high school football player making a tackle
Preventing Common High School Football Injuries

Preventing Common High School Football Injuries

In November 2015, Luke Schemm of Wallace County, Kansas became the eighth high school player to die in that football season. According to his father, he died of a traumatic brain injury. At least three other high school players’ deaths earlier in the year were due to heat stroke or cardiac arrest.

Fatal Injuries:

At least 12 high school football players die every year, according to the New York Daily News, with the majority dying from cardiac and heat-related causes. Non-traumatic causes of death are twice as common as injury-related ones. Data from the National Center for Catastrophic Sports Injury Research recorded 243 football deaths between 1990 and 2010.

  • Nearly half (100 deaths) were due to underlying heart conditions that were not assessed during player recruitment.
  • Brain injury (usually subdural hematoma) accounted for 62 deaths.
  • Thirty-eight were heat-related. In fact, many of those deaths occurred in southern states during hectic pre-season play.
  • Sixteen deaths were caused by underlying and diagnosed problems like sickle-cell anemia, which makes players vulnerable to dehydration and low oxygen during practice, and asthma which causes breathing issues especially after blows to the chest.
  • Five deaths were caused by blood clots and the remainder were caused by broken necks, abdominal injuries, infections and lightning strikes.

Limited Prevention:

Sports pre-qualification screening forms have been developed over the last few years by major sports bodies in the United States. The forms require inquiries about any chronic medical conditions (specifying asthma, diabetes, kidney problems, sickle-cell traits, heart issues, blood pressure issues), medications, allergies, head injuries in the past, heat injuries, limb fractures and family history.

The culture of high school sports makes the use of this kind of screening problematic. Coaches and team officials want to recruit good players and may tend to fill out pre-qualification forms hastily and underplay the results. Football is recognized by many as one the most dangerous sports. Stricter third-party medical disqualification requirements may be necessary.

In the 1970s a combination of rule changes, improved helmet safety standards, and medical advances have made high school football fields dramatically safer, halving the risk of death from head, neck, and spine injuries. However, after that sharp reduction, the risks have remained without further improvement. These injuries have dropped over the last decades, but remain concerning even at current levels. Indirect fatalities in football have continued to increase.

Dr. Douglas Casa, of the University of Connecticut Korey Stringer Institute, points out that since 1980 school and state governments have stopped putting in the right policies to fully protect athletes. He writes,

“The best practices are not being followed…people are just not implementing evidence-based medicine and policies at the high school level.”

Doctors and trainers who study catastrophic injuries in high school sports have recommended that people involved with high school sports on the field learn how to respond to life-threatening injuries. They recommend on-site defibrillators with the training in how to use them. They recommend immersion pools to prevent heat stroke, as well as other basic medical capabilities on the field.

Too many schools don’t have those devices or strategies in place. Too many states don’t require them. Not a single state meets their own minimum best practices requirements. Only 37 percent of high schools employ full-time athletic trainers. A majority do have part-time trainers, and 75 percent have trainers available at games (not practices). Handling medical emergencies on the front line are often untrained coaches who are unable to recognize danger and frequently place too much value on toughness and self-sufficiency.


High school players are nearly twice as likely to sustain a concussion as college players. A long-term analysis found that in 10,000 games, high school players suffered 11.2 concussions, college players suffered 6.3. That means the risk of a concussion among high school players is about 1 per 1,000 games. Among high school sports, football players have the highest risk of head injuries by far. Among college athletes, wrestling has the highest risk (followed by ice hockey).

According to the manufacturer of most high-quality sports helmets, Riddell, industry safety standard helmets only reduce the potential for concussion by 5 percent, although they do significantly reduce the risk of skull fractures.

Common Injuries: 

Nearly 1,000 athletes under the age of 18 are treated every year in emergency rooms, doctors offices, and clinics, for football-related injuries.

  • Football players do often complain about overuse injuries like low back pain, often caused by over-training.
  • Tendonitis in the knee is a common problem that can be treated by specific quadriceps strengthening programs.

However, traumatic injuries caused by the contact forces of the game are most common.

  • Knee injuries are the most common contact injuries in football, especially those affecting ligaments and cartilage of the knee.
  • Shoulder injuries are also common, especially shoulder injuries affecting the cartilage surrounding the socket part of the shoulder.

Heat Injuries:

While deaths caused by heat injuries are still comparatively rare, heat injuries are a major concern for young football players, especially when they begin practice in the late summer. Intense physical activity results in excessive water and salt depletion from sweat. This depletion causes cramping in major muscle groups. If not treated promptly with body cooling and fluid replacement the problem can progress to heat exhaustion and heat stroke.

Prevention of Common High School Football Injuries:

A complete program of injury prevention should include,

  • A pre-season health and wellness evaluation should be added to the player selection. This evaluation should go beyond the standard form but should be adjusted to account for the age of the athlete and the anticipated level of competition. It should include neuromuscular, cardiovascular, and psychological components. It should be repeated whenever the level of competition is changed.
  • Proper warm-up and cool-down activities routines should be part of training and game playing preparation. Preliminary warm-up activities and post sports cool-down activities involve doing the sport at a slower pace and reduced activity level in preparation for or following full body engagement.
  • The strength training and stretching activities should be consistent during training and between games. Strength training for football has to be more comprehensive than virtually any other sport. It has to contain different types of lifting programs. The programs may vary from position to position.
  • Hydration should be adequate to maintain health and minimize cramps. Both players and coaches have to maintain proper hydration throughout training during hot weather. Drink 12 ounces a half-hour before the activity begins. After the activity, drink every 20 minutes to make up for fluid losses. Cold water is recommended during activity. Sports drinks work well after activity to replenish lost electrolytes.
  • Players should remain active during pre-season periods to prepare for a return to sports in the fall. The best players maintain near peak condition year round (barring injury). Many players will choose to attend a spring and summer development camp held by professional and college coaches and players. Some players will seek personal coaching or cross training. Passing leagues, being established throughout the country are another route to keeping up conditioning level during the off-season.
  • Protective equipment like properly fitted helmets, pads, and mouthguards should be worn during all active training. Proper helmet fit is the key in reducing head injury. All helmets should have a current NOCSAE certification stamp. Helmets should be properly sized and the fit should be checked. Shoulder pads should be fitted only worn over a t-shirt. The fit should be tested as the pads perform during functional movements.
  • Rules about tackling with head up and not leading with the helmet should be emphasized and practiced at all times.
  • Players should not hesitate to avail themselves of sports medicine or qualified athletic trainers regarding football injuries or injury prevention strategies.

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