Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football

Abstract

Background:Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice.Purpose:To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated.Study Design:Cohort study; Level of evidence, 2.Methods:Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non–Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs.Results:A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found between the practice concussion rates among 11- to 15-year-olds in the HUF+PW (0.14/1000 AEs) and NHUF groups (0.79/1000 AEs) (IRR, 0.18; 95% CI, 0.04-0.85).Conclusion:These findings support comprehensive coach education and practice contact restrictions as effective methods of injury mitigation. Future research should continue evaluating similar programming within other levels of competition and sports.

Head-Impact–Measurement Devices: A Systematic Review

“…Football. Whereas the HITS and 6DOF devices fit into a football helmet, some researchers [90][91][92] have used the X2 X-Patch to study head impacts among collegiate, high school, and youth athletes. Swartz et al 91 observed that collegiate football players sustained 13.8 6 7.27 impacts per session.…”

“…90 Compared with collegiate football players, youth football players (aged 8-15 years) sustained fewer average impacts: 12.9 6 3.9 impacts per game and 7.5 6 3.4 impacts per practice. 92 Soccer. Soccer is a nonhelmeted sport requiring a different impact-monitor design.…”

“…By understanding the injury mechanism, sports medicine professionals can make more informed decisions on improved equipment 46 and rule changes 91,92,[107][108][109] to reduce concussion incidence. 8 Biomechanical data have effectively improved player safety via protective equipment and rule changes.…”

“…8 Biomechanical data have effectively improved player safety via protective equipment and rule changes. 26,86,92,95,[110][111][112] For example, the STAR helmet rating was initiated in 2011 at Virginia Tech to identify which helmets have a theoretical reduced concussion risk. 113 Combining laboratory and field data, the injury-risk function estimates the concussion risk for an individual player for 1 season.…”

“…In youth football players aged 5 to 15 years, implementing the ''Heads Up Football'' coaching-education program reduced practice concussion rates from 0.79 concussions per 1000 athleteexposures to 0.14 concussions per 1000 athlete-exposures, or 82%. 92 Whether equipment changes lead to improved player safety via reduced concussion incidence is unknown. More research is needed to determine whether mitigated athlete-exposure from equipment or rule changes reduces concussion incidences for all sports at all levels.…”