Comparing Head Impacts in Youth Tackle and Flag Football

Key points

  • Two CDC studies report that tackle football athletes sustained more head impacts than flag football athletes.
  • Head impacts increase the risk for concussion and other serious head injuries.

Overview

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Youth tackle football athletes had 15 times more head impacts than flag football athletes during a practice or game.
Youth tackle football athletes had 15 times more head impacts than flag football athletes during a practice or game.

Youth tackle football athletes had 15 times more head impacts than flag football athletes during a practice or game.

cdc.gov/HEADSUP

CDC HEADS UP. CDC.gov

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A CDC study published in Sports Health found that youth tackle football athletes ages 6 to 14 sustained 15 times more head impacts than flag football athletes during a practice or game. Tackle football athletes also sustained 23 times more high-magnitude head impacts (hard head impacts) than flag football athletes during a practice or game.

Head impacts increase the risk for concussion and other serious head injuries.

Key findings from the study include:

  • Youth tackle football athletes experienced a median of 378 head impacts per athlete during the season.
  • Flag football athletes experienced a median of 8 eight head impacts per athlete during the season.

These findings suggest that non-contact or flag football programs may be a safer alternative for reducing head impacts and concussion risk for youth football athletes under age 14.

More efforts needed to prevent head impacts during youth football games

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Learn how you can keep athletes safe from head impacts.
Learn how you can keep athletes safe from head impacts.

Learn how you can keep athletes safe from head impacts.

Learn more: cdc.gov/HEADSUP

CDC HEADS UP. CDC.gov

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A second CDC study published in The American Journal of Sports Medicine reports youth tackle and flag football athletes sustained two times more head impacts during a game than during a practice.

Key findings from the study include:

  • Youth tackle football athletes had an estimated 18 times more head impacts per practice and 19 times more head impacts per game than flag football athletes.
  • Youth tackle football athletes had an average rate of almost 7 head impacts during a practice and 13 impacts during a game, resulting in 2 times more ≥10g head impacts in games versus practices (g is a measurement of gravitational force equivalent).
  • Youth flag football athletes had an average rate of 0.4 head impacts during a practice and 0.8 impacts during a game, resulting in 2 times more ≥10g head impacts in games versus practices.
  • Youth tackle football athletes sustained 2 times more high magnitude head impacts (≥40g) in games vs practices.

These findings suggest a greater focus on game-based interventions, such as fair play interventions and strict officiating. In addition, the expansion of non-contact or flag football programs may be beneficial to reduce head impact exposures—especially for youth football athletes.

Five actions to lower head impacts in youth football

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Five Actions to Lower Head Impacts in Youth Football graphic
Head impacts increase the risk for TBIs and other serious brain injuries.

Five Actions to Lower Head Impacts in Youth Football:

  1. Expand opportunities for youth in all communities to play noncontact football (flag and touch football).
  2. Reduce the number of contact practices for tackle football programs.
  3. Strictly enforce penalties for hitting another player in the head with their helmet.
  4. Teach and reinforce position specific and age-appropriate tackling and blocking skills.
  5. Provide education on prevention of head impacts to players, parents, coaches, and sports officials.

Learn more: cdc.gov/HEADS-UP. CDC HEADS UP

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1. Expand opportunities for youth in all communities1 to participate in low-cost2 non-contact football programs, such as flag and touch football.

Why this is important: Non-contact football, like other sports, help youth build skills in athletics, leadership, and teamwork.3

2. Reduce the number of contact practicesA per week and the amount of time contact is allowed during a practice for tackle football programs.

Why this is important: Head impacts during the high school football season dropped by 42% when a school reduced contact practices from 3 or more days to 2 or fewer days per week.4

3. Strictly enforce penalties for hitting another player in the head with their helmet, such as spearing or targetingB for tackle football programs.

Why this is important: Strict officiating and enforcing rules by coaches and athletes can decrease rates of injuries.5678

4. Teach and reinforce position-specific910 and age-appropriate tackling and blocking skills11 that avoid using the head to hit another player when contact drills are used during tackle football practice.

Why this is important: Head impacts are more common among linemen12 and when players do high-speed,13 intensive14 and multiplayer tackle drills.1516

5. Provide education for players, parents, coaches, and sports officials on the:

  • Dangers of head-first contact in football.
  • Limits of protective equipment.
  • Best techniques to avoid head impacts.
  • Penalties for spearing, targeting, and hitting another player in the head.
  • Importance of communication about brain safety between coaches, parents, athletes, and sports officials.

Why this is important: Training can improve identification and response to concussions and other head injuries.1718 Policies that require education combined with rule enforcement and contact practice restrictions may be most effective.19202122

Protecting players from head impacts lowers their chance for:‎

- Traumatic brain injuries (including concussions)2324


- Spinal cord injuries25


- Potential changes in the brain and brain diseases that are associated with long-term exposure to repeated head impacts.26272829


Head-first contactC and spearingD create the greatest forces to the head and risk for severe injury and disability.2528303132339

More information

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What parents need to know about brain safety and youth football.
What parents need to know about brain safety and youth football

What parents need to know about brain safety and youth football.

CDC HEADS UP. CDC

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What Parents Need to Know About Brain Safety and Youth Football

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What sports programs need to know about brain safety and youth football
What sports programs need to know about brain safety and youth football.

What sports programs need to know about brain safety and youth football.

CDC HEADS UP. CDC

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What Sports Programs Need to Know About Brain Safety and Youth Football

Additional resources

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Content Source:
National Center for Injury Prevention and Control
  1. Contact practices may be defined as those that include drills or scrimmage run at game-speed or using game-like conditions, such as player versus player contact in pads and taking a player to the ground during a tackle.
  2. Examples of targeting may include making helmet-to-helmet contact or hitting another player above the shoulders.
  3. Head-first contact involves a player using the top or crown of the helmet to initiate contact with another player.
  4. Spearing includes intentionally lowering the head and using the top or crown of the helmet to contact or tackle another player.
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  15. Kelley ME, Kane JM, Espeland MA, et al. Head impact exposure measured in a single youth football team during practice drills. J Neurosurg Pediatr. 2017;20(5):489-497. doi:10.3171/2017.5.PEDS16627.
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  • These actions are adapted from recommendations and findings in:
  • American Academy of Pediatrics, Council on Sports Medicine and Fitness. Policy statement: tackling in youth football. Pediatrics. 2015;136(5):e1419-e1430. doi:10.1542/peds.2015-3282.
  • Eliason PH, Galarneau J, Kolstad AT, et al. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sport Med. 2023;57:749-761. doi: 10.1136/bjsports-2022-106656.
  • Parsons JT, Anderson SA, Casa DJ, et al. Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations. Br J Sport Med. 2020;54:208-215. doi: 10.1136/bjsports-2019-101090.
  • Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. Br J Sport Med. 2023;57:695-711. doi: 10.1136/bjsports-2023-106898.
  • Pankow, M.P., Syrydiuk, R.A., Kolstad, A.T. et al. Head games: a systematic review and meta-analysis examining concussion and head impact incidence rates, modifiable risk factors, and prevention strategies in youth tackle football. Sports Med 52, 1259–1272 (2022). doi:10.1007/s40279-021-01609-4.
  • Swartz EE, Register-Mihalik JK, Broglio SP, et al. National Athletic Trainers' Association position statement: reducing intentional head-first contact behavior in American football players. J Athl Train. 2022;57(2):113-124. doi: 10.4085/1062-6050-0062.21.
  • Waltzman D, Sarmiento K, Devine O, et al. Head impact exposures among youth tackle and flag American football athletes. Sports Health. 2021;13(5):454-462. doi:10.1177/1941738121992324.