A new study from the CDC found that tackle football players sustain substantially more head impacts and are at greater risk of sustaining high-magnitude head impacts compared to flag football players. For most people, these findings aren’t surprising. Flag football is a non-contact version of the sport, so it makes sense that there would be fewer head impacts. Yet, this is only the second study to directly compare the difference in impacts between flag and tackle football. Like the first, this study provides data to back up what was already believed to be true, and it has important implications for safety in youth football.
What the Study Found
CDC researcher Dana Waltzman and colleagues measured head impacts in 477 tackle football players and 47 flag football players ages 6- to 14-years-old over one regular season. Tackle football players sustained a median of 378 impacts during the season, while the flag football players sustained a median of just 8 impacts.
The flag players did, on average, participate in fewer practices than tackle players, though the number of games were similar. The researchers account for this by comparing the impacts per athletic exposure, essentially measuring the average number of hits the players incur every time they step on the field for a game or practice. On average, the tackle football players sustained 9 impacts per athletic exposure compared to just 0.63 for flag players. That means tackle football players averaged 15 times more impacts per athletic exposure than flag football players.
The magnitude of impact was also higher in the tackle football players. The average linear acceleration, or the strength of head acceleration in one direction, was slightly lower in flag (16.8 g) than tackle (18.2 g) players. However, the tackle football players were 23 times more likely to sustain a high magnitude impact of 40g or higher.
I often hear people say that youth players don’t hit that much or that hard compared to the older players. Unfortunately, the results of this study (and others like it) show that isn’t really true. Sure, they’re smaller and slower, but youth tackle football players still experience hundreds of impacts over a season at magnitudes similar to that of their high school and college counterparts. Many players in this study sustained impacts over 40g, with the highest-magnitude impact measuring in at 80.7 g. The strongest impact sustained by a flag football player was 55.2 g. One youth tackle player in this study sustained 1170 impacts in one season. That is high even for high school and college players, who average between 300-775 impacts per season. The most impacts sustained over the season by a flag player in this study was just 43.
Why is this important?
When it comes to brain trauma in sports, concussions are only part of the story. The repetitive brain trauma that occurs on every play with routine tackles and blocks has an effect on the brain, even when the impacts don’t result in concussion symptoms. These hits are often called subconcussive impacts. Studies have shown alterations in brain structure and function over the course of one season of football in youth, high school, and college athletes who did not sustain a concussion. Repetitive impacts over time have also been linked to later-life cognitive, behavioral, and mood difficulties and the development of the neurodegenerative disease chronic traumatic encephalopathy (CTE). The more impacts sustained over a lifetime, the greater the risk for developing these later-life consequences.
Repetitive impacts during youth, while the brain is rapidly developing, may have additional consequences. The brain undergoes critical developmental processes in childhood and early adolescence, and there is evidence to suggest that sustaining repetitive impacts during that time can alter or disrupt these processes (more on this in an upcoming blog). Though the effects of this disruption may not be apparent in early or even middle adulthood, it may lead to accelerated aging or an earlier age of onset of symptoms in those who go on to develop a neurodegenerative disease such as CTE or Alzheimer’s disease.
What does this mean for youth athletes?
The best way to protect the brain is to avoid impacts altogether, and this study clearly shows that playing flag football leads to far fewer impacts than tackle football. Of course, we will never eliminate every single impact, or every single concussion for that matter. Accidental collisions will happen. Kids will fall. Players will collide while jumping to catch a pass. That is a natural and acceptable risk of sport in general.
But tackles are not accidents. They are an inherent part of the game that are known to lead to repetitive brain trauma. Playing a non-tackle form of the game until high school will substantially reduce the amount of repetitive brain trauma sustained by athletes over their careers, reducing their likelihood of having long-term cognitive or behavioral consequences or developing CTE. It will also give their brain more time to mature without disruption.
There has been a lot of emphasis in recent years on teaching proper tackling technique. This study examined youth tackle football in the fall of 2017, well after most youth leagues implemented tackling restrictions in practice and adopted “new” (though not really new) tackling techniques intended to reduce impacts and improve safety in the sport. In fact, the study authors stated that the tackle football players were originally divided into groups to study two different tackling techniques and the use of robotic dummies for tackling practice, but there were not differences between the groups using these techniques. As a result, they chose to group them all together in this study to compare tackle to flag football. That is consistent with other studies that showing minimal effects of different tackling techniques in youth football. While better technique may have some benefit, especially at older ages when athletes have better body control, the only way to avoid repetitive brain trauma is to avoid impacts.
I want to be very clear that I am all for kids playing sports. We shouldn’t be eliminating tackle football without substituting a non-contact version of the game. And it isn’t about eliminating football, just the tackling aspect of the game at younger ages. Much of the sport remains the same, with the key difference being how the play ends. Youth players can learn a lot about the game and develop football skills and athleticism without tackling. Unfortunately, many communities have limited if any flag football options, leaving athletes and their parents to choose between playing tackle football or not playing at all. Additionally, rules need to be enforced in flag football to ensure it doesn’t just become tackle without padding.
There is no downside to playing flag football before high school. Many arguments have been made for why kids need to tackle young, and none of them hold water. I have a whole section of my book dedicated to busting these myths, but here are a few examples: You don’t have to hit young to earn a scholarship or become a superstar. Many great players, including Tom Brady, didn’t start playing tackle football until high school. Waiting to start tackling until an older age does not increase the risk of injury when the athlete does start tackling. Participation numbers won’t suffer if kids aren’t tackling. In fact, after USA Hockey eliminated checking before age 13, participation in the sport skyrocketed. And there is no evidence that children will fall behind or high school teams won’t be successful if their feeder programs don’t tackle.
Flag football is a great way to promote physical activity and all of the wonderful benefits of sports without a high number of repetitive impacts and brain trauma. Ultimately, we should be doing everything we can to promote sport participation while also protecting children’s developing brains.