As brilliant red and gold foliage heralds the return of autumn, over a million combined high school and college football players will take to the field with hearts full of hope, minds tuned into strategy, and bodies kept in tip-top condition during the offseason. Student athletes give their all to bring their schools glory—and sometimes, tragically, they give too much.

According to the National High School Sports-Related Injury Surveillance Study, there were more than 500,000 injuries related to high school football in 2014, while the Center for Disease Control reports an average of about 9,500 college football injuries annually in recent years. Injuries typically range from minor cuts and scrapes to severe concussions, but with chronic traumatic encephalopathy (CTE) dominating sports headlines lately, many schools are now prioritizing injury prevention.

Competition and practice injury rates per 1,000 athlete-exposures

The “forgotten” injuries

Concussions are the most talked-about football injury, but there are several others that just as serious and shouldn’t be ignored.

Traumatic Injuries

Injuries to the knees—especially the ACL/PCL and cartilage areas—are quite common for football players of all ages, and they can adversely affect long-term involvement in the sport. Ankle sprains from inadequate playing surfaces and shoulder injuries, especially in offensive and defensive lineman, are also common.

Heat Injuries

The younger the football player, the greater the concern for injuries like heat exhaustion and heat stroke, which can result in death if not treated immediately. The danger is highest during training camp, usually in August, when intense physical activity after a relaxing summer combined with excessive heat can swiftly result in dehydration.

Overuse Injuries

Back pain in general—and lower back pain specifically—is a frequent complaint among football players due to overuse of the back muscles. Overusing muscles can also lead to overtraining syndrome, which is when a player trains so hard his body can’t recover.

Second Impact Syndrome

This injury, which has recently gained the attention of school coaches and administrators, is when a player suffers two concussions close enough together that the first has not had time to heal. Researchers have found that repeated trauma of this sort is a contributing factor to CTE, especially in student athletes who eventually go pro.

Safety and victory, working hand-in-hand

From Pop Warner to the NFL, football associations are taking injury prevention seriously—even at the government level, all 50 states have adopted concussion legislation with minimum return-to-play guidelines. But it’s up to players, coaches, schools and even parents to take the lead in team safety.

General safety guidelines

 At the very minimum, high school and college football players should:

• Complete a pre-season health and wellness evaluation
• Perform proper warm-up and cool-down routines
• Incorporate strength training and stretching into conditioning routines
• Hydrate adequately, especially in high temperature and humidity conditions
• Stay active in the offseason
• Make sure protective equipment—helmet, pads, mouthguard—fit properly

Schools can also help prevent and prepare for injuries by having an athletic trainer and team physician on staff, plus an ambulance and two paramedics on site during practices and games.

 Prevention tips for head injuries

The best prevention starts with the helmet—schools should ensure they are providing helmets that are highly rated in concussion safety tests. But even with top-of-the-line equipment, players should always tackle with their heads up and never use their helmet as a battering ram into other players. Additionally, many coaches are now encouraging rugby-style tackling, which leads with the shoulder and not the head, and emphasizes more wrapping up on a tackle.

 Prevention tips for traumatic injuries

Quadriceps-strengthening programs are well known ways to prevent knee pain and injuries, but newer methods such as “proprioceptive training”—increasing balance with simple exercises like standing on one leg for long periods of time—are gaining popularity to prevent ACL/PCL injuries.

Prevention tips for heat injuries

The best way to prevent heat stroke is to hydrate frequently and treat heat exhaustion in its earliest stages. Muscle cramps are an early sign, so that’s when players need to step off the field to cool off and replace fluids until they feel strong enough to return.

Prevention tips for overuse injuries

 The main causes for overuse injuries are poor technique, weak abdominal muscles, and low flexibility. Training year-round can help prevent back pain and injury—especially core exercises—and stretching before and after football practice is a must. Also, players should ensure they’re following proper techniques for lifting weights.

Winning is great, but it’s not everything

Sportsmanship is usually taught from a young age, but as kid athletes become student athletes with their hearts set on the big leagues, the pressure to win—from within and without—sometimes overshadows the reason the player started playing the first place: fun!

It’s important for parents and coaches at every stage of an athlete’s career to emphasize the importance of safety during practices and games. Pushing beyond a player’s abilities isn’t always a good thing—in fact, many injuries can be prevented by knowing individual limits and identifying where the line of safety falls in relation to achievement.

Sports can provide lifelong benefits in terms of physical fitness, teamwork, and close friendships, but players who ignore safety guidelines will soon find themselves on the sidelines—sometimes permanently. Thankfully, high school and college football programs now understand that making sure players keep playing is just as important as winning. So go, fight, win—but do it safely!

Stay tuned as we discuss in further detail, each of these injury types and preventative measures you can take as a parent and/or coach.