It's football season in America, which means that, in addition to all those NFL and NCAA games on the tube, players from peewee age to middle age are tossing the pigskin around in pick-up contests, recreational leagues or organized school sports.

It also means emergency departments across the nation will see an influx of football-related spine injuries, according to a new study led by Houston Methodist orthopedic spine surgeon Dr. Comron Saifi. Such injuries are more common and more serious than public perception might suggest, especially for kids and young adults ages 10 to 19.

A quick look at the study data, which Dr. Saifi is presenting at the National Association of Spine Specialists annual meeting on Sept. 29, tells you a lot about who's playing, who's not and where the vulnerabilities lie.

Emergency Department visits for football-related spine injuries from 2010 to 2019:

• • 720 per 100,000 population, or about 2.4 million Americans per year
  • 99% male; 1% female
  • 68% 10-19 years old; 11% 20-29; 9% 30-39; 7% 50-59; 3% 40-49; 1%; .2% 60+
  • 51% White; 34% Hispanic; 15% Black; 0.1% Asian
  • 73% routine discharge; 27% admitted to the hospital
  • 62% fracture of vertebrae; 38% nerve injury
  • 40% thoracic (upper trunk); 37% lumbar (lower spine); 23% cervical (neck)
    
    

Dr. Saifi sat down with Leading Medicine to discuss the study, its findings and the implications for those at highest risk of serious injury.

Q: Why did you want to study football-related spine injuries?

Football remains the most popular spectator sport in America. However, we need to be cognizant about the potential for injuries, particularly to the spine. Football is one of the most popular and widely played sports among school-aged children and adolescents. We wanted to study football-related injuries over time throughout the United States. Specifically, we wanted to learn about the severity of spine injuries occurring in middle school, high school and college-aged students.

Q: How did you find the people that you included in the study?

We utilized the National Electronic Injury Surveillance System (NEISS) database. A big strength of this study is that we are looking at a representative sample of the entire U.S. It gives us a good snapshot of regular, everyday folks, high school sports players from small towns and large cities, affluent and non-affluent communities, all across the country.

That's important because we have found that safety training, procedural safeguards, quality of equipment and player size and skill match-ups can vary widely depending on where you're playing and at what level.

Think about the adults who are getting injured. They're probably having friendly pickup games with friends or at a rec league. They don't have the same high level of competition or pressure to perform that younger student athletes might be facing. We wanted to get the broadest cross-section, and this allowed us to do that.

Q: What did you learn after you dug into the numbers?

Well, the first thing we found that kind of surprised us was that there was no change in overall number of football-related spine injuries. One might have expected to see the numbers drop over time, due to the growing national awareness of safety issues.

Not only did they not drop, but the types of injuries shifted a bit. There was a trend in the increase in injuries of the cervical spine (P=0.06), which is typically more dangerous and more likely to require hospitalization and surgery than lower back injuries. Our study also found that it is significantly more likely to occur in children, particularly ages 15-19, than in adults. Adults are significantly more likely to have a lower acuity injury of the lumbar spine.

Another way to look at the shifting risk profile is to look at fractures versus nerve injuries. A fracture of the thoracic spine is literally breaking one or more of the spine bones in your mid-back; it's not having a torn ligament or experiencing whiplash. Children, particularly those ages 9-14, were more prone to fracture, whereas adults were more likely to experience a nerve injury than a fracture.

So the main takeaway is that we're seeing an increase in the more serious types of spine injuries at the levels of the spinal cord (cervical and thoracic) among children. Which leads us to wonder if we're offering kids the knowledge and protection they need if they're going to be able to safely play this game.

Q: What do you think is causing children's injuries to trend in this dangerous direction?

It is likely multi-factorial. I think the level of competition has increased in adolescent sports in general in recent years. There's a lot of research out there showing high rates of injury in other sports. In baseball, there are little leaguer's elbow and little leaguer's shoulder, which are stress injuries due to excessive throwing. In girls' soccer, ACL injuries have become an increasingly concerning issue.

For some high school students, the desire or need to obtain a sports-related college scholarship may drive a higher level of competition. For other students, it may be a lack of proper training and practice.

Further research is necessary to determine the cause of the trends we are seeing in young football players. Our study sheds light on this important issue for parents, trainers, coaches and other sports injury experts and researchers. It brings to light the specific types of injuries we are seeing in each age range. The next step, for our research and others', is to figure out the causes and reduce that risk to the greatest extent possible.