11. Rules that reduce head impacts in football predict fewer neuroimaging abnormalities in frontal neocortical regions

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ID: 324514
2026
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Ranked #79 of 79 articles by views in archives of clinical neuropsychology : the official journal of the national academy of neuropsychologists

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Abstract
Abstract Purpose Repetitive, non-concussive head impacts in American football are associated with structural and neurovascular brain abnormalities. In 2015, the North Carolina High School Athletic Association implemented rule modifications to reduce the frequency of head impacts during practices. This study evaluated whether these rule changes were associated with reduced biomechanical brain injury risk and corresponding neuroimaging abnormalities. Method Across 87 concussion-free high school football player-seasons, voxel-wise linear regressions were used to identify region-specific relationships between accelerometer-based brain injury risk for one season (RWE-Lin) and preseason-to-postseason changes in mean diffusivity (%ΔMD) as well as resting-state fMRI power spectral density (%ΔfMRI-PSD). Significant clusters were averaged for all player-seasons and included in multivariate linear regression models that included RWE-Lin, rule change era (pre- vs. post-implementation), age, BMI, inter-scan interval, position group, level of play, and prior concussion diagnosis. Players were stratified into high-impact (H-FB; n=13) and low-impact (L-FB; n=31) groups based on RWE-Lin. Non-collision athletes (NCAC; n=11) served as external controls. Results Greater RWE-Lin and pre-rule change era were associated with increased %ΔMD and decreased %ΔfMRI-PSD in overlapping frontal neocortical regions (p<0.001). Elevated %ΔMD and lower %ΔfMRI-PSD within the H-FB were found to be abnormal when compared to both L-FB and NCAC (p<0.05), while L-FB did not significantly differ from NCAC. Conclusions Rule modifications that limit head impacts are associated with reduced structural and neurovascular abnormalities in frontal neocortical regions that are implicated in chronic traumatic encephalopathy pathogenesis. Our findings support policy-level interventions as an effective strategy to mitigate subclinical brain injury in American football.
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Authors M N Bell, L E Miller, Y Xi, C C Johnson, B C Wagner, F S Feltrin, A K Powers, J E Urban, C T Whitlow, J D Stitzel, J A Maldjian, E M Davenport
Journal archives of clinical neuropsychology : the official journal of the national academy of neuropsychologists
Year 2026
DOI
10.1093/arclin/acag055.011
URL
https://doi.org/10.1093/arclin/acag055.011
Keywords Keywords not found

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