Injuries to High School Football Players in Long Island, New York: A Five-Year Study

BackgroundAmerican football has the highest injury rate of any U.S. high school sport, yet most studies examine a single injury type or position.We characterized injury patterns among high school football athletes in Long Island, New York, over five consecutive seasons, focusing on how injury patterns vary by level of play, setting, and position. MethodsIn this retrospective cohort study, certified athletic trainers and sports medicine physicians documented all in-season injuries among varsity and junior varsity (JV) athletes at 16 high schools from 2019 to 2023.Level of play, setting, mechanism, anatomic location, diagnosis, position, and time to return to play were recorded.Proportions were compared using two-sample Z-tests for independent proportions, with a twosided p < 0.05 considered significant.Test statistics are reported as Z values alongside exact p-values. ResultsAmong 3,861 athletes (2,093 varsity, 54.2%), 1,476 injuries were recorded.Varsity athletes accounted for a greater share of injuries than JV athletes (n = 1,104, 74.8% vs. n = 372, 25.2%; Z = 26.95,p < 0.001).Most injuries occurred in games despite far more practices (n = 732 of 1,308 injuries with setting recorded, 56.0%; Z = 6.10, p < 0.001).Direct contact was the leading mechanism (n = 796 of 1,344 injuries with the mechanism recorded, 59.2%).The lower extremity was most often injured (n = 672, 45.5%), followed by the upper extremity (n = 431, 29.2%) and head/neck (n = 187, 12.7%).Concussion was the most common specific diagnosis (n = 131, 8.9%).Profiles differed by position: offensive linemen had the highest proportion of concussions, and linebackers had the highest proportion of contact-related injuries.The proportion of athletes with a recorded concussion did not differ between varsity and JV athletes (Z = 0.53, p = 0.594). ConclusionsA greater proportion of recorded injuries occurred among varsity athletes, in games, and through direct contact.Injury profiles differed by position, most notably a high proportion of concussions among offensive linemen.Because athlete exposure denominators were unavailable, these findings describe the distribution of recorded injuries rather than exposure-adjusted risk.These multiyear, position-specific data can inform targeted prevention and safety policy in high school football.