Skip to main content
Top
Published in: Sports Medicine 10/2019

01-10-2019 | Traumatic Brain Injuries | Systematic Review

Frequency and Magnitude of Game-Related Head Impacts in Male Contact Sports Athletes: A Systematic Review and Meta-Analysis

Authors: Jack V. K. Nguyen, James H. Brennan, Biswadev Mitra, Catherine Willmott

Published in: Sports Medicine | Issue 10/2019

Login to get access

Abstract

Background

Sensor devices have enabled estimations of head impact kinematics across contact sports.

Objectives

To quantitatively report the magnitude (linear and rotational acceleration) and frequency of game-related head impacts recorded in male contact sports athletes.

Methods

A systematic review was conducted in June 2017. Inclusion criteria were English-language in vivo studies published after 1990 with a study population of male athletes aged ≥ 16 years, in any sport, where athletes were instrumented with an accelerometer device for measuring head impacts. Study populations were not limited to players with a clinical diagnosis of concussion.

Results

Twenty-one studies met the inclusion criteria with 12 conducted on American Football athletes. Six of these studies were included for meta-analysis. At a threshold of 10g, amateur rugby players sustained the most impacts per player per game (mean = 77, SD = 42), followed by amateur Australian Football (mean = 29, SD = 37) and collegiate lacrosse athletes (mean = 11.5, SD = 3.6). At thresholds of greater than 14.4g, high school American Football athletes sustained between 19 (SD = 19.1) and 24.4 (SD = 22.4) impacts per player per game. Statistically significant heterogeneity was observed among the included studies, and meta-analysis of impact magnitude was limited.

Conclusions

The frequency of “head acceleration events” was quantified and demonstrated substantial variation in methodology and reporting of results. Future research with standardised reporting of head impacts and inclusion of non-helmeted sports is warranted to enable more robust comparisons across sports.

Prospero ID

CRD42017070065.
Appendix
Available only for authorised users
Literature
1.
go back to reference Beck A, Kerr J. The epidemiology of sports head injuries in a rural population. Br J Sports Med. 2011;45(15):A20.CrossRef Beck A, Kerr J. The epidemiology of sports head injuries in a rural population. Br J Sports Med. 2011;45(15):A20.CrossRef
2.
go back to reference Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, et al. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17(6):591–6.CrossRefPubMed Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, et al. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17(6):591–6.CrossRefPubMed
3.
go back to reference Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed
4.
go back to reference Meier TB, Brummel BJ, Singh R, Nerio CJ, Polanski DW, Bellgowan PS. The underreporting of self-reported symptoms following sports-related concussion. J Sci Med Sport. 2015;18(5):507–11.CrossRefPubMed Meier TB, Brummel BJ, Singh R, Nerio CJ, Polanski DW, Bellgowan PS. The underreporting of self-reported symptoms following sports-related concussion. J Sci Med Sport. 2015;18(5):507–11.CrossRefPubMed
5.
go back to reference McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.PubMed McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.PubMed
7.
go back to reference Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th edition (SCAT5). Br J Sports Med. 2017;51(11):848–50.CrossRefPubMed Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th edition (SCAT5). Br J Sports Med. 2017;51(11):848–50.CrossRefPubMed
8.
go back to reference King A. The proposed King-Devick test and its relation to the Pierce saccade test and reading levels. Available from the Carl Shepherd Memorial Library, Illinois College of Optometry, Chicago, IL. 1976. King A. The proposed King-Devick test and its relation to the Pierce saccade test and reading levels. Available from the Carl Shepherd Memorial Library, Illinois College of Optometry, Chicago, IL. 1976.
9.
go back to reference Galetta MS, Galetta KM, McCrossin J, Wilson JA, Moster S, Galetta SL, et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci. 2013;328(1–2):28–31.CrossRefPubMed Galetta MS, Galetta KM, McCrossin J, Wilson JA, Moster S, Galetta SL, et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci. 2013;328(1–2):28–31.CrossRefPubMed
10.
go back to reference Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. J Clin Sport Med. 2003;13(1):28–32.CrossRef Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. J Clin Sport Med. 2003;13(1):28–32.CrossRef
11.
go back to reference Lovell M, Collins M, Podell K, Powell J, Maroon J. ImPACT: immediate post-concussion assessment and cognitive testing. Pittsburgh: NeuroHealth Systems, LLC.; 2000. Lovell M, Collins M, Podell K, Powell J, Maroon J. ImPACT: immediate post-concussion assessment and cognitive testing. Pittsburgh: NeuroHealth Systems, LLC.; 2000.
12.
go back to reference Brennan JH, Mitra B, Synnot A, McKenzie J, Willmott C, McIntosh AS, et al. Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Med. 2017;47(3):469–78.CrossRefPubMed Brennan JH, Mitra B, Synnot A, McKenzie J, Willmott C, McIntosh AS, et al. Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Med. 2017;47(3):469–78.CrossRefPubMed
13.
go back to reference Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):2069–78.CrossRefPubMedPubMedCentral Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):2069–78.CrossRefPubMedPubMedCentral
14.
go back to reference Shultz SR, MacFabe DF, Foley KA, Taylor R, Cain DP. Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res. 2012;229(1):145–52.CrossRefPubMed Shultz SR, MacFabe DF, Foley KA, Taylor R, Cain DP. Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res. 2012;229(1):145–52.CrossRefPubMed
15.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
16.
go back to reference Wilcox BJ, Beckwith JG, Greenwald RM, Chu JJ, McAllister TW, Flashman LA, et al. Head impact exposure in male and female collegiate ice hockey players. J Biomech. 2014;47(1):109–14.CrossRefPubMed Wilcox BJ, Beckwith JG, Greenwald RM, Chu JJ, McAllister TW, Flashman LA, et al. Head impact exposure in male and female collegiate ice hockey players. J Biomech. 2014;47(1):109–14.CrossRefPubMed
17.
go back to reference Cobb BR, Rowson S, Duma SM. Age-related differences in head impact exposure of 9–13 year old football players. Biomed Sci Instrum. 2014;50:285–90.PubMed Cobb BR, Rowson S, Duma SM. Age-related differences in head impact exposure of 9–13 year old football players. Biomed Sci Instrum. 2014;50:285–90.PubMed
18.
go back to reference King D, Hume P, Gissane C, Brughelli M, Clark T. The influence of head impact threshold for reporting data in contact and collision sports: systematic review and original data analysis. Sports Med. 2016;46(2):151–69.CrossRefPubMed King D, Hume P, Gissane C, Brughelli M, Clark T. The influence of head impact threshold for reporting data in contact and collision sports: systematic review and original data analysis. Sports Med. 2016;46(2):151–69.CrossRefPubMed
19.
go back to reference Shamliyan T, Kane RL, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010;63(10):1061–70.CrossRefPubMed Shamliyan T, Kane RL, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010;63(10):1061–70.CrossRefPubMed
20.
go back to reference Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef
21.
22.
go back to reference Naunheim RS, Standeven J, Richter C, Lewis LM. Comparison of impact data in hockey, football, and soccer. J Trauma Acute Care Surg. 2000;48(5):938–41.CrossRef Naunheim RS, Standeven J, Richter C, Lewis LM. Comparison of impact data in hockey, football, and soccer. J Trauma Acute Care Surg. 2000;48(5):938–41.CrossRef
23.
go back to reference King D, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med. 2015;43(3):614–24.CrossRefPubMed King D, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med. 2015;43(3):614–24.CrossRefPubMed
24.
go back to reference King D, Hecimovich M, Clark T, Gissane C. Measurement of the head impacts in a sub-elite Australian Rules football team with an instrumented patch: an exploratory analysis. Int J Sports Sci Coach. 2017;12(3):359–70.CrossRef King D, Hecimovich M, Clark T, Gissane C. Measurement of the head impacts in a sub-elite Australian Rules football team with an instrumented patch: an exploratory analysis. Int J Sports Sci Coach. 2017;12(3):359–70.CrossRef
25.
go back to reference Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Quantifying head impacts in collegiate lacrosse. Am J Sports Med. 2016;44(11):2947–56.CrossRefPubMedPubMedCentral Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Quantifying head impacts in collegiate lacrosse. Am J Sports Med. 2016;44(11):2947–56.CrossRefPubMedPubMedCentral
26.
go back to reference Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am J Sports Med. 2013;41(12):2877–84.CrossRefPubMedPubMedCentral Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am J Sports Med. 2013;41(12):2877–84.CrossRefPubMedPubMedCentral
27.
go back to reference Broglio SP, Sosnoff JJ, Shin S, He X, Alcaraz C, Zimmerman J. Head impacts during high school football: a biomechanical assessment. J Athet Train. 2009;44(4):342–9.CrossRef Broglio SP, Sosnoff JJ, Shin S, He X, Alcaraz C, Zimmerman J. Head impacts during high school football: a biomechanical assessment. J Athet Train. 2009;44(4):342–9.CrossRef
28.
go back to reference Martini D, Eckner J, Kutcher J, Broglio S. Subconcussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sports Exerc. 2013;45(4):755.CrossRefPubMedPubMedCentral Martini D, Eckner J, Kutcher J, Broglio S. Subconcussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sports Exerc. 2013;45(4):755.CrossRefPubMedPubMedCentral
29.
go back to reference Press JN, Rowson S. Quantifying head impact exposure in collegiate women’s soccer. Clin J Sports Med. 2017;27(2):104–10.CrossRef Press JN, Rowson S. Quantifying head impact exposure in collegiate women’s soccer. Clin J Sports Med. 2017;27(2):104–10.CrossRef
30.
go back to reference Cortes N, Lincoln AE, Myer GD, Hepburn L, Higgins M, Putukian M, et al. Video analysis verification of head impact events measured by wearable sensors. Am J Sports Med. 2017;45(10):2379–87.CrossRefPubMed Cortes N, Lincoln AE, Myer GD, Hepburn L, Higgins M, Putukian M, et al. Video analysis verification of head impact events measured by wearable sensors. Am J Sports Med. 2017;45(10):2379–87.CrossRefPubMed
31.
go back to reference Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, et al. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 2017;51(11):888–94.PubMed Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, et al. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 2017;51(11):888–94.PubMed
32.
go back to reference Broglio SP, Eckner JT, Surma T, Kutcher JS. Post-concussion cognitive declines and symptomatology are not related to concussion biomechanics in high school football players. J Neurotrauma. 2011;28(10):2061–8.CrossRefPubMedPubMedCentral Broglio SP, Eckner JT, Surma T, Kutcher JS. Post-concussion cognitive declines and symptomatology are not related to concussion biomechanics in high school football players. J Neurotrauma. 2011;28(10):2061–8.CrossRefPubMedPubMedCentral
33.
go back to reference Guskiewicz KM, Mihalik JP, Shankar V, Marshall SW, Crowell DH, Oliaro SM, et al. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–53.CrossRefPubMed Guskiewicz KM, Mihalik JP, Shankar V, Marshall SW, Crowell DH, Oliaro SM, et al. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–53.CrossRefPubMed
34.
go back to reference Gardner AJ, Kohler R, McDonald W, Fuller GW, Tucker R, Makdissi M. The use of sideline video review to facilitate management decisions following head trauma in super rugby. Sports Med Open. 2018;4(1):20.CrossRefPubMedPubMedCentral Gardner AJ, Kohler R, McDonald W, Fuller GW, Tucker R, Makdissi M. The use of sideline video review to facilitate management decisions following head trauma in super rugby. Sports Med Open. 2018;4(1):20.CrossRefPubMedPubMedCentral
35.
go back to reference Wilcox BJ, Beckwith JG, Greenwald RM, Raukar NP, Chu JJ, McAllister TW, et al. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. J Biomech. 2015;48(10):2201–4.CrossRefPubMedPubMedCentral Wilcox BJ, Beckwith JG, Greenwald RM, Raukar NP, Chu JJ, McAllister TW, et al. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. J Biomech. 2015;48(10):2201–4.CrossRefPubMedPubMedCentral
36.
go back to reference Duma SM, Manoogian SJ, Bussone WR, Brolinson PG, Goforth MW, Donnenwerth JJ, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15(1):3–8.CrossRefPubMed Duma SM, Manoogian SJ, Bussone WR, Brolinson PG, Goforth MW, Donnenwerth JJ, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15(1):3–8.CrossRefPubMed
37.
go back to reference Brolinson PG, Manoogian S, McNeely D, Goforth M, Greenwald R, Duma S. Analysis of linear head accelerations from collegiate football impacts. Curr Sports Med Rep. 2006;5(1):23–8.CrossRefPubMed Brolinson PG, Manoogian S, McNeely D, Goforth M, Greenwald R, Duma S. Analysis of linear head accelerations from collegiate football impacts. Curr Sports Med Rep. 2006;5(1):23–8.CrossRefPubMed
38.
go back to reference Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery. 2007;61(6):1229–35.CrossRefPubMed Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery. 2007;61(6):1229–35.CrossRefPubMed
39.
go back to reference Rowson S, Brolinson G, Goforth M, Dietter D, Duma S. Linear and angular head acceleration measurements in collegiate football. J Biomech Eng. 2009;131(6):061016.CrossRefPubMed Rowson S, Brolinson G, Goforth M, Dietter D, Duma S. Linear and angular head acceleration measurements in collegiate football. J Biomech Eng. 2009;131(6):061016.CrossRefPubMed
40.
go back to reference Broglio SP, Schnebel B, Sosnoff JJ, Shin S, Feng X, He X, et al. The biomechanical properties of concussions in high school football. Med Sci Sports Exerc. 2010;42(11):2064.CrossRefPubMedPubMedCentral Broglio SP, Schnebel B, Sosnoff JJ, Shin S, Feng X, He X, et al. The biomechanical properties of concussions in high school football. Med Sci Sports Exerc. 2010;42(11):2064.CrossRefPubMedPubMedCentral
41.
go back to reference Rowson S, Duma SM, Beckwith JG, Chu JJ, Greenwald RM, Crisco JJ, et al. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann Biomed Eng. 2012;40(1):1–13.CrossRefPubMed Rowson S, Duma SM, Beckwith JG, Chu JJ, Greenwald RM, Crisco JJ, et al. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann Biomed Eng. 2012;40(1):1–13.CrossRefPubMed
42.
go back to reference Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9(4):e94734.CrossRefPubMedPubMedCentral Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9(4):e94734.CrossRefPubMedPubMedCentral
43.
go back to reference Miyashita T, Diakogeorgiou E, Marrie K, Danaher R. Frequency and location of head impacts in Division I men’s lacrosse players. Athl Train Sports Health Care. 2016;8(5):202–8.CrossRef Miyashita T, Diakogeorgiou E, Marrie K, Danaher R. Frequency and location of head impacts in Division I men’s lacrosse players. Athl Train Sports Health Care. 2016;8(5):202–8.CrossRef
44.
go back to reference Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of head impacts to change in Balance Error Scoring System scores in Division I men’s lacrosse players. Sports Health. 2017;9(4):318–23.CrossRefPubMedPubMedCentral Miyashita TL, Diakogeorgiou E, Marrie K. Correlation of head impacts to change in Balance Error Scoring System scores in Division I men’s lacrosse players. Sports Health. 2017;9(4):318–23.CrossRefPubMedPubMedCentral
45.
go back to reference O’Day KM, Koehling EM, Vollavanh LR, Bradney D, May JM, Breedlove KM, et al. Comparison of head impact location during games and practices in Division III men’s lacrosse players. Clin Biomech. 2017;43:23–7.CrossRef O’Day KM, Koehling EM, Vollavanh LR, Bradney D, May JM, Breedlove KM, et al. Comparison of head impact location during games and practices in Division III men’s lacrosse players. Clin Biomech. 2017;43:23–7.CrossRef
46.
go back to reference Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Effects of sex and event type on head impact in collegiate soccer. Orthop J Sports Med. 2017;5(4):2325967117701708.CrossRefPubMedPubMedCentral Reynolds BB, Patrie J, Henry EJ, Goodkin HP, Broshek DK, Wintermark M, et al. Effects of sex and event type on head impact in collegiate soccer. Orthop J Sports Med. 2017;5(4):2325967117701708.CrossRefPubMedPubMedCentral
Metadata
Title
Frequency and Magnitude of Game-Related Head Impacts in Male Contact Sports Athletes: A Systematic Review and Meta-Analysis
Authors
Jack V. K. Nguyen
James H. Brennan
Biswadev Mitra
Catherine Willmott
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 10/2019
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-019-01135-4

Other articles of this Issue 10/2019

Sports Medicine 10/2019 Go to the issue