Recreational Injury Interventions



Football is the premier contact sport in the US. 1.3 million high school athletes and 75,00 college athletes participated in football in 1974, Porter et al, 1999. Participation in this sport can lead to catastrophic injury that results in death or permanent disability. From 1977 to 1992, 113 of 155 player (73%) with cervical cord injuries were defensive players, with only 24 of the injuries occuring on the offensive side of the ball, Mueller et al, 1996. A majority of these injuries occurred while the defensive player was tackling. There are varying physical demands of different positions, with a higher incidence of predictable injuries occuing to players of certain positions. Familiarity with these injuries can aid in examination and diagnosis. Mueller et al, 1996, provide some epidemiologic research to identify patterns within the individual athlete and within a larger population.

The most frequently injured part of the body is the lower extremity, with 20% of all injuries occuring to the knee, Porter et al, 1999. Dynamic knee bracing has been evaluated as a means to minimize injury while not subjecting players to unnecesary prophylacitc measures. However, studies have not revealed an effect on the frequency or severity of knee injury in football players. (Further information regarding the effectivness of knee braces can be obtained in the knee bracing intervention portion of this website).

Hamstring muscle strains are responsible for a significant loss of playing time for collegiate football players, Heiser et al, 1984. This study is reviewed below. (Additional information regarding the effectiveness of thermal pants or warmers in preventing hamstring injury in rugby players is available in the rugby intervention section of the website).

Additionally, some studies have evaluated the preventive effects of footwear and playing surfaces. Soccer style cleats reduce foot fixation, and have shown to result in fewer and less severe knee injuries. Playing surfaces have been compared, reporting a twice as high rate of injury for participation on artifical turf as on natural surfaces, Porter et al, 1999.

Review of football studies:


Heiser, et al, 1984

Study design and target population

Prospective cohort study.

Population: University of Nebraska football players from 1973-1977, Group I. Group II, consisted of players from the 1978-1982 period.


Supervised winter running programs, and self-designed year-long stretching, running, and weight lifting.

Group II received baseline testing of hamstring and quadriceps (for all players) and Cybex II high speed isokinetic workouts (for injured players) in addition to running and self-designed program.


Hamstring injuries and recurrences.


For Group I, 41 (7.7%) hamstring injuries in 534 player years with 13 (31.7%) recurrences.

For Group II, 6 (1.1%) hamstring injuries occurred in 564 player years with no recurrences.

Difference in number of players sustaining a first-time injury was statistically significant at P<0.005, chi square test.

Difference in number of players sustaining a recurrence was not significant at P<0.1.

Study quality and conclusions

Confounding variables not controlled for. Poor design.

Group II had a more closely supervised strength training program, and a greater emphasis on stretching was introduced.

The greatest worth of isokinetic dynamometer may be that it produces objective data to aid in determining when an athlete can return to action.

Summary of football studies

The study above demonstrated that early detection of muscle imbalances through isokinetic testing followed by a muscle imbalance rehabilitative program decreased the incidence of primary and recurrent hamstring strains in intercollegiate football players.

Recommendations on football interventions

Communication between medical staff, players, and coaches is essential for injury prevention, in combination with education and awareness of position-specific symptoms and injuries. Early detection of injury, rehabilitation, and reevaluation of lower extremity strength imbalances and deficiences must be stressed. Adequate warm-up, stretching, strength training and conditioning are necessary, in particular during times when players are fatigued or returning to play after rest or half-time. It should also be considered that the players who seem to do better in this sport have a higher tolerance for pain, thus indicating a need for an objective measure to evaluate the severity of injury. Football interventions should include an objective measure, such as an isokinetic dynamometer, to evaluate the degree of injury severity in determing when an athlete can return to action.

Recommendations for future research

There is a need for more ongoing epidemiologic studies to determine the scope and magnitude of injury in football. Additionally, there is a need for randomized controlled trials to study the effectiveness of knee bracing.and the preventive effects of helmets and other protective equipment. Studies should also be conducted in younger populations who may not have an experienced medical clinician or trainer on staff.