Injury rates in the National Football League during the 2020 COVID-19 season

ABSTRACT

Objectives

The National Football League (NFL) altered the 2020 season due to the COVID-19 pandemic, which resulted in canceled preseason games and a dynamic regular season schedule to accommodate for canceled games. The purpose of this study was to evaluate if the disrupted training and preseason schedule lead to increased injury rates as seen in other professional sports. We hypothesized that the overall injury rate would be higher in the 2020 season compared to the 2018–2019 seasons and that this increase will affect all body regions equally.

Methods

Publicly released NFL weekly injury reports were queried to identify players listed as out or placed on the injured reserve for at least one game in the 2018–2020 seasons. Injuries were categorized into upper extremity, lower extremity, spine/core, head, illness, not injury related and undisclosed injuries. Incidents per 1000 athlete exposures were calculated for the prior two seasons (2018–2019) and for the 2020 season separately. Percentage of injuries occurring in each position was calculated separately for the pre-COVID-19 (2018 and 2019) and post-COVID-19 (2020) cohorts. Incidence rate ratios (IRR) and confidence intervals were used to compare injury rates in 2018–2019 versus 2020. The z-test for proportions was used to determine significant differences between injury incidences.

Results

The overall incidence rate per 1000 athlete exposures in 2020 was not significantly different compared to pre-COVID-19 seasons (21.6 versus 23.1, IRR 0.94, 95% CI: 0.9–1.0 p > 0.999). The proportion of injuries by position did not change before and after COVID-19 either (p > 0.999). Out listings due to illness were significantly increased during the 2020 season (0.8 versus 0.3, IRR 2.8, 95% CI: 1.4–5.2, p = 0.004).

Conclusion

The incidence of NFL injuries did not significantly change in 2020. The distribution of injuries did not change with respect to position.

KEYWORDS:

• Football
• American football
• injury
• epidemiology
• COVID-19

Disclosure statement

Dr Stone reports the following potential conflicts of interest: AOSSM and AANA membership; education for Smith and Nephew, Arthrex, and MedWest Associates; travel and lodging from Smith and Nephew and Styker; food and beverage from Styker, Smith and Nephew, CDC Medical LLC, Vericel Corporation, Wright Medical Technology Inc; consultant Smith and Nephew, Allosource; Research support Flexion therapeutics, Allosource.

Dr Johnson reports the following potential conflicts of interest: Consulting for Smith and Nephew, royalties from Smith and Nephew, travel and lodging from Smith and Nephew, food and beverage from Smith and Nephew, Medtronic Vascular, and DJO LLC.

Dr Jacobs reports the following potential conflicts of interest: Consulting for Flexion Therapeutics and grants from Flexion Therapeutics and Smith and Nephew.

Dr Stockwell reports the following potential conflicts of interest: Education for Medical Device Business Services, Inc., food and beverage from Depuy Synthes Sales Inc. and Stryker.

Drs Platt and Collofello report no potential conflicts of interest.

Data availability statement

The data supporting the findings of the study are available within the article, supplementary materials, and via the following link https://docs.google.com/spreadsheets/d/19axN3Xa-RXWW2IlJJ22PY-nxlv8yQrMgIS-b3QnipsQ/edit?usp=sharing

Supplementary material

Supplemental data for this article can be accessed here.