Youth Football Study Sheds Light on Health Issues

Will Carroll@injuryexpertSports Injuries Lead WriterMay 23, 2013

Apr 24, 2013; New York, NY, USA; NFL commissioner Roger Goodell (center) poses for photos at the NFL Play 60 Youth Football Festival at Chelsea Waterside Park. Mandatory Credit: Debby Wong-USA TODAY Sports

USA Football and the Datalys Center released preliminary findings from their landmark, two-year study of injuries across youth football. The findings are for the most part extremely positive, but any move by a governing body is seen with many suspicious eyes, so let's look a bit deeper into these early findings:

Is This a Good Study?

First and foremost, this is a scientifically valid study conducted by a respected firm. The study is not complete, but the importance of its findings and the possible impact led the stakeholders to release some of the preliminary discoveries.

The study looked at over 1,900 players across several states and youth leagues. While the specifics of the players are hidden by need, it appears to be a broad cross section. And while not random, since the leagues had to agree to participate, there is no apparent selection bias. 

The methods and findings of the study all seem valid, though again, these are preliminary. USA Football is in a unique position, as more of an advocacy group than a true governing body. With no authority over football at any level, their strategies have been based on education and marketing.

I should also note that while USA Football and Datalys are located in Indianapolis, I have no connection to them aside from our shared interest in reducing injuries. 

What Are the Key Takeaways from This Study?

It's important to note again that these are preliminary results from a two-year study. There are no solid recommendations that will occur until the study is completed.

There are, however, some interesting notes, such as an apparent lower number of injuries than expected. There are also fewer concussions than expected, as well as an absence of catastrophic injuries, either from head, spine or heat-related causes. This may be due to the relative low incidence of these not being captured within the sample.

The most interesting thing may be that all of the samples were collected from leagues that were not compliant with USA Football's "Heads Up Football" program. That program, which is focused on educating coaches on key points like tackling technique, equipment fitting and heat illness, is designed to reduce the injuries even further. 

What this study does not answer is the one question so many parents want to know: Is youth football safe?

Is the Fact That More Players Are Injured in Games Than Practice Surprising?

It is not surprising. The key here is remembering that this is youth football, what many call Pop Warner or Little League in some areas. The ages are between six and 14, and high school players are ineligible to participate. 

USA Football has rejected some of the most dangerous football drills, such as the Oklahoma drill or "Bull In The Ring." The Oklahoma drill, as seen to the right, is often used at high school and lower levels, but has led to significant injuries and even death.

While contact and collision is part of football, minimizing that contact is smart. The reduction of contact drills in the NFL has led to a reduction in both general injuries and head injuries in particular. While this reduction in contact is not as aggressive as some (including myself) would hope, there has been some movement in this direction. 

The Most Common Injuries Are Contusions and Sprains. What Does This Mean?

This makes sense to anyone around football. Watch any youth football game and you'll see why this is the case. Simply put, these are the injuries you usually see when kids tackle and block each other in the course of normal play.

Any tackle, block or collision may result in these, leading to the raw numbers for bruises (contusions). The same is true for sprains, especially given the amount of simple sprains, like a sprained ankle or sprained finger. 

The game, under its current rules, is never going to be perfectly safe, and given that, it is important that there is always the proper available care to treat mild injuries. There is an increased call for medical professionals, especially athletic trainers, to be on site for games. Cost and availability is often prohibitive for many leagues, however.

Are They Minimizing the Danger of Concussions?

The presentation here is a bit of a question mark. A four-percent rate is not high or low and passes the "smell test." However, this means that 76 children, none older than age 14, suffered a reportable concussion. Given what we know about concussions, this may be an unacceptable risk for many children and parents. However, the effect of concussions on developing brains is a major unknown in the medical community. 

There is some concern about the data. Dustin Fink, an athletic trainer who runs The Concussion Blog, questions why the data is significantly below the levels normally seen. According to the preliminary results, the observed rate is around four percent, about half the eight-to-10 percent seen in previous studies of more advanced levels. 

"It's a subjective injury we are relying upon the injured to know/understand when they are hurt and then willfully report that," explained Fink. "When reporting symptoms, we must be clear with the 'threshold' used to determine if it is a concussion, is it one symptom, two? Is it based on severity, only cognitive test, etc."

While Fink's concerns are valid, the use of on-site athletic trainers to collect data certainly appears to address this concern. There are a number of possible factors as to why the number is low, from random deviations to the less forceful impact of collisions in the youth game.

Are They Minimizing the Danger of Heat Illness?

The study showed no incidences of heat-related illness during the first year of the study. I do not believe the study is intentionally minimizing the severity of heat illnesses, nor do I believe that USA Football is not committed to making sure that heat illness is handled properly.

Heat illness is thankfully rare, but deadly. Each summer, we'll hear of deaths of players across the country due to heat illness, usually at the high-school level. It can be dangerous for pros, too, with the death of Korey Stringer a major tipping point in terms of treatment and perception of the problem. 

Youth leagues have more leeway in canceling practices than high schools, which means they likely practice in safer situations. The greater presence and involvement of parents at these levels also reduces the chance of atmospheric conditions leading to heat illness. 

"Heat illness is one of three primary player-health and safety-related points of emphasis in our coach certification course," said USA Football's Steve Alic. "It's as important to us as tackling technique and proper equipment fitting."

The organization's emphasis on heat illness and prevention has been forward-thinking, so the fact that none occurred within this study should not be interpreted as minimization.

What Does USA Football Hope to Accomplish With This Study?

USA Football has done an amazing job in growing its Heads Up Football program. From pilot programs last year to being adopted by over 1,500 youth leagues is stunning to many that did not believe that a voluntary program would gain much traction.

The only similar study was one undertaken by Little League Baseball and the American Sports Medicine Institute, which led to new guidelines for pitcher usage. That study has been very influential in terms of changing the rules of the game, though it remains to be seen if it can reduce the number of injuries. It was certainly successful in terms of awareness.

Another key point that came up in my conversation with Alic was that the 10 leagues followed in this study were not Heads Up Football-compliant last season. Several of the organizations will be taking part during the 2013 season. It will be very interesting to see what changes come as they follow the same organizations through a second season under new health and safety guidelines.

Is Youth Football Safe?

This simple question is one that simply does not have an answer. Parents and administrators are debating this openly, a testament to a major shift in public sentiment over the past three years. While nothing is perfectly safe, the question is whether it can be made relatively safe and if the long-term consequences are worth the risk.

While some will say this is another step towards "bubble wrap kids," the inherent dangers of football are more evident now. Twenty years ago, we did not know as much. Twenty years from now, we will know more. Parents and players will have to be cognizant of the available information and make an informed decision.

This study will increase the amount of available information and help parents make better decisions. One can only hope that all sports will collect and publish the same kind of data. For that, USA Football should be congratulated. 


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