With students gearing up to take part in America’s favorite pastime, there’s a new report raising red flags about the sport’s safety and reiterating the need for proper training and equipment, especially helmets.

The study, in the August issue of The American Journal of Sports Medicine,  found that four of every 1,000 high-school football exposures—either in practice or competition—resulted in an injury. The rate was double, eight per 1,000 exposures, for college athletes. But most significant, the study said: high school football players sustained a greater proportion of fractures and concussions. 

Why? The study says that college athletes participate in more rigorous training and conditioning, making serious injuries less prevalent--although the athletes may have an increasing risk of overuse injuries. Also, players prone to concussions in high school may not continue to play football in college, thus reducing that incidence among college players.

Another finding: running plays were the leading cause of injury. And running backs and linebackers were the positions most commonly injured. 

So what does this mean for players and parents? For starters, injury prevention in high school should focus on running plays and injuries to the knees and ankles, the study says. There should be additional instruction on appropriate tackling and blocking techniques as well as position-specific conditioning to help reduce the risk of injury during running plays. Targeted stretching exercises may also help.

Additionally, says Dawn Comstock, an assistant professor of pediatrics at Ohio State University and one of the study’s co-authors, parents should make sure their children wear protective equipment at all times. And “make sure it’s in good repair and fitted properly. Parents may not realize that kids shouldn’t just grab a helmet and put it on.” It needs to be fitted properly, which is a “complex, multi-step process.”

At the same time, Comstock added, parents and coaches need to talk to their young athletes to make sure they know the signs and symptoms of a concussion. Unlike a bruise or fracture, these symptoms aren’t “immediately apparent” and the long-term consequences can be significant, she added.

The long term effects are underscored by another recent study—this one of retired football players--that linked concussions to clinical depression. Retired players reporting three or more previous concussions were three times more likely to be diagnosed with depression, the University of North Carolina study found. Those with a history of one or two previous concussions were 1.5 times more likely to be diagnosed with depression. 

Comstock says helmets have improved considerably over the years. But concussions remain a big problem, accounting for about 11 percent of all injuries. Perhaps helmets have improved, but an 11 percent brain injury rate is unacceptable in our book.  It time to look for better helmet designs, softer playing surfaces or whatever it takes to significantly reduce this serious injury rate.