NCAA Concussion Tackling Rules May Be Increasing Lower Extremity Injuries

Athletes may be making contact lower on the body to avoid the head-to-head contact and thus stiffer game penalties.

In an attempt to reduce increasing rates of concussions in collegiate football players, the NCAA introduced rule changes beginning in 2008 penalizing head-to-head contact. An unintended consequence of these new tackling rule changes, however, may be an increase in knee, ankle, and thigh injuries, according to research presented at the 2016 American Orthopaedic Society for Sports Medicine (AOSSM) Specialty Day.

“With the relatively recent rule changes, concussion rates have not decreased. [However,] our analysis of the NCAA Injury Surveillance Database noted increased rates of ankle and knee injuries, which may result in osteoarthritis and disability issues later in life for these athletes,” Robert Westermann, MD, from the University of Iowa said in a statement. “Athletes may be making contact lower on the body to avoid the head-to-head contact and thus stiffer game penalties.”

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In order to assess whether injuries to lower extremities increased after concussion rule changes, Dr Westermann and colleagues examined in-game injuries suffered between 2009 and2014. Injuries that occurred in competition and that resulted in lost participation time were included, including injuries to the thigh/upper leg, knee, lower leg/Achilles, ankle, and foot, as well as concussions.

The researchers found that a total of 2400 lower extremity injuries were reported from 2009-2014, 59% of them due to player contact, with most occurring to the knee (33.6%) and ankle (28.6%). The rate of lower extremity injuries increased from 9.45 injuries per 1000 atheletic exposures in the 2009-2010 season to 12.63 injuries per 1000AE in the 2013-2014 season.

Non-contact/overuse injuries did not increase during this time period, nor did the rate of concussions significantly change (1.64 concussions per 1000 atheletic exposures in 2009-2010 season vs 2.87 concussions per 1000 AE’s in the 2013-2014 season).

“During our study period, injuries to the lower extremity have increased. In order to comply with avoiding head-to-head contact, players may be targeting the lower extremities,” the researchers wrote. “This is concerning as lower extremity injuries and post-traumatic osteoarthritis are common causes of disability in retired American Football players.”

“Our research is the first to report trends in injury patterns since ‘targeting’ rule changes took effect. Continued surveillance to examine these trends, and a more in-depth examination of how targeting rule changes are impacting injuries both at the targeted site and at other parts of the body, [need] to be performed to prevent long-term health issues,” said Dr Westermann.


Westermann RW, Wehr P, Amendola A. Unintended Consequences of Concussion Prevention in NCAA Football. Presented at: 2016 American Orthopaedic Society for Sports Medicine (AOSSM) Specialty Day. March 5, 2016; Orlando, Florida. Paper 15.