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Concussion Rates in Football, Hockey and Lacrosse Rising

Result of increased awareness, more honest self-reporting?

Football still has the highest number of concussions and concussion rate at the high school level, but concussions are common in boys' hockey, boys' lacrosse and wrestling, and also occur frequently in boys' and girls' soccer and basketball, and girls' lacrosse and field hockey.



Schultz 20041

(converted to per 1000 AE)

Gessel 20071 

Injury Rate (per 1000 AE)

Lincoln 20112

Concussion Rate (per 1,000 AE)

Meehan 20113

Concussion Rate per 1,000 AE)

Boys' Baseball  0.11  0.05  0.06  0.04
Softball  0.10  0.07  0.11  0.16
Boys' Basketball
 0.10  0.07  0.10  0.22
Girls' Basketball
 0.17  0.21  0.16  0.18
Boys' Soccer
 0.23  0.22  0.17  0.19
Girls' Soccer
 0.13  0.36  0.35  0.33
Football  0.33  0.47  0.60  0.76
Field Hockey
 NR  NR  0.10  0.24
Boys' Ice Hockey
 NR  NR  NR  0.62
Girl's Volleyball  NR  0.05  NR  0.08
Boys' Wrestling  0.09  0.18  0.17  0.23
Boy's Lacrosse
 NR  NR  0.30  0.46
Girl's Lacrosse
 NR  NR  0.20  0.31
Cheerleading  NR  NR  0.06  0.11
All boys
 NR  NR  0.34  NR
All girls
 NR  NR  0.13  NR
All athletes
 NR  NR  0.24  NR

The 2011 Lincoln study2 of injuries in high school sports over an 11 year period from 1997 to 2008 found that:

  • The overall (12-sport) concussion rate increased from 0.12 per 1000 AEs (Athletic exposure = one athlete's participation in a practice or competition) in 1998 to 0.49 per 1000 AEs in 2008;
  • Girls had a higher rate of concussion than boys in those sports (soccer, basketball, baseball/softball) where the boys' and girls' games are essentially the same.  While the reasons for the increased rate remain unclear, a possible bias towards increased reporting of concussion in females continues a likely factor;
  • While the concussion rate in cheerleading was relatively low (0.06), the low rate was heavily influenced by the large number of athletic exposures (games and practices) and the fact that participation spans both multiple sports seasons during an academic year. From a frequency perspective, the sport had the second highest number of concussions over the study period, making the implementation of prevention strategies critical;
  • While rates for all 6 boys' sports, whether helmeted or not, increased over time, rates for helmeted sports (football, boys lacrosse, baseball) were nearly twice those of non-helmeted sports.  Such findings were, the researchers noted, consistent with previous studies reporting that use of protective equipment does not have a conclusive effect on concussion risk in high-impact helmeted sports and that protection from concussion requires a multifaceted approach to injury prevention.

The 2011 Meehan study3 of concussion rates at U.S. high schools, looking only at data for the 2009-2010 school year, found that:

  • As expected, rates of concussion per AE were highest for collision sports, such as football, boys' ice hockey, and boys' lacrosse.
  • Most of the concussions recorded were sustained by football players (47.2%).
  • Concussions accounted for a higher percentage  of total injuries in boys' ice hockey (24.2%) than any other sport.
  • The upward trend in the concussion rate for football "may result from the increased attention focused on concusssions in football." [Note: the 57% increase in emergency department visits for traumatic brain injury between 2001 and 2009 recently reported by the Centers for Disease Control and Prevention has also been attributed to such increased awareness]. 
  • While the concussion rate in girls' soccer (.33 per 1,000 AEs) was higher than in boys' soccer (.19 per 1,000 AEs), the concussion rate in boys' basketball (.22) was slightly higher than the rate in girls' basketball (.19, a sharp departure from the numbers reported in the Lincoln study (.10 versus .16), although the study found that female athletes' symptoms of concussion were more likely to take longer than 7 days to clear than those of male athletes.  

For the most comprehensive and up-to-date concussion center on the Internet, click here.

1.Kevin Guskiewicz, PhD, ATC, "Preventing Sudden Death in Sport: Head Injury Considerations." NATA Annual Meeting, Philadelphia, PA (June 24, 2010).

2. Lincoln A, Caswell S, Almquist J, Dunn R, Norris J, Hinton R. "Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study" Am. J. Sports Med. 30(10) (2011), accessed January 31, 2011 @ http://ajs.sagepub.com/content/early/2011/01/29/0363546510392326.full.pdf+html  

3.  Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).

Editor's Note: Concussion rates in the Lincoln study (note 2) were reported for an 11-year period (1997-2008) at 25 high schools in Fairfax County, Virginia where, through 2005, each high school employed 2 part-time certified athletic trainers, and, after 2005, each school had 1 full-time certified athletic trainer (AT) and 1 part-time.  This access to a trained professional, and expanded access after 2005, was believed by the study's authors to have "substantially increased the likelihood that concussion was recognized and treated."   Only 42% of U.S. high schools have access to a certified athletic trainer.  Concussion rates in the Meehan study (note 3) were for the 2009-2010 school year for U.S. high schools that had at least one athletic trainer. As a result, the authors cautioned against "generalizing [their] findings to high schools that do not employ ATs."  For more on the important role athletic trainers play in concussion evaluation and assessment and the critical return to play decision, click here.

Posted March 14, 2011; revised and updated October 10, 2011