Article Featured on Complete Concussion Management

Concussion is a serious concern for all athletes, particularly for those involved in contact, high-speed or collision sports. These injuries have become a significant issue for certain sports. In fact, some contact sports, such as American or tackle football, are seeing a decline in registration and participation year over year.

But, what sport – or sports – has the most concussions? What sports have higher concussion rates? What sports pose the greatest risk to athletes?

Looking at the research on concussion rates

There have been several large-scale epidemiological studies, which have examined the incidence rate of concussions in various sports for male and female athletes. Many of these studies look at the concussion rates in practices compared to games as well as youth sports compared to adult sports.

We went through some of the research using recent systematic reviews and meta-analyses – which are basically a collection of ALL the research put together – to bring you a summary of the sports with the highest risk for concussion.

The results may surprise you…

Athletic exposures: how we measure concussion rates

The rate of concussion is generally measured in ‘Athlete Exposures’ (AE). This is defined as one athlete participating in one game or practice.

The numbers for concussion incidence rate are typically shown as “X” per 1,000 AE.

This means that there are “X” number – or a certain number – of injuries for every 1,000 times one athlete plays in one practice or game.

Let’s look at a sport like football. A football team has about 50 players on the roster. Therefore, a practice would equal 50 AE, and a game played between 2 teams would be 100 AE. In other words, 10 games is equal to 1,000 AE in American football.

Adult athletes (18 years and older)

According to a recent systematic review, examining the concussion rate in team sports, men’s rugby was found to have the highest incidence of concussion in both match play (3.00/1,000 AE) and practice (0.37/1,000 AE).[1]

Men’s tackle football came in second for match play concussion rate at 2.5 per 1,000 AE, and third for concussions experienced during practice (0.30/1,000 AE).[1]

Women’s ice hockey came in third for match-play concussions with 2.27 per 1,000 AE and second for practice concussions with 0.31 per 1,000 AE.[1]

Check out the full list below:

Game Play

  1. Men’s rugby match play (3.00/1,000 AE)
  2. Men’s American football (2.5/1,000 AE)
  3. Women’s ice hockey (2.27/1,000 AE)
  4. Men’s Ice hockey (1.63/1,000 AE)
  5. Women’s soccer (1.48/1,000 AE)
  6. Men’s football (or soccer) (1.07/1,000 AE)

During practice

  1. Men’s rugby (0.37/1,000 AE)
  2. Women’s ice hockey (0.31/1,000 AE)
  3. Men’s American football (0.30/1,000 AE)
  4. Women’s football (or soccer) (0.13/1,000 AE)
  5. Men’s ice hockey (0.12/1,000 AE)
  6. Men’s football (or soccer) (0.08/1,000 AE)

One important finding is that in sports played by both men and women, women sports typically had a higher rate of concussion. This is especially interesting in sports like hockey. Women’s hockey is non-contact, but has a higher rate of concussion compared to men’s hockey – which is full body contact.

Youth athletes (18 years and under)

Concussions in youth sports are particularly concerning as recent evidence suggests that the earlier in life a concussion is experienced, the higher likelihood of having prolonged complications. This is potentially due to injuring a brain that is still developing.

Similar to adult sports, the youth sport with the highest rate of concussion is rugby at 4.18 concussions per 1,000 AE.[2] Unlike the above study, the youth study did not separate injury rate by male or female, or by games or practice.

Ice hockey had the second highest concussion rate with 1.20 concussions per 1, 000 AE. American football came in third (0.53 concussions/1000 AE).[2] See the full list below:

  1. Rugby (4.18/1,000 AE)
  2. Ice hockey (1.20/1,000 AE)
  3. American football (0.53/1,000 AE)
  4. Lacrosse (0.24/1,000 AE)
  5. Football (or soccer) (0.23/1,000 AE)
  6. Wrestling (0.17/1,000 AE)
  7. Basketball (0.13/1,000 AE)
  8. Softball & Field Hockey (Tie) (0.10/1,000 AE)
  9. Baseball (0.06/1,000 AE)
  10. Cheerleading (0.07/1,000 AE)
  11. Volleyball (0.03/1,000 AE)

Concussion vs. other injuries

Concussions account for a significant number of injuries in high school sports. In a 2012 study, researchers found that concussions account for over 15% of all injuries in some very popular sports.[3]

  • Boys’ ice hockey: 23%
  • Girls’ lacrosse: 21%
  • Cheerleading: 20%
  • Boys’ lacrosse: 17%
  • Football: 17%
  • Girls’ soccer: 15%

There are some significant limitations to these studies. It’s important to realize that as many as 50% of all concussions are not reported. This could be for a variety of reasons such as the culture of toughness in sport or for fear of missing games, for example.

There are also many sports that are missing from these lists because they do not have reliable tracking metrics at this time. Please take the above information with a grain of salt.

Involved in sport? Concussions are bound to happen in sport, but how we manage these injuries can make a big difference. As part of our commitment to athletes and sport, we develop, implement and enhance evidence-informed concussion management programs for sports and schools. What are you doing to help keep your athletes safe? Provide the program that’s right for you and your athletes!

Fall is arguably the most beautiful season of the year.  Cooler temperatures, comfy sweaters, the smell of a fire burning in the fireplace and the changing colors of nature that surround us in the beautiful northwest.  Raking leaves can be an enjoyable way to spend time outdoors, soaking up the sights and smells of the season. Be careful out there, though, because if you’re not careful you could end up with back pain or sciatica or other potential injuries.

One of the most common complaints following several hours of raking leaves is low back pain. The repetitive movements and constant bending and lifting can wreak havoc on your back. If you’re not careful it’s easy to injure your back, making everyday activities and a good night’s sleep a challenge.

Rose City Physical Therapy is very familiar with back pain experienced by homeowners trying to keep up with constantly falling leaves. Every autumn they see many patients complaining of low back pain and sciatica after a weekend of raking leaves.

“One of the biggest mistakes many people make when raking leaves is not raking with both sides of the body,” says Rose City Physical Therapy. Most people only rake with their dominant hand causing the muscles and other tissues to strain on one side of the body. Switching hands is important to give those muscles a break and to build up strength in the same muscles on the other side.

Rose City Physical Therapy recommends following these 12 tips when raking leaves to help reduce muscle fatigue and to ideally avoid back pain all together.

Original Article found at easyrest.com
1. Warm up.
 Take a 5-10 minute brisk walk to warm up your muscles. Avoid any stretching of cold muscles prior to the activity. Scientific evidence reports that stretching without a warm-up increases risk of injury and there is no evidence that stretching before an activity prevents injury.

2. Choose the Right Rake. Use a rake that is proportionate to your body size. Using a rake that is too long or too short will cause you to alter your posture and strain your muscles. Consider the rake width. Narrow rakes may make the weight of the leaves lighter but they can also make the job longer. Extra wide rakes gather more leaves but can put more of a strain on your back.

3. Watch Your Posture. Like any exercise, proper form is important. Muscle pain and strain occurs when you put your body in awkward positions and then try to contract or extend muscles in these odd positions. To maintain proper posture while raking keep your legs slightly bent, your weight centered, and reach with your arms and not your back. After every 20 minutes of raking activity stand up, place hands on hips and gently stretch into a back bend for a few seconds 3-5 times especially before lifting anything. Do not extend to the point of causing pain.

4. Switch Hands Frequently. You exhaust your muscles with repetitive motion. Switch your lead arm frequently while raking to prevent, or alleviate, muscle exhaustion

5. Bend With Your Knees. When lifting leaves keep your back straight and bend with your knees and hips, not your back, when reaching down. The power for your lift comes from your buttocks and legs. Make the piles small to decrease the weight.

6. Rake With the Wind. Let Mother Nature give you a hand if possible. Rake leaves with the wind, even if the spot in the yard is different from where you wanted to rake the leaves.

7.Use a Tarp. Leaves are lightweight and can easily be moved on a tarp. Rake the leaves onto the tarp and pull one end of the tarp to move the leaves to your desired location. Doing this can save your back constant bending over to pick up piles of leaves to put into a garbage bag or wheelbarrow.

8.Drink Plenty of Water. Muscles need water to function optimally. When you maintain your body’s hydration during activity, you reduce the risk of muscle strain.

9.Wear Good Shoes. Wear supportive shoes with good support and skid-resistant soles. Standing on your feet and raking all day can put a lot of strain on your feet and legs. Good foot support can stop some of that strain from reaching your back and skid-resistant soles can minimize the risk of slipping on wet leaves and falling.

10. Consider a Leaf Blower. There are some lightweight gas and electric leaf blowers on the market that are hand held or can be worn like a backpack. Blowing all the leaves into one large pile or onto a tarp can save time and lots of energy.

11. Wear Gloves. Give your hands a break and wear gloves to prevent painful blisters.

12. Take Frequent Breaks. Taking your time will make it less likely for injuries to occur. Pushing yourself to the point of exhaustion can cause you to get sloppy with good posture and lifting techniques, setting you up for injury.

What can you do if you follow all of these tips and still wind up with low back pain?

We recommend conservative treatments including:

  • Ice pack for 20 minutes three times daily for 2-3 days for an acute injury. Alternate moist heat and ice treatments thereafter, or just use moist heat.
  • Exercise, stretching techniques, or physical therapy to repair and strengthen muscles.
  • Lifestyle changes such as weight loss and regular exercise.
  • Propping pillows behind your back when sitting to avoid slouched postures, and under knees when resting in bed to take pressure off of your lower back.

Contact us to set up a complimentary 20-minute consultation if you are experiencing back pain or sciatica, or if you have any questions.


Karl Kolbeck is a physical therapist and along with his wife Sasha they own Rose City Physical Therapy located in NW Portland. He’s been practicing for 25 years with specialties in treating the shoulder as well as runners. Karl is dual board certified in both orthopedic and sports clinical specialties, is certified in manual and manipulative therapy and is a fellow of the American Academy of Orthopedic Manual Physical Therapists. He teaches rehab based continuing medical education courses to physicians, physical therapists and athletic trainers across the nation. He and his staff are involved with multiple running groups in the Portland metro area, offering educational sessions and athlete screenings. Karl also provides care for the Bowerman Track Club Nike professional running team based in Portland.

Motivation for sports participation includes enjoyment, social outlet, stress management, and cardiac, musculoskeletal and general health. As we age, there is the desire to continue to be active and avoid injury.

Often referenced as one of the top three running related injuries, plantar fasciopathy – commonly termed plantar fasciitis or plantar fasciosis – can be one of the most painful and limiting of running related injuries.