The Injury Rate in National Football League Players Increased Following Cancellation of Preseason Games Because of COVID-19

PURPOSE: To investigate the injury rate in National Football League (NFL) athletes during the first 4 weeks of the 2020 NFL season. METHODS: This study was a retrospective review of all NFL players who were placed on the injury report during the preseason and the first 4 weeks of the regular season from the 2016-2017 through the 2020-2021 NFL regular seasons. Players’ dates of injury were cross-referenced with an absence of statistics from the respective games for which they were ruled out so as to ensure accuracy. Injury rates were calculated per 1,000 athletic exposures. Relative risk with 95% confidence intervals compared injury rates between the 2 cohorts. RESULTS: Over the course of the study period of 4 NFL seasons, 3,025 injuries were reported. Of the 3,025 injuries reported, 582 (19%) occurred during weeks 1-4 of the 2020-2021 regular season, whereas 1,292 (53%) occurred during preseason weeks 1-4, and 1,151 (38%) occurred during regular-season weeks 1-4 of NFL seasons 2016-2017, 2018-2019, and 2019-2020. There was a significant increase in the injury rate during weeks 1-4 of the 2020-2021 regular season for all comparisons with the injury rate both during the preseasons and the regular seasons of 3 recent past NFL seasons. CONCLUSIONS: The rate of injury in NFL players during weeks 1-4 of the 2020-2021 regular seasons was significantly higher than during 3 recent past NFL preseasons and regular seasons. LEVEL OF EVIDENCE: Level IV, diagnostic case series.