High Energy Side and Rear American Football Head Impacts Cause Obvious Performance Decrement on Video

Adam J. Bartsch*, Daniel Hedin, Jay Alberts, Edward C. Benzel, Jason Cruickshank, Robert S. Gray, Kenneth Cameron, Megan N. Houston, Tyler Rooks, Gerald McGinty, Erick Kozlowski, Steven Rowson, Joseph C. Maroon, Vincent J. Miele, J. Chris Ashton, Gunter P. Siegmund, Alok Shah, Michael McCrea, Brian Stemper

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes’ post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40–100 g, 3.3–7.0 m/s and 35–118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts.

Original languageEnglish
Pages (from-to)2667-2677
Number of pages11
JournalAnnals of Biomedical Engineering
Issue number11
StatePublished - Nov 2020
Externally publishedYes


  • American football
  • Concussion
  • Head impact sensor
  • Mouthguard
  • Obvious performance decrement
  • Video review


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