Ask the PT: Youth Football Edition
Our resident expert, Yukiko Matsuzaki from the Hospital for Special Surgery explains why flag may lead to a HIGHER injury rate than tackle. Plus, more burning youth football questions answered.
In case you didn’t notice, football season is in full force. The Guardian and BBC have kept me quite busy the past week with radio spots and columns. The Rams already made my prognosticating skills look like 💩. And the Aaron Rodgers’ injury was, dare I say, the single most devastating moment in Jets history. It was a tough write. A large chunk of the NFL season’s anticipation was sucked away in an instance. But more so, it was the splashiest reminder from the weekend of just how injury-ridden the sport of football can be. (Yeah, yeah a 39-year-old QB being protected by a 38-year-old left tackle doesn’t help.)
My younger son plays flag, and my older son would if he wasn’t so jam-packed with other fall sports. Football, whether tackle or flag, is a beautiful sport with positions for a number of athletic profiles. I absolutely love the rapid growth of girls’ flag as well.
As a mom who writes about football and now youth sports, I’m periodically asked if I’d let my kids play football in high school. The consistent answer from me and my husband has been no, at least for tackle. The only exception might be as a field goal kicker. But it’s complicated and always subject to change. I’ve seen destruction in the NFL and talked to plenty of players who fear CTE and even a couple that are certain that have symptoms. It’s not pretty. Yet the appeal is obvious. Football is an incredible sport with opportunities for growth and life lessons at every turn. I’d like to think most players, whether they stop after youth flag or go on to the NFL, end their playing days relatively unscathed.
There are varied opinions about when to start. Here, I ask then Saints QB Drew Brees that very question during Super Week four years ago:
Brees’ answer may have shifted one way or the other at this point. The best thing parents can do is to stay informed on the latest in health and safety. The good news is there are plenty of outfits that are making safe tackling and concussion safety a priority, yet still fielding competitive teams.
That’s leads us to return of Yukiko Matsuzaki to answer our burning questions all about youth football.
As a reminder, Yukiko is a Board-Certified Clinical Specialist both in Orthopedic and Sports Physical Therapy in the Pediatric Physical Therapy department of HSS (Hospital for Special Surgery) in New York. She treats a slew of injured young athletes, and has an abundance of wisdom to offer us sports parents. We very much appreciate her insight!
Yukiko, take it away!
Good Game: Are you generally seeing less injuries among those that play flag vs. tackle? What injuries in flag are on the rise and why is that?
Yukiko Matsuzaki: Flag football is categorized as a limited-contact sport, and is thought to be a safer option compared to tackle football, but is it really? Here are the findings from a limited number of good research studies:
Overall injury rate in flag football is similar (or higher!) than in tackle. This may be because flag football athletes don’t wear protective gear. Also, flag football athletes run and dive for flags, which may limit player-to-player contact but does not limit contact with the ground. So, flag football injuries are still a result of direct contact either with another player or with the ground. The good news is that most injuries are contusions, strains, and sprains and are not too serious.
A 2021 Center for Disease Control and Prevention (CDC) study found that kids 6-14 years old sustained 15 times more head impacts in tackle football compared to flag football during practices or games. Head impacts increase the risk for concussion. While risk of concussion in flag football is less than in tackle football, it can happen. Concussions are serious injuries and while many recover relatively quickly from each episode, it’s the cumulative effects of multiple concussions that can be dangerous. Note that these symptoms may not be obvious and usually do not appear until the athlete is older.
The challenge with being involved in a contact sport at a younger age is body size: two kids who are both 9 years old can be a very different size (height and weight).
GG: How is the new way tackling is being taught impacting injuries including head trauma?
YM: Initiating contact with the shoulder while keeping the face mask up is thought to be the safest way to tackle in football. Athletes should learn and practice the proper technique to reduce the risk of injury. There is currently no data on the impact of shoulder tackling on rates of brain injury or other catastrophic injuries.
GG: What are some of the major injury risks that football players should be aware of that are tied to the current state of youth tackle football?
YM: More practices can be a problem if they’re doing the same thing over and over- leading to increased risk of overuse injuries. These are not typically serious injuries like ACL injuries or concussions but can lead to time off from play or burn out. Limiting the number of contact practices is also important in reducing the risk of head injuries. More practice can be good in the setting of the right coach/ trainer, who can include the proper drills, the right amount of contact practices, basic strength development as well as rest and recovery.
GG: What are your recommendations for injury prevention?
YM: Learning the proper tackle!!!! Knowing and doing are two different things- so athletes must understand how to do the proper tackle but also how must perfect the proper tackle technique in practice.
It is crucial to have an excellent coach who can not only teach athletes the proper technique, but also avoid over-hitting (limit the number of contact practice), do appropriate tackling drills, and making sure that the athletes are properly matched up during practice.
In general, I recommend basic strength training that target the core, legs, and upper body as well as stretching, and agility and coordination training for the majority of athletes.
GG: What is the age you recommend kids start tackle?
YM: Unfortunately, there is no magic number. Many health care professionals and organizations advocate for eliminating tackle football until the age of 14 due to the developing brain and weaker neck (which is more suspectable to injury compared to the adult old brain!). In the age group leading into it, proper tackling technique can be introduced and practiced in a controlled manner.
GG: Relatedly, more and more kids are playing flag through middle school and then jumping to tackle in high school. What are the keys things parents should be aware of related to injury risk?
YM: As discussed previously, if kids are not tackling and playing flag football through middle school and at 14 years old (freshman in high school) they jump into tackle football, this can create an opportunity for a serious head or neck injury. Also note that at age 14, many boys are still undergoing growth spurts and are often significantly smaller than 17 & 18 year olds. Starting to learn and practice proper tackling technique in the year leading into high school football sounds reasonable and effective.
GG: Girls flag is on the rise. How do the injuries for boys and girls playing flag differ?
YM: Similar to other spots like lacrosse and soccer, Injury rate in girls is unfortunately higher than boys in flag football, but the specific reasons for why and how are not understood yet.
GG: What general messages do you want to share with football parents?
YM: Just like any other sport, football has positive benefits like improved fitness, building teamwork, leadership skills, resiliency, fostering friendship, and simply having fun. The most important thing to do as a parent of a football athlete (or any other sport really) is to ensure that your child’s team has a concussion safety policy, and a coach who is informed and trained on the safe tackling technique as well as practice drills. “No pain no gain” is an old-school approach that likely is dangerous.
If you have a teenage football athlete that’s been playing for a while, it’s also important to check in with them to make sure they still love the sport and look for signs of burn out.
Thanks to Yukiko, and thanks to all of you for reading and supporting Good Game. Please consider sharing our newsletter with a friend.