Age, power, and sport-related concussion. Is there a tension between sport performance and concussion risk in tackle football?

Sport-related concussion (SRC) poses a barrier to otherwise health-promoting sport participation. Tackle Football (American Football) is a popular sport with an elevated risk of SRC, which prioritises strength and conditioning. The association between physical performance, notably lower body maximal muscle power and concussion rate, is not well understood in youth tackle football. This prospective cohort study investigated the association between lower body power and concussion rate in 595 Canadian adolescent-age (ages 14-18) tackle football players. Data collection included baseline characteristics (height, weight, vertical jump, age, player position, concussion history), sessional practice and game player attendance, and validated injury surveillance to identify SRC incidence. Missing baseline data were estimated using multivariable imputation by chained equations. Multilevel multivariable Poisson Regression analyses were used to estimate incidence rate ratios (IRR) examining the association between lower body power and SRC rates (adjusted for position, age, concussion history), clustered by team, and offset by player session participation time (hours). Higher lower body power was associated with a 3.18-fold higher concussion rate per 1000 W from 2000W to 5000 W (IRR = 3.18, 95% CI; 1.24-8.17). Age was associated with a 0.49-fold lower SRC rate (IRR = 0.49, 95% CI; 1.08-4.00). Participants with higher lower body power and younger age have higher SRC rates.