August 2017

Out on a Limb: Seeking a safer preseason

Jordana Bieze Foster, Editor

Anyone watching the injuries accumulate during the most recent National Football League (NFL) preseason might be en­couraged by the league’s  plans to shorten the pre­season from four weeks to three. But the medical literature suggests a much better way to reduce the incidence of preseason injuries.

It’s no secret that injury incidence in the NFL is significantly higher during the preseason than during the regular season, and that definitely includes lower extremity injuries. A 2016 study found anterior cruciate ligament tears in the NFL were most prevalent during the month of August; 20 such injuries were reported this year before the second week of the preseason was over. Similarly, a 2011 study found more than half of all hamstring strains in the NFL occurred during the preseason; at least 50 had been reported short of midway through this year’s preseason.

Shortening the preseason won’t make the injury problem go away; it will just ensure a higher rate of injuries during the first few weeks of games that count.

But something that actually could make a difference is monitoring load. This could involve keeping track of overall workload for each player, in terms of the intensity of one practice or game versus the next, or the cumulative intensity of one week versus the next, for example. A study published in late July by the Journal of Strength & Conditioning Research used global positioning system (GPS) technology to calculate workload in collegiate football players and found higher cumulative loads for each week of the preseason relative to the regular season.

Load-monitoring technologies will have a much greater impact on NFL injuries than simply shortening the preseason.

High cumulative loads in the preseason aren’t necessarily bad, particularly for players who regularly put in high intensity workouts during the off-season. But research in other sports suggests that, for athletes whose off-seasons are more like what the rest of us think of as a vacation, a significant spike in workload can dramatically increase injury risk.

GPS-based workload calculations, of course, can’t zero in on how much load is being experienced by specific anatomical structures that may be vulnerable to injury. But other new technologies are using wearable sensors to help narrow that focus.

In a study epublished on August 1 by the American Journal of Sports Medicine, researchers used a sensor-embedded sleeve to calculate varus torque on the elbow through each phase of the pitching motion in 81 professional baseball players. This technology, if used to track elbow loads during the course of a game or a season, could go a long way toward preventing Tommy John injuries. It’s not a stretch to think that similar technology, adapted for lower body use, could help identify dangerous acute or cumulative load levels in lower extremity muscles, ligaments, tendons, or bones in time to prevent an injury before it derails a player’s season.

Many, if not all, NFL teams have access to these types of technologies. It will take time, of course, to determine the most efficient and effective ways to use them to assess injury risk. But that kind of evidence-based paradigm shift will have a much greater impact on NFL injuries than simply shortening the preseason.

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