Bringing athletes back to sport safely: Data-driven ramp-up intervention from wearable data linked with EHR in the NFL

Background: In the U.S. National Football League (NFL), approximately 1 in 4 players sustains a lower extremity (LEX) strain each season. Nearly 20% occur in the ~2-week period of Training Camp at the start of preseason, and LEX strains have a high rate of recurrence.

Objectives: Use wearable player tracking devices to collect data on Training Camp practice schedule strategies and examine how these strategies are associated with LEX strain incidence. Use implementation science to identify and implement an actionable reduction strategy and evaluate effectiveness.

Methods: Data from the league-wide electronic health record were combined with wearable player tracking data from 2018-2022. Individual Club practice patterns were analyzed and described, then grouped into strategies. LEX strains to the hamstring, quadriceps, adductor, and calf were identified. Incidence rates per 100 practice-minutes and 95% confidence intervals during and following Training Camp were calculated.

Results: From 2018-2021, 5 distinct practice schedule strategies were identified from 82 Club-seasons: gradual 15-minute ramp-up (15 Club-seasons), < 10-minute ramp-up (27 Club-seasons), high-low duration variation (13 Club-seasons), stable duration (18 Club-seasons), and reverse ramp-up (9 Club-seasons). Clubs utilizing the gradual 15-minute ramp-up strategy had lower LEX strain rates (0.41 injuries per 100 practice-minutes, 95% CI 0.34, 0.51) and Clubs utilizing the reverse ramp-up strategy had higher LEX strain rates (0.57 injuries per 100 practice-minutes, 95% CI 0.45, 0.72) during Training Camp compared to the other strategies. Results were communicated to stakeholders in 2021-2022, and in 2022, a league-wide gradual 15-minute ramp-up was implemented mandating maximum practice durations coupled with individual Club education sessions. Following the intervention, league-wide LEX strain incidence during Training Camp decreased by 25% from 286 in 2021 to 215 in 2022. Recurrent LEX strains in 2022 regular season decreased by 50% compared to 2021 (n=11 vs. n=22, respectively).

Conclusions: Wearable player tracking devices allowed for generation of data on Training Camp practice schedule strategies that were otherwise unavailable, and these data linked to an electronic health record led to identification of an actionable injury reduction strategy. Effective results communication translated to a mandated gradual ramp-up and concurrent education at the beginning of preseason, which successfully reduced LEX strains in the NFL.