882 FO33 – Bringing athletes back to sport safely: data-driven gradual practice ramp-up strategy during preseason reduces lower extremity strains in U.S. national football league

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. Objective Examine Training Camp practice schedule strategies associated with LEX strain incidence, identify and implement an actionable reduction strategy, and evaluate effectiveness. Design Observational study comparing LEX strain incidence by practice schedule strategy using wearable player tracking data linked to Club schedule. Setting 32 NFL Clubs Patients All NFL players participating during 2018–2022 Interventions Data from the league-wide electronic health record were combined with player tracking data. Individual Club practice patterns were analyzed and described, then grouped into 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 (Figure 1). Main Outcome Measures 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, <10-minute ramp-up, high-low duration variation, stable duration, and reverse ramp-up (Figure 1). Clubs utilizing the gradual 15-minute ramp-up strategy had lower LEX strain rates and Clubs utilizing the reverse ramp-up strategy had higher LEX strain rates during Training Camp compared to the other strategies (Table 1). Following the intervention, league-wide LEX strain incidence during Training Camp decreased by 25% from 286 in 2021 to 215 in 2022 (Figure 2). Recurrent LEX strains in 2022 regular season decreased by 50% (n=11 vs. n=22). Conclusion A mandated gradual ramp-up coupled with education at the beginning of preseason successfully reduced LEX strains in the NFL.