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.
Council Adopts Heat Management Policy
March 26, 2013
The adoption of a heat management policy for MHSAA tournaments and a detailed model policy to be submitted to member schools for suggested use during practice and regular-season competition was the main focus of the Representative Council of the Michigan High School Athletic Association during its annual Winter Meeting on March 22 in East Lansing.
Heat and humidity management is the next step of the MHSAA’s ongoing focus on health and safety issues in school sports. The model policy, while not setting requirements for member schools, proposes actions based on heat index – the degree of felt discomfort derived by combining temperature and humidity measurements – that are designed to minimize the risk of heat-related illness during interscholastic participation. It will be published as a recommendation for regular-season practice and competition in the 2013-14 MHSAA Handbook, and it will be mandatory for MHSAA tournaments beginning this fall.
Executive director John E. “Jack” Roberts said there are a number of member schools with solid heat management policies in place, but he hopes the adoption of this “best practice” will further raise awareness of the risks of heat-related illness while giving schools – especially those without a protocol – an opportunity to adopt a standardized policy similar to what is in place for other environmental factors such as lightning and tornadoes.
“For the past several years, we’ve used four ‘H’s’ to focus our efforts to improve the health and safety of student-athletes: Heads, Hearts, Heat and health Histories,” Roberts said. “To maintain momentum, we’ve identified several focus areas for the next four years: better acclimatization of athletes, better health and safety preparedness for coaches and modification of practice policies and contest rules to reduce head trauma and the frequency of each sport’s most injurious situations.
“Friday’s action was significant; but it’s just the next step in a continuous series of actions being taken to make school sports as healthy as possible for students.”
The heat management policy states that temperature and humidity readings should be taken at the site of the practice or competition 30 minutes prior to its start and then 60 minutes after it has begun. Recommendations for hydration and levels of activity are suggested for each of four levels of heat index readings.
Key tenets include frequency and length of water breaks, appropriate uniforms based on heat index and mandates on what time of day practices should be conducted and for how long. Practices are suggested to be postponed or moved when the heat index measures 99 to 104 degrees, and all outdoor activity (and indoor if air conditioning is unavailable) is to be stopped if the heat index rises above 104.
The Representative Council also discussed raising expectations for coaches’ education and preparedness for promoting student-athletes’ health and safety. Three proposals are under consideration for Council votes during its next three meetings:
- The first would require all assistant and sub-varsity coaches at the high school level to complete the same MHSAA rules meeting required of varsity head coaches (which includes safety information) or one of the free online sports safety courses posted on or linked to MHSAA.com. This would take effect in 2014-15 and could be voted on at the Council’s May meeting.
- The second proposal would require current CPR certification for all varsity head coaches at the high school level, with AED training a recommended component of the course. This would take effect in 2015-16 and could be voted on at the December meeting.
- The third proposal would require varsity head coaches hired to begin on or after July 1, 2016 to complete Level 1 or 2 of the MHSAA’s Coaches Advancement Program, a six-level educational regimen that aids coaches in their growth and development. This could be voted on at the Council’s March 2014 meeting.
Two sport-related actions also were taken by the Council during last week’s meeting:
- Boys lacrosse: Beginning this season, an official must be a member in good standing of an approved local boys lacrosse officials association in order to be eligible to work MHSAA tournament games. This is in addition to other existing requirements.
- Wrestling: For school years during which there are only 15 Saturdays between the first day of practice and the MHSAA Individual Finals (rather than the traditional 16 Saturdays), the number of days from the beginning of practice until the first competition shall be reduced from 23 to 19. For the 2013-14 season, the earliest day of competition is Dec. 7, instead of Dec. 11 under the previous regulation. There is no reduction in the minimum number of days when practice actually is held prior to the first competition.
The Representative Council is the 19-member legislative body of the MHSAA. All but five members 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.