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2018-19 Concussion Data Reinforces Trends

September 26, 2019

By Geoff Kimmerly
Second Half editor

Data on student-athlete concussions collected by the Michigan High School Athletic Association from member high schools during the 2018-19 school year further reinforced findings from the first three years of reporting, and will contribute significantly as a number of MHSAA-associated groups work during the coming year to reduce the incidence of those injuries.

The 2018-19 concussion report found student-athletes at MHSAA member high schools encountered a total of 3,686 head injuries during the past school year – 3.0 percent more than in 2017-18. But that slight increase barely affected two key ratios. The number of injuries per member school was 4.9, up just a tenth of a percent from 2017-18, and for the second straight year only 1.3 percent of participants in MHSAA sports experienced a head injury, still down from 1.4 in 2016-17 and 1.6 percent the first year of the study. Total participation in MHSAA sports for 2018-19 was 281,992 – with students counted once for each sport they played.

The MHSAA has continued to invite Michigan’s universities, health care systems and the National Federation of State High School Associations (NFHS) to take part in analyzing the data and resulting questions that have arisen during the past three years. The 2018-19 results will be examined by the MHSAA’s newly-formed Sports Medicine Advisory Committee and also undergo analysis by representatives of Michigan State University’s Institute for the Study of Youth Sports. Furthermore, the MHSAA is directing its sport committees to study the data as they consider adjustments that could be made to rules for practice and competition. 

“The 2018-19 concussion survey further reinforced the findings and trends we have seen emerge; not only in specific sports, but across all of our activities – and this latest set of results also raises new questions,” MHSAA Executive Director Mark Uyl said. “We must continue to look at how changes to playing rules and improvements in equipment may be beneficial moving forward, and also how we can further educate administrators, coaches, athletes and parents to identify and provide treatment for these injuries as soon as possible. We also are excited for the opportunity to have more eyes on these results as we continue to explore more ways to make our games safer.”  

As first mandated in 2015-16, member schools are required to report head injuries to the MHSAA identifying the sport that each student-athlete was participating in and whether the injury was sustained during practice or competition. Schools also are required to designate at which level – varsity, junior varsity or freshman – the injury occurred.

The full report of all head injuries experienced during 2018-19 by student-athletes at MHSAA member high schools – including percentages by sport (per 1,000 participants), gender and team level, as well as data tracking when athletes returned to play – is available on the Health & Safety page of the MHSAA Website.

Keeping with the first three years of this survey, the MHSAA continued to receive data from more than 99 percent of its member high schools after the fall, winter and spring seasons. Member junior high and middle schools also were allowed, although not mandated, to report their head injuries; and those findings are not part of the published report.

Boys in 2018-19 experienced 2,404 – or 65 percent – of concussion injuries, just a percent less than during 2017-18, and not surprisingly as boys have a much higher participation in contact sports. More than half of head injuries – 59 percent – were experienced by varsity athletes, a slight increase of three percent from the previous year. A total of 2,441 head injuries – or 66 percent – came in competition as opposed to practice. Just more than half took place during either the middle of practice or middle of competition as opposed to the start or end, and 51 percent of injuries were a result of person-to-person contact. 

The MHSAA also asked schools to report the number of days between the head injury and the athlete’s return to activity – and the two largest groups returned to activity after either 6 to 10 days of rest (24 percent) or 11 to 15 days (23 percent). All of these findings were within 1-3 percent of those discovered from the 2017-18 data. 

Contact sports again revealed the most head injuries. Ranking first was football, 11 and 8-player combined, with 44 head injuries per 1,000 participants – an increase of three per 1,000 from 2017-18 but the same ratio as 2016-17 and still down from 49 head injuries per 1,000 football participants shown by the first study in 2015-16. Ice hockey again revealed the second-most injuries per 1,000, with 35 (also up three from a year ago but still down from 36 injuries per 1,000 from 2016-17 and 38 per 1,000 in 2015-16), and girls soccer was third with 25 head injuries per 1,000 participants for the second year in a row. Wrestling followed with 22 head injuries per 1,000 participants. 

Continuing a noticeable trend of the last few years, the next three sports to show the highest incidences of head injuries were girls sports – girls lacrosse, competitive cheer and basketball also revealed 20 per 1,000 participants, although basketball was down two injuries per 1,000 participants or nearly 10 percent from the previous year. Boys lacrosse (16), boys soccer (14), girls volleyball (11), softball (11) and gymnastics (10) also showed double-digit head injuries per 1,000 participants. 

Females again reported significantly more concussions than males playing the same or similar sports – soccer, basketball and baseball/softball. Female soccer players reported nearly double the concussions per 1,000 participants as male soccer players (25 to 14), while female basketball players reported nearly triple the number of concussions per 1,000 participants (20 to 7). Softball players also reported nearly triple the concussions per 1,000 participants of baseball players (11 to 4). 

Schools report possible concussions online via the MHSAA Website. Reports are then examined by members of the MHSAA staff, who follow up with school administrators as those student-athletes continue to receive care and eventually return to play. Student privacy is protected. 

The reporting of concussions is part of a three-pronged advance by the MHSAA in concussion care begun during the 2015-16 school year. The MHSAA completed in spring 2017 the largest-ever state high school association sideline concussion testing pilot program, with a sample of schools from across the state over two years using one of two screening tests designed to detect concussions. The MHSAA also was the first state association to provide all participants at every member high school and junior high/middle school with insurance intended to pay accident medical expense benefits – covering deductibles and co-pays left unpaid by other policies – resulting from head injuries sustained during school practices or competitions and at no cost to either schools or families. 

Previously, the MHSAA also was among the first state associations to adopt a return-to-play protocol that keeps an athlete out of activity until at least the next day after a suspected concussion, and allows that athlete to return to play only after he or she has been cleared unconditionally for activity by a doctor (M.D. or D.O.), physician’s assistant or nurse practitioner.

In addition, the MHSAA’s Coaches Advancement Program – which includes courses that must be completed by all varsity head coaches hired for the first time at a member school – provides substantial instruction on concussion care. Separately, rules meetings that are required viewing for high school varsity and subvarsity head and assistant coaches at the start of each season include detailed training on caring for athletes with possible head injuries.

Rep Council Wrap-Up: Spring 2015

May 11, 2015

By Geoff Kimmerly
Second Half editor

The Representative Council of the Michigan High School Athletic Association took a number of significant actions during its annual Spring Meeting, May 3-4, in Glen Arbor, highlighted by changes to out-of-season coaching rules, a call for a member vote on a Constitutional amendment affecting middle school and junior high athletics, and initiatives to promote participant health and safety.  

The Spring Meeting of the 19-member legislative body of the Association’s more than 1,400 member schools is generally the busiest of its three sessions each year. The Council considered 13 committee proposals and also dealt with a variety of eligibility rule, postseason tournament and operational issues.

For the past eight months, the MHSAA focused member schools’ attention on an overhaul of out-of-season coaching rules. While support was lacking for a radically different approach, consensus developed for several significant changes within the existing approach for expanding contact between school coaches and their students out-of-season during the school year.

Included in the changes are that coaches will be permitted to work with up to four players in all situations out-of-season during the school year; previously, coaches could work with three or four players, depending on the circumstance. Coaches also will be allowed out of season during the school year to provide coaching in non-school competition to up to four students from that coach’s school. Under this same set of out-of-season coaching rules during the school year, the Council permitted more contact among school coaches and students allowing for previously banned offseason practice rotations to occur. Voluntary workouts out-of-season that involve rotations from conditioning, open gyms, weight lifting and sport-specific skill work may occur so long as there is no more than one four-player station with sport skills being coached. 

Following up on more than a year of consideration by the MHSAA Junior High/Middle School Committee and a Junior High/Middle School Task Force created in December 2013, the Council also approved a request for a membership vote to amend the MHSAA Constitution to allow for school membership beginning at the 6th grade. The membership vote is expected to be conducted in late October; if membership approves the amendment, the Council will consider for which sports 6th-graders will be eligible to compete with and against 7th- and 8th- graders.

The MHSAA’s historical concern for health and safety has been intensified during the past six years of an eight-year campaign focused on “4 H’s” – Health Histories, Heads, Heat and Hearts – and the Council approved several initiatives which continue to improve the environment of school-based sports.

The Council authorized up to three pilot programs to be conducted by volunteer schools, aimed at assisting in decision-making regarding the removal of athletes from activity after possible concussion events as well as in reporting and record-keeping of those events.

The Council mandated that member schools report head injury events through a web-based reporting system the MHSAA is developing. The Council also approved the purchase of another level of insurance aimed at assuring that children of uninsured or underinsured families receive prompt and professional care for suspected head injuries. Both the reporting requirement and the insurance protection are for eligible athletes in all levels of all sports, grades 7 through 12, in both practices and competition.

The Council was briefed on an electronic system that could be used to track pre-participation physical examination forms while improving injury reporting and record-keeping; currently, the MHSAA provides paper forms to member schools at no charge. The Council also was updated on MHSAA plans to provide at no cost to every high school in Michigan the ANYONE CAN SAVE A LIFE – Emergency Action Planning Guide, and informed on the MHSAA’s support of the MI HEARTSafe School initiative of the Michigan Department of Health and Human Services, which on May 13 will recognize 128 schools and/or districts for cardiac emergency preparedness.

Here is a summary of other actions taken by the Representative Council at the Spring Meeting, which will take effect during the 2015-16 school year: 

Handbook/Administrative Matters

  • Participation was expanded by the Council for 9th- and 10th-grade transfer students with no history of high school athletic participation who gain immediate subvarsity eligibility through a waiver by the MHSAA Executive Committee. Students who are granted such a waiver may now participate in designated non-scoring subvarsity heats or non-scoring races of varsity individual contests in sports such as swimming and diving, cross country and track and field. Previous to this action, subvarsity eligibility was permitted in subvarsity team sports only or subvarsity-only meets in individual sports. The subvarsity definition also will apply to international students present in the U.S. on an F-1 Visa but not from an MHSAA-approved international student program. 

  • Athletes in ice hockey and boys and girls soccer must compete in four regular-season games against other MHSAA schools to be eligible to compete with their school teams in the MHSAA Tournament. This currently is a requirement in alpine skiing, and a waiver procedure similar to what is utilized in skiing will be developed for hockey and soccer as well.

  • Non-school sports activities coordinated or directed by administrators and parents were added to situations which trigger an athletic link and an extended period of ineligibility for transfer students if those students then enroll at new schools that have association with those administrators or parents. The Council expanded the athletic-related transfer rule which previously involved only non-school coaches and transferring students who do not make a residential change. 

Classification

  • The Council created a “life line” allowance for schools to form a cooperative agreement in excess of the 3,500-student enrollment cap in sports sponsored by fewer than 250 schools. A program may be approved by the Executive Committee for up to three years, if during the previous year, the school or the cooperative program in which the school was a part dropped the sport because of a demonstrated lack of participation. Sports sponsored by 250 or fewer schools during 2014-15 were gymnastics, ice hockey, boys and girls lacrosse, boys and girls alpine skiing and boys and girls swimming and diving. This three-year “life line” allowance is similar to the regulation which allows for a “startup” cooperative program to be created among schools whose combined enrollment exceeds 3,500 students but the schools involved did not sponsor the sport in the previous school year.

Sport Matters

  • For boys and girls basketball, the Council approved an MHSAA Basketball Committee recommendation to seek permission from the National Federation of State High School Associations (NFHS) to allow teams to play up to two regular-season games made up of 18-minute halves instead of the current 8-minute quarters. If permission is granted by the NFHS, schools will be required to seek permission from the MHSAA prior to events and provide reports after 36-minute games are played.

  • In bowling, it was announced that Kegel is developing a bowling lane oil pattern for high school bowling called the “Allen Pattern,” named after former MHSAA Assistant Director Randy Allen, who administered the MHSAA bowling program from its inception during the 2003-04 school year until retirement in 2013. Michigan has the largest number of schools in the U.S. sponsoring interscholastic bowling. The Allen Pattern is being designed specifically for the high school level and will be utilized for the 2016 MHSAA Bowling Tournament.

  • In cross country, the MHSAA will appoint and administer a task force of coaches and athletic administrators to address unbalanced Lower Peninsula Cross Country Regionals – including some Regionals having more complete teams in competition than others because teams decide to not compete or cannot compete with a full lineup after Regional groups are drawn. The task force will present its findings to the Council in 2016.

  • For ice hockey, four-person officiating crews were approved for Quarterfinals. The MHSAA began using four-person crews for Semifinals and Finals in 2014.

  • In boys lacrosse, a “play in” game was approved for teams seeded 9-16 in each Regional. Play-in games will be played three days earlier than the traditional start of the MHSAA Tournament, with winners then playing teams seeded 5-8 at the traditional start of tournament play.

  • In wrestling, the Council approved a recommendation by the MHSAA Wrestling Committee that eliminates the second weigh-in at the MHSAA Team Finals. The Friday weigh-in before the start of Quarterfinals will be used for all three rounds of competition during Finals weekend.

The Council also reviewed reports on membership, with 754 senior high schools and 703 junior high/middle schools in 2014-15; eligibility advancement applications, which totaled four for the year; the use of Educational Transfer Forms, which held steady this year; school violations, attendance at athletic director in-service workshops and Coaches Advancement Program sessions, officials’ registrations, rules meetings attendance and officials reports submitted for the past three sports seasons. The Association’s $10.4 million budget for the 2015-16 school year also was approved. 

The Representative Council is the 19-member legislative body of the MHSAA. All but five are elected by member schools. Four members are appointed by the Council to facilitate representation of females and minorities, and the 19th position is occupied by the Superintendent of Public Instruction or designee.

The MHSAA is a private, not-for-profit corporation of voluntary membership by more than 1,400 public and private senior high schools and junior high/middle schools which exists to develop common rules for athletic eligibility and competition. No government funds or tax dollars support the MHSAA, which was the first such association nationally to not accept membership dues or tournament entry fees from schools. Member schools which enforce these rules are permitted to participate in MHSAA tournaments, which attract more than 1.4 million spectators each year.