So, thanks for having me. I'm going to change the tune a little bit from the NFL and talk now a little bit about what data we have in the NCAA based on injury. These are my disclosures, which do not apply to this particular talk. So I want to go through the injuries and kind of give you the background of how I put this together based on the data, and we're going to talk about injuries in preseason as well as regular season and postseason in the NCAA and the different divisions, and especially some time on time loss injuries and then specific football position injuries. So these are the references I used. A lot of this comes, the epidemiology comes from this particular article that was published a couple years ago in the Journal of Athletic Training going through the numbers, and I'll kind of share with you the background of how this came about. So the numbers are NCAA football participation has increased 12% in the past decade. Correspondingly, the injury rate, and this particular study that I'll share with you has been done three times. This is the third time. But the first time they did it from 1998 to 2004, injury rate was four per 1,000 occurrences. So this is basically an injury for a number of practices or games that was calculated or that was documented. And now it's up to 36 per 1,000 exposures. The data that I'm going to share with you has to do with the actual numbers from the schools that reported to the NCAA Injury Surveillance Program. So it's not, by any means, all the schools, which I'm going to show you on the next slide. But the interesting thing is, there's been a lot of rule changes, right, in NCAA football, targeting chop block, blindside blocks to hopefully minimize injuries, but yet injuries are increasing. So this data is really important to try to help us in the future, what other changes could be made to hopefully lessen injuries. So what I'm going to share with you is, again, based on this NCAA ISP Injury Surveillance Program, which is based on the athletic trainers at the member institutions documenting injuries in practice and play. It's an injury that either the trainer saw, certified trainer saw, or a physician saw. Again, that first study was from 1988, 2004. This talk, this data covers the most recent, which is 2014-15 football season to 18-19. So this is the most current data that's available. The interesting thing is, the average of only 5% of Division I schools in Division II and III participated, the data participated in this study, only 5%. So the problem is documentation, right? So a lot of programs aren't getting their data in. So what you're going to see here is based on just 5% of all the schools that are playing football. So that being said, what is the overall risk of injury if you play college football? It's 9.31 per 100 exposures per practice in games. So that's definitely significant. Your risk of injury, just living life, is probably one in 1,000, and now it's going to be up to 9.31 per 1,000 exposures for playing football. It is division-based, Division I, more injuries than II, and more injuries than III. So the injuries are more in competitive play in practice. These are the numbers. If you look at the ratio of injury likelihood in a game versus a practice, 6.45 difference in that injury rate. Division I overall, injury rate 7 per 1,000, and you can see Division II is less and Division I is less. So Division I is certainly more at risk, and that's statistically significant in this study. Also Division I football players are more likely to get hurt both in practice and games compared to the lower divisions. So if you look at this slide right here, and this is from the start of this study in 14 to the end in 2018-19 season, the number of injuries in the games in practice look pretty stable, right? But again, much more higher injury rate in games than practice, but it hasn't really changed that much in that five-year period. How about injury segment? You know, Tim touched on some of the NFL data about preseason. Preseason is the problem in NCAA football. Look at the injury rate there. It's up to 10 now. And again, Division I is higher and statistically significant at 11.27 injury rate. So preseason, right, people are fighting for a position, it's more intense, padded practices, and this is what you see, a higher injury rate. And it's, again, higher in Division I than two and three. Two and three, there is no differences. So if you look at the difference between the regular season and preseason, it's statistically higher in preseason at all levels. And so again, and even at the, and versus postseason, it's even higher statistically significant, 1.52. So preseason is the worst, and then regular season and postseason. Regular season injury rate was 9.15 in this study, just to give you an idea. So that's, you know, 11,292 injuries out of, you know, over a million plays. So even though this is only 5% of schools reporting, you can see these are big numbers that we're looking at in terms of number of plays that are calculated based for these injury rate numbers. And Division I, again, is higher in the regular season than two and three. Two and three are about the same. How about the postseason? Now, you know, you've got less practices and less injuries. So it's 6.65, and again, you can see the numbers, less than regular season and less than preseason. And Division III was the lowest compared to I, again, really no differences between Division here, two and three, but one and two, about the same as well. So if you look at this graph, just trying to show the difference in preseason, postseason and regular season, over the years, pretty much it's been stable in the preseason, regular season, postseason's kind of up and down, but again, not as many games. Interesting is time loss. So time loss injuries are where an athlete loses at least one day or more. And then 41% injuries result in at least one day. But 36.4% of time loss injuries were more than 10 days. So that's a big number that, you know, 36% of these athletes miss more than 10 days from their injuries. More in practice, as you'd expect, again, more intensity at that level. So their higher chance for time loss injury is in a practice situation. And then if you look at this graph, go over the years now, look at the game has actually gone down, and time loss injuries, practice is about the same. So, you know, it's just for us to be aware of, you know, the athletes that get hurt early may be out longer. So what about types and locations? It's a little different than what Tim showed a little bit. So this data, again, is based on what's reported. So 50%, 51% of the injuries were contact, and 62% of those injuries happened in the games. Non-contact injuries occurred in practice more than in games. You can see the number there. And overuse injuries were more in practice, which makes sense than the games, the overuse problems. How about types of injury? Categorized as sprains, about 29%. Strains about 19%. You can see the breakdown. Games versus practice, and practice versus games, opposite there. And about 14% labeled as contusion. So not all injuries were able to be categorized, but this is the three biggest categories that they came up with. Where do they happen? In college football, knee is number one, 16%, then shoulder, then ankle, and interesting, head and face was fourth. Shoulder and ankle injuries, more common in games, but no difference seen in the knee injuries in games. Specific injuries at the college football level now, concussions were a problem, 7.5%. Then lateral ankle sprains were reported next, and then hamstring strains were after that. So if you look at this graph just over the years, you can see the difference of ankle sprains and hamstrings, which are the black and the gray, they are actually increasing. Concussions have remained stable over that segment of time from 14 to 19. How about how do they occur? This particular article and the way it was documented, general play, which I'm not sure exactly how to explain that to you, and they didn't really explain it either in the article, but that was accounted for about 17.5% of the injuries, but when they broke down specific activities that they could discern the injury occurred, interestingly, if you're blocking, blocking somebody, your risk of injury is about 16%. If you're the person getting blocked, it's about half. How about tackling? Again, it's the tackler who's delivering the blow is more likely to be injured than the person being tackled, and running injuries were about 12%, obviously that would get more into the hamstrings. How about other activities in terms of when do they occur? General play seemed to be a little bit more than in running, occurred more in practice than in games, and then the tackling and being tackled occurred more in games, which makes sense, right? In the heat of the battle, the blows that are being delivered might be more intense, so that does make good sense. How about positions in NCAA football? Number one, high risk injury, defensive backs, and number two are linemen, either offensive or defensive linemen are about the same. You put linemen together, it's over 31%, linemen have a risk of injury. Special teams players, more commonly in games, Tim touched on it with the deceleration injuries, but special teams have been an issue, even with the rule changes on fair catches on kickoffs, moving the kickoffs up to get more into the end zone. It's been recognized that special teams are a problem, but it really hasn't yet changed the injury rate in NCAA football. What else is out there in terms of documentation in actual NCAA articles that have been published? This is an interesting article looking at elbow injuries over a five-year period, found they were more in competition. You can see the numbers, nine versus 1.12. Acute elbow instability was the most common injury, and it's from contact as expected, but the majority, 97%, were treated conservatively. Elbow injuries typically are relatively, I wouldn't say mild necessarily, but treated non-operatively at the college football level based on this particular study. How about hand and wrist? This looked at 725 hand and wrist injuries, a study from the Mayo Clinic, and games were more of an injury risk than practice with this. Most common during blocking, which makes sense, but 71% did not result in any time loss. Hand and wrist injuries seemed to be not quite that severe in terms of the college football level getting back to play. What about knee injuries in this question of turf versus grass? Obviously, it's something that's come up in the NFL recently quite a bit. Big number of athletes here, looking over three million athletes. This is over a 10-year period. You can see two, four, six knee injuries total. PCL was almost three times more likely to occur on turf than grass. Lower divisions only reported an increased ACL risk. The ACL injury risk at division one was not reported to be increased, but was at two and three. But PCL seemed to be more of a problem, falling on a flexed knee on turf, maybe a harder surface for that direct blow to tear the PCL. Again, this is the NCAA data. How about shoulder injuries? This looked specifically at quarterbacks over a 10-year period in college football. 133 shoulder injuries, number of exposures. AC joint, not surprisingly, was most common. Contact was 60% player to player, and 28% occurred by player to contact surface. Majority of these were treated conservatively, and that's something that might come up in the discussion. What do you do with your dominant quarterback with an AC joint dislocation type injury? How do you treat him? But in this particular study, the majority were treated conservatively. What about concussion? Talk a little bit about this, and this is a really good study that was done in the Pac-12 looking at the issue of targeting and concussions. What they found is, in this period of time, in Pac-12 games only, they had 7% of their concussions related to a targeting fall. When they looked at this, though, and you can see the numbers, the risk of concussion from a targeting was almost 37% times greater than a non-targeting play. In this study, though, they didn't differentiate who got the concussion. Was it the player that hit the other player, or the player that received the blow? But you can see this big-time number increase, so targeting is an issue. When you look at this, and I've looked at the NCAA definition, there are multiple definitions. Targeting at our level is very confusing, and you see it every Saturday when there's a review, and you think it looks like a classic targeting, and Ohio State's probably still talking about that blow in that game against Georgia. What is the definition? Well, to try to get the exact definition isn't really not possible, but these are definitions that I got from NCAA sources. Aiming at an opponent for purposes of attacking, forcible contact beyond making a legal tackle or a legal block. And really, this could apply not just a blow to the head. This could be trying to take somebody's knee out, could also be considered targeting. But we focus on the helmet-to-helmet, right? So no player shall initiate contact and target the opponent with the crown or the top of his helmet. And the other issue that comes into play is this defenseless receiver, or defenseless player. It's a player who's defined as they've completed the role in their play, and so this would be like a receiver that's already crossed the middle, maybe didn't get the catch and somebody blows him up from behind, right head on when they don't see him coming. So all of a sudden, now you have to determine intent. So the referee has to, in a split second, decide was that malicious blow on purpose or not? And then they go to the replay, and then they gotta figure out, so how do you figure intent comes into play? So targeting, I think, is an issue that is great to be addressed at the level of NCAA college football, but it's far from being figured out. But know that there is a significantly higher risk, almost 37%, for concussions with targeting fouls to the head. Sometimes it's pretty easy. This is Missouri's favorite son, Nick Bolton, who now plays for the Chiefs. And so you can see here, that definitely was targeting and was called appropriately. So I think this is another area of injury prevention at college football that's gonna need a lot more work done. The rule's there, but it's difficult to define the rule and to exactly enforce it. So what I'd summarize with epidemiology at the college football level, despite rule changes, there's been increased injury rate, defined as nicely in this epidemiologic study from the NCAA data. It's a higher injury rate if you're a Division I player. Games are worse than practice, get hurt. Preseason, by far, is the most risky. And that's even after two-a-day practices have been stopped during that period. We used to have two-a-days, and those no longer happen, of course, in college football. Defensive-offensive linemen are the highest risk, and then D-backs would be second. Thirty-six percent of the time, these injuries result in a time loss for the athletes of greater than 10 days, which is significant. Fifty-one percent are contact injuries. And most special teams occur in games, so that's an issue that, despite rule changes again, has not been solved. PCL injuries, almost three times more likely on turf, and that's in Division I. And in lower divisions, ACL tears occur more on turf than on grass. And the risk of concussion from targeting is 37 times greater than non-targeting plays. Thank you.

NCAA football

injury data

injury rate

rule changes

NCAA Injury Surveillance Program