Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies

Abstract

Background: Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. Purpose: To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games. Study Design: Cohort study; Level of evidence, 2. Methods: Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods. Results: For impacts ≥10 g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10 g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40 g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10 g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games. Conclusion: This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes.

Neuropsychological Profiles of Athletes and Views of Parents Choosing Flag Versus Tackle Football Participation

“…While our power calculation that assumed a 1:1 enrollment ratio determined a total of 62 subjects would be needed, as reported by others, participation of tackle players exceeded flag players, leading to an imbalance in group size. 12,17 Based on our achieved enrollment of 64 subjects with a ratio of 41:23, we still achieved an a priori power of 78%, which closely approximated our intended goal of 80%.…”

“…This is important as flag football participation has increased over the past decade with the promotion of its safety as an alternative to tackle football, even as data on head impact exposure between tackle and flag football continue to be limited and contradictory, suggesting that each type of football has its own inherent risks. 10 , 12 , 13 , 16 , 17 , 20 While we do not have a league-specific injury pattern data that could affect participation enrollment in this study, we presumed that these patterns would correlate with national data. Furthermore, injury rates for most of the leagues that we recruited from have been described previously by Peterson et al 12 as our study recruited from the same locations.…”

“…Flag football leagues have similar rules across the country in that a player is down if their flag is pulled from their waist, with additional prohibitions on hitting and tackling. 15 , 17 …”

“…Regardless, although flag football is considered a limited-contact sport, especially compared with tackle football, it is clearly not a noncontact sport and may be just as, if not more, dangerous than tackle football. 13 , 17 , 20 The study by Peterson et al 12 has been criticized by reviewers and the popular press for failing to account for potential intrinsic differences between tackle and flag football players that may drive their choice to play one type over another and subsequently impact reported injury rates.…”

American Football: Watch Your Head!

“…From analyzing the sensor data, we found that tackle football players had about 15 times more head impacts (of any severity) than the flag football players during a game or practice [ 6 , 7 ]. The tackle football players also had 23 times more hard head impacts than flag football players during a game or practice [ 6 ].…”