Is Flag Football the “Safer” Alternative?

More kids aged 6-12 now play flag football than play tackle football (Sports & Fitness Industry Association).1 Participation in youth flag football has risen by almost 40% over the last several years – more than any other sport. Coinciding with this participation boom, we’ve also seen the media promote flag football as the “safer” alternative to tackle football.? But do we really know how many injuries and safety concerns there are in youth flag football? I decided to investigate these questions as the subject of my doctoral dissertation. This effort became the largest epidemiological study to date of youth flag football, in part, because data was collected through two, large organizations. We now have some insights into the following questions:

• ???????? What types of injuries occur and where on the body?
• ???????? Is flag football really a “limited contact” sport?
• ???????? Are there changes to technique instruction that would help?
• ???????? Could your equipment be a cause of injury?

The study was conducted with the cooperation of two large flag football organizations, Flag Football World Championship Tour (now called USA Flag) and Flag Football Life. Data was collected at regional and national youth tournaments for both organizations.? A total of 1,939 athletes (1,744 boys and 195 girls), ages 6 - 12 years, participated in this study. There were 9,228 athlete “exposures,” meaning one athlete participating in one coach-directed session.? Out of all tournaments attended, there were a total of 47 recorded injuries – 36 in boys and 11 in girls.? This means the overall risk of injury for a youth playing flag football was 2.4%.? However, the risk for girls suffering an injury is almost 3 times higher than it is for boys.? Future research is warranted to investigate why girls are at increased risk of injury in flag football.

What Types of Injuries Occur and Where?

The area of the body most commonly injured was the head/face/neck region and this area accounted for 32% of all injuries.? With the push towards flag football stemming from concern over head impacts in youth tackle football, this finding that the head is still the most commonly injured area is noteworthy.? However, we only had one reported concussion, one of the girl athletes. Most of these injuries were contusions, bloody noses, or lacerations.? The percentage of injuries for the various body parts between girls and boys is presented in the figure below.? Contusions were the most common type of injury overall, accounting for 55% of all injuries.? Thinking about this type of injury, it may be beneficial to think about wearing some form of padded shorts and shirts to help protect against these contusions.? Such a simple change may go a long way to prevent these minor, albeit common, causes of injury.

?Is Flag Football Really Limited Contact?

The American Academy of Pediatrics classifies flag football as a “limited contact” sport, whereas tackle football is a “collision sport” by comparison.2? Surprisingly though, 75% of all injuries in this study were a result of direct contact to the player.? This contact was typically player-to-player, or player-to-the-ground in nature.? Most of the player-to-ground contact occurred from the defender going for the flag and falling after losing balance, or diving for the flag.? As mentioned above, wearing padded undergarments, or incorporating some soft padding into the jersey and shorts, may reduce the risk of injury from these incidental contacts.?

?Do we need to change technique instruction?

To potentially reduce the risk of injury to these kids, changing the technique instruction should be considered.? With many of the injuries resulting from falling and ground contact due to the kids launching themselves towards the flags, it may be beneficial to teach kids about taking a lower stance, and not leaving their feet.? Tackle football organizations have implemented coach and player education in an effort to teach better tackling techniques to reduce injury risk.3,4? Implementing coach education on proper tackling technique has been shown to reduce injuries in high school5 and youth6 tackle football.? The development of similar flag football technique education may have a similar impact on reducing injury risk in the sport.

?Could your equipment be a cause of injury?

One of the positives of flag football is that there is very little equipment required which makes the sport accessible to more kids.? But what if the flag belt may be contributing to injury?? All of the hip-trunk-related injuries in this study were due to impact between the player and the hard-plastic attachment point of the flag they were wearing when the player fell to the ground (Figure 2).? Redesigning the attachment point of the flags, or using a compressible/deformable material, may have a significant impact on reducing these hip/trunk injuries.? Another point to consider is the actual placement of the flag “belt.”? With many injuries occurring from kids going for the flag and launching themselves downward to grab the flag, what if, instead, the flags were worn as a harness around the shoulders/upper back??? This way players would remain upright when reaching for the flags and this posture may reduce the incidence of losing balance and falling.

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Some key take-home points from this study:

1. Understanding the frequency and nature of injuries that occur in youth flag football potentially informs preventative measures through equipment adoption or rule changes.
2. Flag belts that have hard-plastic attachment points may increase injury to the hip area when kids land on them.
3. This study highlights the importance of additional education related to technique as a potential means to reduce injury in the sport of flag football.

- Flag placement that is higher (such as a harness around the chest/back) may deter kids from lunging downward to pull a flag and falling to the ground after losing balance.

-Ground impacts and their associated injuries may also be reduced by teaching this better technique.

?Although this study focused on injury in flag football, it’s important to keep in mind that playing flag football is a valuable alternate method of sports participation for youth. It gives more kids the opportunity to experience positive physical, emotional, and mental benefits that sports activity provides.

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You can find a full copy of the research study here:? https://doi.org/10.4085/1062-6050-0427.22

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1.???????? Association SFI. 2019 SFIA Topline Participation Report. https://sfia.org/. Published 2019. Updated 2019. Accessed 12/01/2021, 2021.

2.???????? Rice SG, Medicine CoS, Fitness. Medical conditions affecting sports participation. Pediatrics. 2008;121(4):841-848.

3.???????? Football U. USA Football Tackling Systems. https://usafootball.com/development-training/tackling-systems/. Published 2022. Accessed 05/02/2022.

4.???????? Operations NF. NFL Way To Play. https://operations.nfl.com/inside-football-ops/nfl-way-to-play/nfl-way-to-play/. Published 2022. Accessed 05/02/2022.

5.???????? Kerr ZY, Dalton SL, Roos KG, Djoko A, Phelps J, Dompier TP. Comparison of Indiana high school football injury rates by inclusion of the USA Football “Heads Up Football” player safety coach. Orthopaedic journal of sports medicine. 2016;4(5):2325967116648441.

6.???????? Kerr ZY, Yeargin S, Valovich McLeod TC, et al. Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthopaedic journal of sports medicine. 2015;3(7):2325967115594578.

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