Purpose
The purpose of this study was to compare the injury incidence of the 2018-2019 and
2020 National Football League (NFL) seasons with the 2021 season.
Methods
Publicly released NFL weekly injury reports were queried to identify players listed
as “out” or placed on injured reserve (IR) for at least 1 game in the 2018-2021 seasons.
Injuries were then categorized into upper extremity, lower extremity, spine/core,
and head. Incidence per 1,000 athlete exposures were calculated for each season, and
proportions of injuries by position were calculated separately for the 2018-2019,
2020, and 2021 cohorts. Incidence rate ratios (IRR) were used to compare injury rates.
Results
Overall injury incidence in the 2021 NFL season increased compared to the pre-COVID-19
seasons (2018-2019) in all anatomical zones except for the upper extremity (28.70
vs 23.09 per 1,000 exposures, IRR 1.24 [95% CI: 1.14-1.36]; P < .001). The injury rate remained elevated and further increased in 2021 compared
to the 2020 season for all anatomical zones other than the spine/core [28.70 vs 21.64
per 1,000 exposures, IRR 1.33 (1.19-1.47); P < .001]. No significant difference existed during the early season (weeks 1-4); however,
injury rates after week 4 increased in 2021 compared to both the 2018-2019 and 2020
seasons.
Conclusions
The injury incidence in the 2021 season remained elevated and increased further compared
to both the 2018-2019 and 2020 seasons. Traumatic injuries resulting in missed games
increased despite return to a more traditional season since the beginning of the COVID-19
pandemic. The injury rates significantly increased in mid-season to late season.
Level of Evidence
Level III, cross-sectional study.
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Article info
Publication history
Published online: December 11, 2022
Accepted:
November 25,
2022
Received in revised form:
November 8,
2022
Received:
August 16,
2022
Footnotes
Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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