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Heads Up Football Training Decreases Concussion Rates in High School Football Players

Shanley, Ellen, PT, PhD, OCS*,†; Thigpen, Charles, PhD, PT, ATC*,†; Kissenberth, Michael, MD†,‡; Gilliland, Robert Gil, ATC; Thorpe, John, ATC; Nance, Darryl, CMAA, CIC§; Register-Mihalik, Johna K., PhD, ATC; Tokish, John, MD†,‡

doi: 10.1097/JSM.0000000000000711
Original Research: PDF Only

Objective: The objective of this study was to determine whether football players receiving heads up (HU) training would display a lower rate of sport-related concussion (SRC) compared to those without HU training.

Design: Prospective cohort.

Setting: Scholastic football fields.

Patients: Two thousand five hundred fourteen scholastic football players during the 2015 to 2016 football season were monitored throughout the football season.

Interventions: Before the preseason, 1 coach from 14 schools received HU training from US football. These schools were matched with 10 control schools performing standard football training [non–heads up (NHU)]. Random monitoring for proper coaching instruction was performed during the season. School athletic trainers monitored injuries and return to sport over the season for all schools.

Main Outcome Measures: The outcome measures of concussions and associated time loss were determined before data collection began. Injury incidence and rate ratios were calculated to determine program effectiveness.

Results: During the season, football players sustained 117 concussions (HU = 75; NHU = 42). The HU players displayed a significantly lower concussion rate (4.1 vs 6.0/100 players) compared with NHU teams [rate ratio = 1.5; 95% confidence interval (CI), 1.1-5.4]. The HU group returned to full participation 27% faster than athletes in the NHU group [time loss: 18.2 days (95% CI, 15.8-20.6) vs 24.8 days (95% CI, 19.9-29.7)], respectively.

Conclusions: This is the first study to evaluate the impact of the HU program on the incidence of SRC in high school football players. Our data demonstrated that the HU program reduced SRC rates by 33% supporting the use of US HU football training as an effective method to decrease the rate of SRCs in scholastic football.

Clinical Relevance: This study is the first to prospectively explore the effect of HU training on the incidence and recovery from SRC in high school football players.

*ATI Physical Therapy, Greenville, South Carolina;

Center for Effectiveness Research in Orthopedics, SmartState Centers, University of South Carolina, Greenville, South Carolina;

Steadman-Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, South Carolina;

§Greenville County School System, Greenville, South Carolina; and

Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina.

Corresponding Author: Ellen Shanley, PT, PhD, OCS, Center for Effectiveness Research in Orthopedics, University of South Carolina, 200 Patewood Rd Suite 100, Greenville, SC 29615 (

The authors report no conflicts of interest.

The Athletic Directors, Athletic Trainers, Athletes, and Parents associated with Greenville County School System (Greenville, SC).

Received March 13, 2018

Accepted August 24, 2018

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