There are a large number of health risks associated with participating in American football. Injuries are relatively common, due to its nature as a full-contact game, and may occur during both games and practice. Several factors can affect the frequency of injuries: epidemiological studies have shown older players can be at a greater risk, while equipment and experienced coaches can reduce the risk of injury. Common injuries include strains, sprains, fractures, dislocations, and concussions. Concussions have become a concern, as they increase the risk of mental illnesses like dementia and chronic traumatic encephalopathy (CTE). In individual leagues like the National Football League (NFL) and National Collegiate Athletic Association (NCAA), a public injury report is published containing all injured players on a team, their injury and the game-day status of each player. Catastrophic injuries—defined as serious injury to the spine, spinal cord, or brain—and fatalities are uncommon in football; both have become less common since the 1970s, although a small number of them still occur each year. Both concussions and catastrophic injuries can be caused by helmet-to-helmet collisions as well as impact against the ground or other players' knees; in other cases, they can be caused by players who have sustained a head injury returning to play, which can place the player at risk of sustaining a severe injury. Despite the decrease in catastrophic injuries, a greater number of NFL players have reported major injuries and shortened careers since the 1970s, in part due to the increasing size and speed of players and the use of artificial turf. In many cases, injuries sustained while playing can cause long-term damage. In addition to neurological damage caused by hits to the head, injuries to the mid and lower body can force players to retire or lead to nagging ailments in later life. Various methods have been used to reduce injuries in football, including rule changes such as the abolition of large wedge formations; a sharp decline in cervical spine injuries since the 1970s has been attributed to rule changes that altered blocking and tackling techniques. More recently, rule changes to protect players from head injuries have been instituted. Equipment like the football helmet and pads are used to give players a level of protection from injuries, while other factors such as cleat size are used to minimize the risk of injuries due to field condition.
Injuries
Because American football is a full-contact sport, head injuries are relatively common. According to the San Francisco Spine Institute at Seton Medical Center in Daly City, California, up to 1.5 million young men participate in football annually, and there are an estimated 1.2 million football-related injuries per year. An estimated 51% of injuries occur during training sessions, while 49% occur elsewhere. Injuries are nearly 5 times more likely to happen during contact training sessions than in controlled, non-contact sessions. Older players are at the most risk for injuries, while teams with experienced coaches and more assistant coaches are less likely to experience injuries. 50% of injuries occur in the lower extremities (with knee injuries alone counting for roughly 36% of all injuries) and 30% occur in the upper extremities. The most common types of injuries are strains, sprains, bruises, fractures, dislocations, and concussions. According to the NFL Physicians Society, the most common injuries in football are "concussions, blunt injuries to the chest such as cardiac contusions, pulmonary contusions, broken ribs, abdominal injuries, splenic lacerations and kidney injuries." Orthopedic injuries to the knee, foot, ankle, shoulder, neck and back are also common, as are muscle strains to the hamstrings, quads, calves and the abdomen. Concussions are particularly concerning, as repeated concussions may increase a person's risk in later life for chronic traumatic encephalopathy (CTE) and mental health issues such as dementia, Parkinson's disease, and depression. Concussions are often caused by helmet-to-helmet collisions, impact against the ground or other players' knees, and upper-body contact between opposing players. However, helmets have prevented more serious injuries such as skull fractures. Cervical spine injuries can be catastrophic, but have sharply declined since the mid-1970s due to rule changes and improved workout regimes, equipment, and coaching. Performance-enhancing drugs (PEDs) are an issue in both high-school and professional-level football. Steroid use has been linked to an increased risk for musculoskeletal injuries among players. Human growth hormone (HGH) is used by some players to improve performance, recover from injuries, decrease aging, and to lose weight. Although none of these uses are scientifically proven or legal, HGH places users at risk for adverse side effects such as onset of diabetes and negatively impacting joints and organs such as the heart. However, there have been no studies of HGH use or the baseline levels of the hormone in NFL athletes. NFL players are routinely subject to drug tests in accordance with the NFL's two substance policies. Players found using performance-enhancing drugs, including anabolic steroids, can face suspension and other penalties. As of 2014, the league does not test for HGH use among players.
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