AAP backs zero tolerance for headfirst hits in football

WASHINGTON – Teaching young athletes to tackle with their heads up and enforcing rules against illegal headfirst hits can reduce the risks of concussions in youth football, according to a new policy statement by the American Academy of Pediatrics.

An emphasis on proper tackling technique and implementing strategies to reduce head hits maintains the integrity of the game while reducing the most serious injuries as well as subconcussive hits, Dr. Gregory L. Landry, Fellow of the American Academy of Pediatrics (FAAP), and professor of pediatrics and orthopedics at the University of Wisconsin–Madison, said in his plenary talk at the annual meeting of the American Academy of Pediatrics.

Dr. Landry, along with Dr. William P. Meehan III, FAAP, led the Council on Sports Medicine and Fitness in writing the AAP’s policy statement on tackling in youth football (Pediatrics 2015 Oct 25. doi: 10.1542/peds.2015-3282).

©David Peeters/iStockphoto.com

In response to growing calls to ban tackling entirely in youth football, and calls to eliminate football from high school sports, the council reviewed the evidence on youth tackling, concussions, and other injuries in football to reach the seven conclusions outlined in the policy statement, Dr. Landry said.

“Most injuries sustained during participation in youth football are minor, including injuries to the head and neck,” according to the policy statement. “The incidences of severe injuries, catastrophic injuries, and concussion, however, are higher in football than most other team sports and appear to increase with age.”

During his talk, Dr. Landry noted that catastrophic injuries occur more frequently in gymnastics and wrestling than in football. Among all youth football injuries, 3.4% are neurologic and 2.5% are fractures. Half are contusions, 16.7% are sprains, and 9.3% are strains.

Within football, young players tend to have far lower rates of concussions, compared to older players. In one 2-year observational study, the overall concussion rates of 7.4 per 1,000 athletic exposures broke down to 4.3 per 1,000 exposures for fourth- and fifth-graders and 14.4 per 1,000 exposures for eigh^th-graders. On the low end, another study found a concussion rate of 1.8 per 1,000 exposures, with a rate of 0.24 for practices and 6.2 for games.

“One of the common themes is that game rate is always higher than practice rates,” Dr. Landry said. “Running backs seem to be at the highest risk for injuries.”

In addition, tackling is the most common player activity at the time of the injury and at the time of severe injury. “The act of tackling is, in fact, risky business,” Dr. Landry said.

One reason for this relates to improvement in football safety equipment, he explained.

“As football helmets began to improve, football players began leading with their heads instead of their shoulders,” he said. “Leading with the head increases the risk of both concussion and spinal injury. The priority must be that the head must be up when a player tackles someone. The proper way to tackle is leading with the chest.”

A key study showing the effect that heads-up tackling instruction can have on concussion rates involved comparisons with teams taught Heads Up Football, “a comprehensive program developed by USA Football to advance player safety,” according to the program’s website. During the 2014 football season in Indiana, researchers compared teams that participated in the Heads Up program with teams that did not and with a third group of Pop Warner–affiliated teams that had reduced the number of full body contact practices.

Among 71,262 athletic exposures, the rate was lowest for the teams that were both Pop Warner affiliated and Heads Up affiliated, with a rate of 0.97 concussions per 1,000 athletic exposures. The teams involved in neither program had a rate of 7.32 concussions per 1,000 exposures, but even the Heads Up–only teams had a rate more than twice as low, with 2.73 per 1,000 exposures, revealing the importance of not tackling head first, Dr. Landry said.

“That’s the problem with American football – the whole game has changed,” he said, regarding the shift in tackling technique. “And you’re seeing this at the college level and at the professional level.”

In light of the way the game has changed and the risks it presented, the council offered seven conclusions and recommendations in its policy statement:

1. Officials and coaches must enforce the rules of the game, moving toward “zero tolerance of illegal, headfirst hits.” The statement notes a current “culture of tolerance” regarding headfirst tackling. “This culture has to change to one that protects the head for both the tackler and those players being tackled,” the committee stated. “Stronger sanctions for contact to the head, especially of a defenseless player, should be considered, up to and including expulsion from the game.”

2. Although eliminating tackling from football would likely cause a decrease in overall and severe or catastrophic injuries, it would also change essential aspects of the game. “Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling,” the committee stated. Dr. Landry compared the game to hockey. “In ice hockey, if you don’t check, it’s still ice hockey,” he said. “But with football, removing tackling fundamentally changes the game.”

3. Football leagues should consider expanding their options to include football teams without tackling, such as flag football, for those who want to play without the additional risks from tackling. But youth flag football has not been studied, Dr. Landry pointed out, and some adult studies have shown higher rates of injuries, so youth flag football requires more study.

4. Officials and coaches should look for and implement ways to reduce the number of hits to the head that players experience. “If subconcussive blows to the head result in negative long-term effects on health, then limiting impacts to the head should reduce the risk of these long-term health problems,” the committee stated while acknowledging the need for more research in this area.

5. A theoretical risk exists that delaying the age when athletes learn tackling could lead it to become more dangerous. “Once tackling is introduced, athletes who have no previous experience with tackling would be exposed to collisions for the first time at an age at which speeds are faster, collision forces are greater, and injury risk is higher,” the committee stated. “Lack of experience with tackling and being tackled may lead to an increase in the number and severity of injuries once tackling is introduced.” Dr. Landry acknowledged that the risk is theoretical and hasn’t been studied but perhaps needs to be.

6. Neck strengthening might lessen the risk of concussions with head hits, though little scientific evidence exists to support this hypothesis. “Physical therapists, athletic trainers, or strength and conditioning specialists with expertise in the strengthening and conditioning of pediatric athletes are best qualified to help young football players achieve the neck strength that will help prevent injuries,” the committee stated.

7. Football teams should have athletic trainers present at organized football games and practices since research supports a link between trainers’ presence and a lower incidence of sports-related injuries.

Dr. Landry’s overall message focused on ways to reduce risks without ending football. “Let’s not ban the game,” he said. “Let’s just make it safer.”

Dr. Landry has no financial disclosures but had his college tuition paid by playing football, served as team physician for the University of Wisconsin football team for many seasons, and grew up as the son of a high school football coach. Dr. Meehan is involved in researched partly funded by the National Football League Players Association, and he receives compensation from ABC-Clio Publishing, Wolters Kluwer, and Springer International Publishing for works he has authored.

WASHINGTON – Teaching young athletes to tackle with their heads up and enforcing rules against illegal headfirst hits can reduce the risks of concussions in youth football, according to a new policy statement by the American Academy of Pediatrics.

An emphasis on proper tackling technique and implementing strategies to reduce head hits maintains the integrity of the game while reducing the most serious injuries as well as subconcussive hits, Dr. Gregory L. Landry, Fellow of the American Academy of Pediatrics (FAAP), and professor of pediatrics and orthopedics at the University of Wisconsin–Madison, said in his plenary talk at the annual meeting of the American Academy of Pediatrics.

Dr. Landry, along with Dr. William P. Meehan III, FAAP, led the Council on Sports Medicine and Fitness in writing the AAP’s policy statement on tackling in youth football (Pediatrics 2015 Oct 25. doi: 10.1542/peds.2015-3282).

©David Peeters/iStockphoto.com

In response to growing calls to ban tackling entirely in youth football, and calls to eliminate football from high school sports, the council reviewed the evidence on youth tackling, concussions, and other injuries in football to reach the seven conclusions outlined in the policy statement, Dr. Landry said.

“Most injuries sustained during participation in youth football are minor, including injuries to the head and neck,” according to the policy statement. “The incidences of severe injuries, catastrophic injuries, and concussion, however, are higher in football than most other team sports and appear to increase with age.”

During his talk, Dr. Landry noted that catastrophic injuries occur more frequently in gymnastics and wrestling than in football. Among all youth football injuries, 3.4% are neurologic and 2.5% are fractures. Half are contusions, 16.7% are sprains, and 9.3% are strains.

Within football, young players tend to have far lower rates of concussions, compared to older players. In one 2-year observational study, the overall concussion rates of 7.4 per 1,000 athletic exposures broke down to 4.3 per 1,000 exposures for fourth- and fifth-graders and 14.4 per 1,000 exposures for eigh^th-graders. On the low end, another study found a concussion rate of 1.8 per 1,000 exposures, with a rate of 0.24 for practices and 6.2 for games.

“One of the common themes is that game rate is always higher than practice rates,” Dr. Landry said. “Running backs seem to be at the highest risk for injuries.”

In addition, tackling is the most common player activity at the time of the injury and at the time of severe injury. “The act of tackling is, in fact, risky business,” Dr. Landry said.

One reason for this relates to improvement in football safety equipment, he explained.

“As football helmets began to improve, football players began leading with their heads instead of their shoulders,” he said. “Leading with the head increases the risk of both concussion and spinal injury. The priority must be that the head must be up when a player tackles someone. The proper way to tackle is leading with the chest.”

A key study showing the effect that heads-up tackling instruction can have on concussion rates involved comparisons with teams taught Heads Up Football, “a comprehensive program developed by USA Football to advance player safety,” according to the program’s website. During the 2014 football season in Indiana, researchers compared teams that participated in the Heads Up program with teams that did not and with a third group of Pop Warner–affiliated teams that had reduced the number of full body contact practices.

Among 71,262 athletic exposures, the rate was lowest for the teams that were both Pop Warner affiliated and Heads Up affiliated, with a rate of 0.97 concussions per 1,000 athletic exposures. The teams involved in neither program had a rate of 7.32 concussions per 1,000 exposures, but even the Heads Up–only teams had a rate more than twice as low, with 2.73 per 1,000 exposures, revealing the importance of not tackling head first, Dr. Landry said.

“That’s the problem with American football – the whole game has changed,” he said, regarding the shift in tackling technique. “And you’re seeing this at the college level and at the professional level.”

In light of the way the game has changed and the risks it presented, the council offered seven conclusions and recommendations in its policy statement:

1. Officials and coaches must enforce the rules of the game, moving toward “zero tolerance of illegal, headfirst hits.” The statement notes a current “culture of tolerance” regarding headfirst tackling. “This culture has to change to one that protects the head for both the tackler and those players being tackled,” the committee stated. “Stronger sanctions for contact to the head, especially of a defenseless player, should be considered, up to and including expulsion from the game.”

2. Although eliminating tackling from football would likely cause a decrease in overall and severe or catastrophic injuries, it would also change essential aspects of the game. “Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling,” the committee stated. Dr. Landry compared the game to hockey. “In ice hockey, if you don’t check, it’s still ice hockey,” he said. “But with football, removing tackling fundamentally changes the game.”

3. Football leagues should consider expanding their options to include football teams without tackling, such as flag football, for those who want to play without the additional risks from tackling. But youth flag football has not been studied, Dr. Landry pointed out, and some adult studies have shown higher rates of injuries, so youth flag football requires more study.

4. Officials and coaches should look for and implement ways to reduce the number of hits to the head that players experience. “If subconcussive blows to the head result in negative long-term effects on health, then limiting impacts to the head should reduce the risk of these long-term health problems,” the committee stated while acknowledging the need for more research in this area.

5. A theoretical risk exists that delaying the age when athletes learn tackling could lead it to become more dangerous. “Once tackling is introduced, athletes who have no previous experience with tackling would be exposed to collisions for the first time at an age at which speeds are faster, collision forces are greater, and injury risk is higher,” the committee stated. “Lack of experience with tackling and being tackled may lead to an increase in the number and severity of injuries once tackling is introduced.” Dr. Landry acknowledged that the risk is theoretical and hasn’t been studied but perhaps needs to be.

6. Neck strengthening might lessen the risk of concussions with head hits, though little scientific evidence exists to support this hypothesis. “Physical therapists, athletic trainers, or strength and conditioning specialists with expertise in the strengthening and conditioning of pediatric athletes are best qualified to help young football players achieve the neck strength that will help prevent injuries,” the committee stated.

7. Football teams should have athletic trainers present at organized football games and practices since research supports a link between trainers’ presence and a lower incidence of sports-related injuries.

Dr. Landry’s overall message focused on ways to reduce risks without ending football. “Let’s not ban the game,” he said. “Let’s just make it safer.”

Dr. Landry has no financial disclosures but had his college tuition paid by playing football, served as team physician for the University of Wisconsin football team for many seasons, and grew up as the son of a high school football coach. Dr. Meehan is involved in researched partly funded by the National Football League Players Association, and he receives compensation from ABC-Clio Publishing, Wolters Kluwer, and Springer International Publishing for works he has authored.

WASHINGTON – Teaching young athletes to tackle with their heads up and enforcing rules against illegal headfirst hits can reduce the risks of concussions in youth football, according to a new policy statement by the American Academy of Pediatrics.

An emphasis on proper tackling technique and implementing strategies to reduce head hits maintains the integrity of the game while reducing the most serious injuries as well as subconcussive hits, Dr. Gregory L. Landry, Fellow of the American Academy of Pediatrics (FAAP), and professor of pediatrics and orthopedics at the University of Wisconsin–Madison, said in his plenary talk at the annual meeting of the American Academy of Pediatrics.

Dr. Landry, along with Dr. William P. Meehan III, FAAP, led the Council on Sports Medicine and Fitness in writing the AAP’s policy statement on tackling in youth football (Pediatrics 2015 Oct 25. doi: 10.1542/peds.2015-3282).

©David Peeters/iStockphoto.com

In response to growing calls to ban tackling entirely in youth football, and calls to eliminate football from high school sports, the council reviewed the evidence on youth tackling, concussions, and other injuries in football to reach the seven conclusions outlined in the policy statement, Dr. Landry said.

“Most injuries sustained during participation in youth football are minor, including injuries to the head and neck,” according to the policy statement. “The incidences of severe injuries, catastrophic injuries, and concussion, however, are higher in football than most other team sports and appear to increase with age.”

During his talk, Dr. Landry noted that catastrophic injuries occur more frequently in gymnastics and wrestling than in football. Among all youth football injuries, 3.4% are neurologic and 2.5% are fractures. Half are contusions, 16.7% are sprains, and 9.3% are strains.

Within football, young players tend to have far lower rates of concussions, compared to older players. In one 2-year observational study, the overall concussion rates of 7.4 per 1,000 athletic exposures broke down to 4.3 per 1,000 exposures for fourth- and fifth-graders and 14.4 per 1,000 exposures for eigh^th-graders. On the low end, another study found a concussion rate of 1.8 per 1,000 exposures, with a rate of 0.24 for practices and 6.2 for games.

“One of the common themes is that game rate is always higher than practice rates,” Dr. Landry said. “Running backs seem to be at the highest risk for injuries.”

In addition, tackling is the most common player activity at the time of the injury and at the time of severe injury. “The act of tackling is, in fact, risky business,” Dr. Landry said.

One reason for this relates to improvement in football safety equipment, he explained.

“As football helmets began to improve, football players began leading with their heads instead of their shoulders,” he said. “Leading with the head increases the risk of both concussion and spinal injury. The priority must be that the head must be up when a player tackles someone. The proper way to tackle is leading with the chest.”

A key study showing the effect that heads-up tackling instruction can have on concussion rates involved comparisons with teams taught Heads Up Football, “a comprehensive program developed by USA Football to advance player safety,” according to the program’s website. During the 2014 football season in Indiana, researchers compared teams that participated in the Heads Up program with teams that did not and with a third group of Pop Warner–affiliated teams that had reduced the number of full body contact practices.

Among 71,262 athletic exposures, the rate was lowest for the teams that were both Pop Warner affiliated and Heads Up affiliated, with a rate of 0.97 concussions per 1,000 athletic exposures. The teams involved in neither program had a rate of 7.32 concussions per 1,000 exposures, but even the Heads Up–only teams had a rate more than twice as low, with 2.73 per 1,000 exposures, revealing the importance of not tackling head first, Dr. Landry said.

“That’s the problem with American football – the whole game has changed,” he said, regarding the shift in tackling technique. “And you’re seeing this at the college level and at the professional level.”

In light of the way the game has changed and the risks it presented, the council offered seven conclusions and recommendations in its policy statement:

1. Officials and coaches must enforce the rules of the game, moving toward “zero tolerance of illegal, headfirst hits.” The statement notes a current “culture of tolerance” regarding headfirst tackling. “This culture has to change to one that protects the head for both the tackler and those players being tackled,” the committee stated. “Stronger sanctions for contact to the head, especially of a defenseless player, should be considered, up to and including expulsion from the game.”

2. Although eliminating tackling from football would likely cause a decrease in overall and severe or catastrophic injuries, it would also change essential aspects of the game. “Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling,” the committee stated. Dr. Landry compared the game to hockey. “In ice hockey, if you don’t check, it’s still ice hockey,” he said. “But with football, removing tackling fundamentally changes the game.”

3. Football leagues should consider expanding their options to include football teams without tackling, such as flag football, for those who want to play without the additional risks from tackling. But youth flag football has not been studied, Dr. Landry pointed out, and some adult studies have shown higher rates of injuries, so youth flag football requires more study.

4. Officials and coaches should look for and implement ways to reduce the number of hits to the head that players experience. “If subconcussive blows to the head result in negative long-term effects on health, then limiting impacts to the head should reduce the risk of these long-term health problems,” the committee stated while acknowledging the need for more research in this area.

5. A theoretical risk exists that delaying the age when athletes learn tackling could lead it to become more dangerous. “Once tackling is introduced, athletes who have no previous experience with tackling would be exposed to collisions for the first time at an age at which speeds are faster, collision forces are greater, and injury risk is higher,” the committee stated. “Lack of experience with tackling and being tackled may lead to an increase in the number and severity of injuries once tackling is introduced.” Dr. Landry acknowledged that the risk is theoretical and hasn’t been studied but perhaps needs to be.

6. Neck strengthening might lessen the risk of concussions with head hits, though little scientific evidence exists to support this hypothesis. “Physical therapists, athletic trainers, or strength and conditioning specialists with expertise in the strengthening and conditioning of pediatric athletes are best qualified to help young football players achieve the neck strength that will help prevent injuries,” the committee stated.

7. Football teams should have athletic trainers present at organized football games and practices since research supports a link between trainers’ presence and a lower incidence of sports-related injuries.

Dr. Landry’s overall message focused on ways to reduce risks without ending football. “Let’s not ban the game,” he said. “Let’s just make it safer.”

Dr. Landry has no financial disclosures but had his college tuition paid by playing football, served as team physician for the University of Wisconsin football team for many seasons, and grew up as the son of a high school football coach. Dr. Meehan is involved in researched partly funded by the National Football League Players Association, and he receives compensation from ABC-Clio Publishing, Wolters Kluwer, and Springer International Publishing for works he has authored.