five at the high school level. In 2009, there were 14 such injuries. In 2010, 13 additional injuries involved the neck or head, but those athletes experienced full neurological recovery. In addition, three cervical vertebrae fractures, three brain injuries, and one lumbar vertebra fracture were associated with high school football athletes. The data show that a majority of catastrophic injuries occur while athletes are playing defensive football. Since 1977, permanent cervical cord injuries were sustained by 221 players on the defensive side of the ball and 52 on the offensive side (41 injuries were not associated with a specific side of the ball). By position, the breakdown was: defensive backs (35.0%), kick-off team members (9.6%), and linebackers (9.2%).

Although many studies are being carried out — including longitudinal designs — there does not appear to be any particular focus on budget and expenditures on equipment, gear, and coaching talent. Furthermore, this author is not aware of any systematic effort to ensure that football coaches and athletic directors are not caught in multiple, competing goals that can compromise their duty to student athlete safety. The role of the certified athletic trainer could be crucial in reducing the incidence of injury. A case in point is evidenced by data on tackling techniques. Coaches report that their players are taught to tackle with their heads up, but most players appear to lower their heads before making contact. Of players injured while tackling, 19.6% had their heads in a down position — chins on their chests — making contact with the crown of the helmet. Ball carriers are also being injured when their heads are in a down position at the point of being tackled. Coaches must stress head-up tackling, blocking, and ball carrying during both practice and play. The data indicate that many coaches train ball carriers to lower their heads before being tackled and to run over the tackler, but this practice is dangerous and can cause cervical spine and brain injuries with incomplete recovery. Nearly 10% of catastrophic cervical cord injuries result from being tackled. This study is intended to determine whether these issues are related to the financial support a high school team receives, and whether greater professional independence on the part of certified athletic trainers, coaches, or athletic administrators can reduce the tendency to put young football players at risk.