Problem with metrics and referee directions

Vox has a brief little informer on the relative risk of injury in high school sports.  I think it is useful, but reading the definition of injury makes me wary about the data source:

This data on high school sport safety was included in a new study in the journal Pediatrics. The study primarily focused on the relative dangers of cheerleading in America. Turns out cheerleading has lower injury rates than most other high school sports, and tumbles cause more injuries than pyramids. Who knew?

The metric is injuries per 1,000 athletic exposures. An athletic exposure is defined as one athlete “participating in one practice, competition, or performance.” Injuries are defined as anything that required the attention of a physician or athletic trainer,  [my emphasis] or kept the athlete off the field for at least one day.

This definition makes me cautious about the data as I know a few things have changed dramatically in high school sports in my time refereeing. First, more games are far more likely to have a trainer available today than when I first started to referee.  Most high school soccer leagues won’t start a game today without a medical professional on the sideline.  Ten years ago, that was not the case.

Secondly, the direction that soccer referees have been getting on responding to injuries has changed dramatically in the past couple of years.  Now, if we suspect anything, we stop play and get a trainer on.  This applies to high school only.

Unfortunately, the instruction and expectation is variable between sports and genders.

Last week, I was refereeing an off-season girls high school indoor game.  A girl was hit in the face with the ball.  She looked briefly stunned as the ball went off her nose.  We stopped play, and called for a coach to get the player off the field.  If this was a regular season game, a trainer would have come out, pulled the player for 30 seconds, and made her available to re-enter play at the next stoppage.  It was no big deal.  It was a false positive where we want to be wrong by being overly cautious.

The same ball to the face of a male player would not have produced a cultural expectation for a stoppage.   I officiate an off-season sport where the expectation is that unless we see a bone sticking out of the skin, we are still playing.

Counting the times a medical provider is beckoned onto the field is an easy metric.  It is also an easily confounded metric.

I think a better metric would be injuries that kept a player from completing the game or held out of practice for at least a day.  That is a harder data lift but I think far more informative.  Maybe the rankings are the same but the data would have more practical meaning.

30 replies
  1. 1
    jharp says:

    I am old enough to remember being given salt tablets to take during football practice.

    That, and being told to just wash your mouth out with water and avoid drinking water if you can. Drinking water can cause cramps. you know.

    That are my coaches were religious crackpots who “forced” us to pray before practice and games.

    Fuckers. That still pisses me off 40 years later.

  2. 2

    Good points. Numbers may not lie but they can sure mislead.

    I would be surprised if the rate of acute (as opposed to overuse) injury has materially increased in high school sports over the past several decades, but as you say I would expect that the reporting and awareness of said injuries has increased. Maybe for girls it has, as cultural norms for how girls compete have changed a lot more.

    Overuse injuries are different – I would expect those have increased due to more sedentary activities off the actual playing arena doing a worse job preparing kids for sports.

  3. 3
    dr. bloor says:

    The same ball to the face of a male player would not have produced a cultural expectation of a stoppage.

    That really has to change. As it happens, I’m doing an eval for post concussive symptoms in a high school guy who took two balls to the nose over a period of six months. Neither looked very scary on the field (no loss of consciousness), but the aftereffects are all over the data. He’ll almost certainly clear over time (unless someone sends him back out on the field too soon again), but it’s an unnecessary risk and mess.

    Public education is better, but people just don’t seem to grasp “concussion.” Maybe “bruised brain” would have a little more traction.

  4. 4

    @Edward G. Talbot: I think and I am speculating with no evidence, that high school overuse injuries have increased for the population of student athletes who compete one season a year. For the soccer players who are playing 48 weeks a year (20 weeks too many in my opinion), the injuries won’t be injuries due to transition from sedentary to activity but from getting worn down (plantar fasciatis, bursitis etc)

  5. 5

    @dr. bloor: Agreed, and I think this is an area where referees have to get better as the nose ball is not producing a lot of stoppages still. And I am guilty of that as anyone else.

  6. 6
    Anonymous At Work says:

    There’s no data there that would be possible to get and to trust if you could get it. Most football practices, during regular season, are 3 days a week, plus a film day, plus a shorts-and-helmets day for special teams. The level of injuries would vary depending on which day is to be missed. As far as games, depends on factors such as the score, importance of game, position and team’s depth at that position.
    That’s football, a sport with a highly regimented schedule of once-a-week games. Baseball, soccer and basketball are, in theory, 7-day-a-week sports. And with varying severity of injuries. Basketball injuries vary between minor and season/career-ending (for HS players) without much variance between. Baseball is likewise weird in how rotations work for dedicated pitchers and how players can get pulled for being cold as much as injuries or soreness.

    No, tl;dr version is that “missed practices or didn’t complete game” is a subjective metric that will yield unreliable data.

  7. 7
    Alex says:

    First opportunity I’ve seen where you’re discussing officiating since, so allow me to go a bit afield–do you have an opinion on the MLS Cup OOB fiasco that lead to the eventual title-determining goal against Crew SC?

  8. 8
    Punchy says:

    Couldn’t agree more. Today’s ultra-hypersensitivity to injuries, esp. concussions, means a trainer will be used for the slightest of questionable falls, strikes, cuts, etc. This shit definition of an injury is going to make it appear as if “injuries” have exploded in HS, when in fact they have not*. That will in turn lead to helicopter parents demanding all sorts of stupid shit in contact sports, like helmets for soccer players, or body armor for baseball players, or perhaps floaties for the swim team. All to keep Little Hudson and Sydney from skinning a knee or busting a lip.

    Meanwhile, the school district goes BK trying to pay for all this stuff, and fires the janitor and school pyschologist to get back in the black….

    *–gut feeling, cant back this up with data, so more of IMO.

  9. 9
    Amir Khalid says:


  10. 10
    gene108 says:


    I am old enough to remember being given salt tablets to take during football practice.

    That, and being told to just wash your mouth out with water and avoid drinking water if you can. Drinking water can cause cramps. you know.

    Saw an interview with Don Shula about that practice. He said that’s what the medical professionals were telling him was best for athletes.

    I’m not sure how they came up with that idea, but it was prevalent at all levels of football.

  11. 11
    cmorenc says:

    I understand why safety has become a higher priority in high schools sports, one rule change they made a year ago for high school soccer in the purported interest of safety is potentially more perverse than constructive; any time the referee stops the clock to check on whether a player is injured, the player MUST be substituted out and not re-enter until the team’s next legal substitution opportunity – including if the player concerned is the goalkeeper. By making a clock stoppage a mandatory sub threshold, it re-focuses the referee’s thinking beyond whether we ought to pause the game a moment to make sure a player is ok, to also consider whether whatever just happened is worth causing a forced sub out of a team’s key player or Goal Keeper- but without being able to take the time to inspect the player up close and talk with them to check out whether it’s just a dust-up the player will quickly be over, or a sufficient situation that the player needs evaluation by a trainer. This dynamic is especially perverse wrt evaluating Goalkeepers, who will usually have at least one or two hard tumbles with an opponent sometime during every closely contested game, and usually are ok after 30 seconds or so pause.

  12. 12
    Eric U. says:

    @Punchy: Having survived the Sandusky scandal while working at Penn State, and seeing what a school will do to accommodate sports, I wish they didn’t have organized school-sponsored sports at all. I have come to the conclusion that it is a corrupt influence, and looking back at the pathetic sports teams from my high school years, I see no evidence to contradict that notion at all. I have hopes that parents worrying about head injuries will kill high school football and thus the college game, but there seems to be no evidence of that right now. Let the pros run youth sports.

    @gene108: I’m full of popular opinions today, but sometimes when I think about medical practices I find it instructive to realize that my grandmother was alive when leeches were considered a good way to treat many medical conditions. We’ve made a lot of progress in a relatively short period of time. A lot of this has been in the last 20 or even 10 years

  13. 13
    D58826 says:

    OT MSNBC and CBS are reporting that the LA school district is closing all schools due to bomb threats. Just another fun day in the USA

  14. 14


    OT MSNBC and CBS are reporting that the LA school district is closing all schools due to bomb threats.

    LA Times is reporting as well.

  15. 15

    @cmorenc: The key thing is stoppage of the clock. The instruction/work around that we use in my area is a long discussion as the clock is running.

    “You okay?”
    “What was your second period class this morning”
    “Biology with Mrs. Cook”
    “Need a minute”
    “Okay, I have to tie my shoe, we’ll get started once I finish double knotting it”

    It is a sham, but it is a locally accepted sham.

  16. 16
    Amanda in the South Bay says:

    @gene108: Prevalent in mid 1990s cross country too.

  17. 17
    Punchy says:

    @Eric U.: I am of the opposite opinion; I think organized sports are hugely important to kids. Exercise, teamwork, friendship, competition (giving them a head’s up for later in life) are all key outcomes of youth sports. But yes, injuries are going to happen. My beef is with what I perceive to be attempts to change youth sports in order to completely eliminate all occurances, or chance of occurance, of injury, to the detriment of the sport and the experience. Perhaps its a litigation issue, driven by trial lawyers and not helicopter parents, but it’s hard to know for sure.

    Give me slide tackles in soccer. Give me dodgeball during school recess. Give me diving into a pool 5’+ deep. Just my $0.02.

  18. 18
    Amir Khalid says:

    If I’m not mistaken, sliding tackles may be considered dangerous play meriting a straight red card.

  19. 19
    MomSense says:

    There has been an interesting conversation on some running blogs joking that Maine runners are the new Kenyan runners. Maine happens to have some of the best runners in the country–now competing professionally or for out of state colleges and universities. Some are speculating that Maine runners are doing well because Maine is not a competitive state for high school athletics. Given the reduced pressure to perform in high school, Maine runners are avoiding some of the injuries that may be the result of over-training and over-competing in high school in the more competitive states.

  20. 20
    otto says:

    I’d say that some of this issue stems from the far greater tendency for men to take the tumble to draw the foul.

    When we watch soccer, my daughter always makes comments relating to the fact that women don’t take dives the way men do in order to draw a foul.

    I haven’t seen a high school soccer match lately, so I can’t be sure about whether hs boys are doing it in the same as men.

    If a trainer were called onto the field every single time a man goes down in the MLS, it would be a flippin’ parade.

  21. 21
    D58826 says:

    Oh man listening to MSNBC on the bomb threat in LA. The school district is telling parents who have already sent their kids to school to pick them up at the designated school ‘reunion’ site. We now have to have predetermined places for parents to pick up their kids in case of what a school shooting? I guess it goes along with the gunman drills

  22. 22
    otto says:

    @MomSense: I’ve been a parent/coach/teacher in Washington State scholastic chess.

    This state has risen to probably second place in the nation, just behind NY.

    What I saw happen during this time had a lot to do with early learning and training, coupled with a large number of opportunities to compete. One very large for profit outfit drove quite a bit of the expansion, and others picked up the demand created by the growth of these programs in schools.

    Kids have more and more opportunities to specialize at younger ages.

    I wonder if there are very strong running programs for very young people in Maine.

  23. 23
    cmorenc says:

    @Richard Mayhew:

    The instruction/work around that we use in my area is a long discussion as the clock is running

    The same technique is used here in North Carolina – but now you run into another perversity in HS soccer (vs FIFA): mandatory use of an exact count-down clock means that the ref can’t take the lost 30 – 45 seconds into account by flexibly adding stoppage time – instead, you either must stop the clock or else the time you take is lost to the game – which may make a good bit of difference when there’s four minutes left and one team is down a goal.

    This is of course but one of many instances which illustrate how poor a fit an exact count-down clock is to soccer vs addition of flexible stoppage time, and also how half-baked the graft of exact-count-down timing is to soccer compared even to other sports using same which also contain some sort of properly fitting “last play” rule, whether it’s simply ball released from hands on a shot in basketball before 0:00 or else in American football, a play started before 0:00 continues until the player is down without a penalty against the opposing team.

  24. 24
    Eric U. says:

    @Punchy: high school football and basketball offer no such benefits in comparison to the weird corrupting influence they have on the school’s society and budget. The emphasis should be on lifetime sports, not sports where very few people are involved, but they suck up large amounts of resources. And don’t get me started on college football, colleges should license their name to the sports teams and let them prove how much money they make.

  25. 25
    Jay Noble says:

    From the Football Salt Tablet Era too. Water breaks were a reward. Now they are mandatory at least every 1/2 hour. Wrestling practice meant rubber sweats. Track meant Nutrament and oranges.

    Injury=Walk it off. Unless of course you were unconscious. Or bone sticking out.

    But good grief, we didn’t play one sport 48 weeks out of the year! In my hometown here it was basically 13 week quarters – Fall-Football/Girls Volleyball/Girls Golf/Cross Country; Winter – Basketball and Wrestling; Spring – Track and Boy’s Golf; Summer – Baseball and Girl’s Fast Pitch Softball. The seasons have gotten longer with much more tournament exposure. While soccer has become really big it is a non-school sport and ends at 8th grade

    Anyway – One of the things I don’t see addressed much at any level is how much physics is playing a factor in all these injuries. We build them bigger stronger and faster . . .

  26. 26
    Capri says:

    Having recently had kids in high school, my impression is that helicopter parenting takes a different form on the field. First of all, the *real* helicopter parents limited their kids to non-contact sports. Football was out of the question, perhaps soccer. Sports like cross country, rowing,or bowling are favored. The obnoxious parents of student-athletes are the ones that believe that they are raising a Div1 scholarship athlete. They push their kids to play in every off-season league and won’t miss an exposure camp for the world. Most kids burn out way before they graduate HS. And they make coaching hell as they are always trying to get more playing time for their kid. If the kid sits, or the team isn’t winning enough, they agitate to fire the coach.

    Having said that, between my 3 kids they participated in cheerleading, cross country, track (all 3), volleyball, and basketball in high school and 1 became a serious cyclist in college (won the Little 500. See the move Breaking Away for an explanation) and one played volleyball in college. The only serious injury was a broken leg my cheerleader got when she was dropped from the top of a pyramid.

  27. 27
    raven says:

    @Jay Noble: They gave us salt pills in the Nam too.

  28. 28

    @Amir Khalid: No

    Slide tackles done well (including knocking someone on their ass) can be a fair challenge where no whistle is needed.

    Slide tackling from behind through the opponent’s ankles/Achilles/knees is a straight red

  29. 29
    Jay Noble says:

    @Richard Mayhew: Is there still a call for “sandwiching”. Back in the day, a teammate and I kinda leaned in on opponent who got between us and got a whistle for sandwiching. :-)

  30. 30
    Richard Mayhew says:

    @Jay Noble: nothing by that name but yes I will call something like that as an illegal charge.

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