This systematic review examines risk factors for injuries in college football. We reviewed published manuscripts of original studies (1979 -2021) that examined risk factors of injuries among National Collegiate Athletic Association (NCAA) football players. The risk factors for NCAA football related injuries are interrelated and multifactorial inlcuding player characteristics and attributes (such as player position, history of injuries, fatigue, and muscle imbalancey), training factors (like insufficient recovery, high-intensity workloads), and game-related factors (including increased exposure to contact and high-friction surfaces).
AlbrightJ. P.PowellJ. W.SmithW.MartindaleA.CrowleyE.MonroeJ.MillerR.ConnollyJ.HillB. A.MillerD.HelwigD.MarshallJ. (1994). Medial collateral ligament knee sprains in college football: Brace wear preferences and injury risk. The American Journal of Sports Medicine, 22(1), 2–11. https://doi.org/10.1177/036354659402200102
2.
BartelsD.HevesiM.WylesC.MacalenaJ. A.KakarS.KrychA. J. (2019). Epidemiology of hand and wrist injuries in National Collegiate Athletic Association football players from 2009 to 2014: Incidence and injury patterns. Orthopaedic Journal of Sports Medicine, 7(7_suppl5), Article 2325967119S0041. https://doi.org/10.1177/2325967119S00414
3.
BaughC. M.KiernanP. T.KroshusE.DaneshvarD. H.MontenigroP. H.McKeeA. C.SternR. A. (2015). Frequency of head-impact–related outcomes by position in NCAA division I collegiate football players. Journal of Neurotrauma, 32(5), 314–326. https://doi.org/10.1089/neu.2014.3582
4.
BegierE. M.FrenetteK.BarrettN. L.MsharP.PetitS.BoxrudD. J.Watkins-ColwellK.WheelerS.CebelinskiE. A.GlennenA. (2004). A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clinical Infectious Disease, 39(10), 1446–1453.
5.
BodenB. P.BreitI.BeachlerJ. A.WilliamsA.MuellerF. O. (2013). Fatalities in high school and college football players. The American Journal of Sports Medicine, 41(5), 1108–1116. https://doi.org/10.1177/0363546513478572
6.
BradleyJ.HonkampN. J.JostP.WestR.NorwigJ.KaplanL. D. (2008). Incidence and variance of knee injuries in elite college football players. American Journal of Orthopedics (Belle Mead, N.J.), 37(6), Article 310.
7.
BuckleyW. E. (1988). Concussions in college football: A multivariate analysis. The American Journal of Sports Medicine, 16(1), 51–56. https://doi.org/10.1177/036354658801600109
8.
BurkeT. M.LismanP. J.MaguireK.SkeikyL.ChoynowskiJ. J.CapaldiV. F.WilderJ. N.BragerA. J.DobrosielskiD. A. (2020). Examination of sleep and injury among college football athletes. The Journal of Strength & Conditioning Research, 34(3), 609–616.
9.
ButlerR. J.LehrM. E.FinkM. L.KieselK. B.PliskyP. J. (2013). Dynamic balance performance and noncontact lower extremity injury in college football players: An initial study. Sports Health: A Multidisciplinary Approach, 5(5), 417–422. https://doi.org/10.1177/1941738113498703
10.
CacceseJ. B.HouckZ.KaminskiT. W.ClugstonJ. R.IversonG. L.BrykK. N.OldhamJ. R.PasquinaP. F.BroglioS. P.McAllisterT. W.McCreaM.HoyA. M. R.HazzardJ. B.KellyL. A.OrtegaJ. D.PortN.PutukianM.LangfordT. D.GizaC. C., . . . the CARE Consortium Investigators. (2020). Estimated age of first exposure to American football and outcome from concussion. Neurology, 95(21), e2935–e2944. https://doi.org/10.1212/WNL.0000000000010672
11.
CahillB. R.GriffithE. H. (1979). Exposure to injury in major college football: A preliminary report of data collection to determine injury exposure rates and activity risk factors. The American Journal of Sports Medicine, 7(3), 183–185. https://doi.org/10.1177/036354657900700309
12.
CairnsM. A.HastyE. K.HerzogM. M.OstrumR. F.KerrZ. Y. (2018). Incidence, severity, and time loss associated with collegiate football fractures, 2004-2005 to 2013-2014. The American Journal of Sports Medicine, 46(4), 987–994. https://doi.org/10.1177/0363546517749914
13.
ChandranA.MorrisS. N.PowellJ. R.BoltzA. J.RobisonH. J.CollinsC. L. (2021). Epidemiology of injuries in national collegiate athletic association men’s football: 2014–2015 through 2018–2019. Journal of Athletic Training, 56(7), 643–650.
14.
ChristopherZ. K.MakovickaJ. L.ScottK. L.HassebrockJ. D.PatelK. A.ChungA. S.TummalaS. V.HydrickT. C.GinnJ.ChhabraA. (2019). Elbow injuries in national collegiate athletic association football players: An epidemiological study spanning 5 academic years. Orthopaedic Journal of Sports Medicine, 7(9), Article 2325967119867411. https://doi.org/10.1177/2325967119867411
15.
ChungA. S.MakovickaJ. L.HassebrockJ. D.PatelK. A.TummalaS. V.DeckeyD. G.HydrickT. C.RubelN. C.ChhabraA. (2019). Epidemiology of cervical injuries in NCAA football players. Spine, 44(12), 848–854.
16.
DickR.FerraraM. S.AgelJ.CoursonR.MarshallS. W.HanleyM. J.ReifsteckF. (2007). Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. Journal of Athletic Training, 42(2), Article 221.
17.
DragooJ. L.BraunH. J.BartlinskiS. E.HarrisA. H. (2012). Acromioclavicular joint injuries in National Collegiate Athletic Association football: Data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System. The American Journal of Sports Medicine, 40(9), 2066–2071.
18.
GreenJ.ZuckermanS. L.DaltonS. L.DjokoA.FolgerD.KerrZ. Y. (2017). A 6-year surveillance study of “Stingers” in NCAA American Football. Research in Sports Medicine, 25(1), 26–36.
19.
GoodmanA. D.DeFrodaS. F.GilJ. A.KleinerJ. E.LiN. Y.OwensB. D. (2018). Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014. The American Journal of Sports Medicine, 46(8), 1936–1942.
20.
HassebrockJ. D.PatelK. A.MakovickaJ. L.ChungA. S.TummalaS. V.HydrickT. C.GinnJ. E.HartiganD. E.ChhabraA. (2019). Elbow Injuries in National Collegiate Athletic Association Athletes: A 5-Season Epidemiological Study. Orthopaedic Journal of Sports Medicine, 7(8), 2325967119861959.
21.
HootmanJ. M.DickR.AgelJ. (2007). Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), Article 311.
22.
HouckZ.AskenB.BauerR.PothastJ.MichaudetC.ClugstonJ. (2016). Epidemiology of sport-related concussion in an NCAA division I Football Bowl Subdivision sample. The American Journal of Sports Medicine, 44(9), 2269–2275. https://doi.org/10.1177/0363546516645070
23.
HuntK. J.GeorgeE.HarrisA. H.DragooJ. L. (2013). Epidemiology of syndesmosis injuries in intercollegiate football: Incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004-2005 to 2008-2009. Clinical Journal of Sport Medicine, 23(4), 278–282.
24.
KaplanL. D.JostP. W.HonkampN.NorwigJ.WestR.BradleyJ. P. (2011). Incidence and variance of foot and ankle injuries in elite college football players. American Journal of Orthopedics (Belle Mead, N.J.), 40(1), 40–44.
25.
KayM. C.Register-MihalikJ. K.GrayA. D.DjokoA.DompierT. P.KerrZ. Y. (2017). The epidemiology of severe injuries sustained by National Collegiate Athletic Association student- athletes, 2009–2010 through 2014–2015. Journal of Athletic Training, 52(2), 117–128.
26.
KerrZ. Y.HaydenR.DompierT. P.CohenR. (2015). Association of equipment worn and concussion injury rates in National Collegiate Athletic Association Football Practices: 2004–2005 to 2008–2009 academic years. The American Journal of Sports Medicine, 43(5), 1134–1141. https://doi.org/10.1177/0363546515570622
27.
KerrZ. Y.SimonJ. E.GroomsD. R.RoosK. G.CohenR. P.DompierT. P. (2016). Epidemiology of football injuries in the National Collegiate Athletic Association, 2004-2005 to 2008-2009. Orthopaedic Journal of Sports Medicine, 4(9), Article 2325967116664500. https://doi.org/10.1177/2325967116664500
28.
KerrZ. Y.ThomasL. C.SimonJ. E.McCreaM.GuskiewiczK. M. (2018). Association between history of multiple concussions and health outcomes: 15-year follow-up from the NCAA concussion study (1999–2001). The American Journal of Sports Medicine, 46(7), 1733–1741. https://doi.org/10.1177/0363546518765121
29.
KmushB. L.MackowskiM.EhrlichJ.WaliaB.OworaA.SandersS. (2020). Association of professional football cumulative head impact index scores with all-cause mortality among National Football League players. JAMA Network Open, 3(5), Article e204442.
30.
KrillM. K.BorchersJ. R.HoffmanJ. T.KrillM. L.HewettT. E. (2020). Analysis of football injuries by position group in Division I college football: A 5-year program review. Clinical Journal of Sport Medicine, 30(3), 216–223.
31.
KrillM. K.BorchersJ. R.HoffmanJ. T.TatarskiR. L.HewettT. E. (2017). Effect of exposure type and timing of injuries in Division I college football: A 4-year single program analysis. The Physician and Sports Medicine, 45(1), 26–30. https://doi.org/10.1080/00913847.2017.1279520
32.
KrillM. K.TatarskiR.BorchersJ.HewettT. E. (2016). Timing of injuries and type of exposure in Division I college football: A 3-year review: 3080 Board# 145 June 3, 3:30 PM-5:00 PM. Medicine & Science in Sports & Exercise, 48(5S), Article 873.
33.
KrillM. L.NagelliC.BorchersJ.KrillM. K.HewettT. E. (2018). Effect of concussions on lower extremity injury rates at a Division I collegiate football program. Orthopaedic Journal of Sports Medicine, 6(8), Article 232596711879055. https://doi.org/10.1177/2325967118790552
34.
LeeK. M.KayM. C.KuceraK. L.PrenticeW. E.KerrZ. Y. (2019). Epidemiology of cervical muscle strains in collegiate and high school football athletes, 2011–2012 through 2013–2014 academic years. Journal of Athletic Training, 54(7), 780–786.
35.
LewisR. A.CookC. R.SmithP. A.StannardJ. P.SharpR. L.BlechaK. M.CookJ. L. (2020). Knee ultrasonography to determine risk for noncontact injuries in collegiate American football players. The Journal of Knee Surgery, 33(07), 666–672. https://doi.org/10.1055/s-0039-1683953
36.
LiaoS.LynallR. C.MihalikJ. P. (2016). The effect of head impact location on day of diagnosed concussion in college football. Medicine and Science in Sports and Exercise, 48(7), 1239–1243.
37.
LoughranG. J.VulpisC. T.MurphyJ. P.WeinerD. A.SvobodaS. J.HintonR. Y.MilzmanD. P. (2019). Incidence of knee injuries on artificial turf versus natural grass in National Collegiate Athletic Association American Football: 2004–2005 through 2013–2014 seasons. The American Journal of Sports Medicine, 47(6), 1294–1301. https://doi.org/10.1177/0363546519833925
38.
LynallR. C.KerrZ. Y.ParrM. S.HackneyA. C.MihalikJ. P. (2016). Division I college football concussion rates are higher at higher altitudes. Journal of Orthopaedic & Sports Physical Therapy, 46(2), 96–103. https://doi.org/10.2519/jospt.2016.6315
39.
MakovickaJ. L.ChhabraA.PatelK. A.TummalaS. V.HartiganD. E. (2019). A decade of hip injuries in national collegiate athletic association football players: An epidemiologic study using national collegiate athletic association surveillance data. Journal of Athletic Training, 54(5), 483–488.
40.
MakovickaJ. L.PatelK. A.DeckeyD. G.HassebrockJ. D.ChungA. S.TummalaS. V.HydrickT. C.GulbrandsenM.HartiganD. E.ChhabraA. (2019). Lower back injuries in National Collegiate Athletic Association Football Players: A 5-season epidemiological study. Orthopaedic Journal of Sports Medicine, 7(6), Article 232596711985262. https://doi.org/10.1177/2325967119852625
41.
McCunnR.FullagarH. H.WilliamsS.HalsethT. J.SampsonJ. A.MurrayA. (2017). The influence of playing experience and position on injury risk in NCAA Division I college football players. International Journal of Sports Physiology and Performance, 12(10), 1297–1304.
42.
MeyerS. A.SchulteK. R.CallaghanJ. J.AlbrightJ. P.PowellJ. W.CrowleyE. T.El-KhouryG. Y. (1994). Cervical spinal stenosis and stingers in collegiate football players. The American Journal of Sports Medicine, 22(2), 158–166. https://doi.org/10.1177/036354659402200202
43.
MeyersM. C. (2010). Incidence, mechanisms, and severity of game-related college football injuries on FieldTurf versus natural grass: A 3-year prospective study. The American Journal of Sports Medicine, 38(4), 687–697. https://doi.org/10.1177/0363546509352464
44.
MontenigroP. H.AloscoM. L.MartinB. M.DaneshvarD. H.MezJ.ChaissonC. E.NowinskiC. J.AuR.McKeeA. C.CantuR. C.McCleanM. D.SternR. A.TripodisY. (2017). Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. Journal of Neurotrauma, 34(2), 328–340. https://doi.org/10.1089/neu.2016.4413
PetrieT. A.DeitersJ.HarmisonR. J. (2014). Mental toughness, social support, and athletic identity: Moderators of the life stress–injury relationship in collegiate football players. Sport, Exercise, and Performance Psychology, 3(1), Article 13.
48.
Rahnemai-AzarA. A.YaseenZ.Van EckC. F.IrrgangJ. J.FuF. H.MusahlV. (2016). Increased lateral tibial plateau slope predisposes male college football players to anterior cruciate ligament injury. The Journal of Bone and Joint Surgery, 98(12), 1001–1006.
49.
RowsonS.DumaS. M.GreenwaldR. M.BeckwithJ. G.ChuJ. J.GuskiewiczK. M.MihalikJ. P.CriscoJ. J.WilcoxB. J.McAllisterT. W. (2014). Can helmet design reduce the risk of concussion in football?Journal of Neurosurgery, 120(4), 919–922.
50.
SampsonJ. A.MurrayA.WilliamsS.HalsethT.HanischJ.GoldenG.FullagarH. H. K. (2018). Injury risk-workload associations in NCAA American college football. Journal of Science and Medicine in Sport, 21(12), 1215–1220.
51.
SampsonJ. A.MurrayA.WilliamsS.SullivanA.FullagarH. H. (2019). Subjective wellness, acute: Chronic workloads, and injury risk in college football. The Journal of Strength & Conditioning Research, 33(12), 3367–3373.
52.
SinghR.MeierT. B.KuplickiR.SavitzJ.MukaiI.CavanaghL.AllenT.TeagueT. K.NerioC.PolanskiD. (2014). Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA, 311(18), 1883–1888.
53.
SmithJ. J.BaerD. J. (2020). Preseason injury rates in a division II football team before and after the 2017 NCAA practice rule changes. International Journal of Athletic Therapy and Training, 25(1), 17–20.
54.
SmithM. V.NeppleJ. J.WrightR. W.MatavaM. J.BrophyR. H. (2017). Knee osteoarthritis is associated with previous meniscus and anterior cruciate ligament surgery among elite college American football athletes. Sports Health: A Multidisciplinary Approach, 9(3), 247–251. https://doi.org/10.1177/1941738116683146
55.
TummalaS. V.HartiganD. E.PatelK. A.MakovickaJ. L.ChhabraA. (2018). Shoulder injuries in National Collegiate Athletic Association quarterbacks: 10-year epidemiology of incidence, risk factors, and trends. Orthopaedic Journal of Sports Medicine, 6(2), Article 232596711875682. https://doi.org/10.1177/2325967118756826
56.
WestermannR. W.KerrZ. Y.WehrP.AmendolaA. (2016). Increasing lower extremity injury rates across the 2009–2010 to 2014–2015 seasons of National Collegiate Athletic Association football: An unintended consequence of the “targeting” rule used to prevent concussions?The American Journal of Sports Medicine, 44(12), 3230–3236. https://doi.org/10.1177/0363546516659290
57.
WilkersonG. B. (2012). Neurocognitive reaction time predicts lower extremity sprains and strains. International Journal of Athletic Therapy and Training, 17(6), 4–9.
58.
WisniewskiJ. F.GuskiewiczK.TropeM.SigurdssonA. (2004). Incidence of cerebral concussions associated with type of mouthguard used in college football. Dental Traumatology, 20(3), 143–149. https://doi.org/10.1111/j.1600-4469.2004.00259.x
59.
ZemperE. D. (1994). Analysis of cerebral concussion frequency with the most commonly used models of football helmets. Journal of Athletic Training, 29(1), 44.
