Impact of Proper Tackling Technique Education and other Strategies for Safety in

Youth Football

Thomas P. Dompier, PhD, ATCPresident and Injury Epidemiologist

Zachary Y. Kerr, PhD, MPH, Karen Roos, PhD, MSPT, ATC, Aristarque Djoko, MS, and Sara Dalton, MS, ATC

2016 Collaborative Solutions for Safety in Sport National MeetingMarch 22, 2016, Indianapolis, IN

Disclosures• No personal financial conflicts

• I will disclose that my wife and I (both ATs) let our 8-year-old son play sports, including baseball, flag football, basketball, soccer, jungle gym, mt biking, skiing, general mayhem, and many others.

– 1st Sports Injury • Contusion after being hit in face by pitch from the coach in

coach pitch baseball– 2 Concussions

• Mom dropped him, subdural and occipital bone fx• Rollerblading (yes, he was wearing a helmet, no hospital)

• Everyone who receives a grant to study concussion should be required to report their concussions, I’ve had 9:

– 5 on my mountain bike (yes I still ride, aggressively)– 2 in car accidents– 1 on a bike as a kid (lost consciousness)– 1 in a fist fight as a kid (lost consciousness)

Funding for these Studies Provided by

• USA Football• BioCrossroads • National Athletic Trainers Association• NCAA Sport Science Institute

Challenges of Demonstrating Prevention with an Effective Intervention

• “In some circumstances it can be safely assumed that if a certain event had occurred, evidence of it could be discovered by qualified investigators. In such circumstances it is perfectly reasonable to take the absence of proof of its occurrence as positive proof of its non-occurrence.”– Copi, Introduction to Logic (1953), p. 95

A Call for Better Concussion Incidence Data Across all Youth

GAMES

Percent of players who might suffer a concussionYouth 3.3%High School 7.2%NCAA 5.5%

Putting Football in Perspective

Youth High School NCAA TotalPlayers 3,000,000 1,100,000 71,000 4,171,000

Concussions 99,000 79,640 3,905 182,000Team Size 25 77 107Meaning 1 in 30 1 in 14 1 in 20

• Estimated 3,500,000 all-cause traumatic brain injuries (TBI) per year (includes sports, car crashes, gun violence)

• Youth Football’s 99,000 concussions equates to 2.8% of all-cause TBI burden

• According to the Aspen Institute, 5,000,000 youth play soccer• If 1 in 60 youth soccer players get a concussion, would contribute 83,300 or 2.4% of

all-cause TBI burden• Just speculation, we have no idea how many youth soccer players get concussions

Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football.

Kerr ZY, Yeargin SW, Valovich McLeod TC, Nittoli VC, Mensch J, Dodge T, Hayden R, Dompier TP.

Published in 2015

Theoretical Framework• Social-Ecological Model in Public Health

– Posits that public health interventions are most effective when multiple factors are intervened upon at the same time.

PlayerBehavior

Coach Behavior

TeamRules

Culture

OrganizationPolicy

CulturePublic Policy

Kerr et al 2014

Methods – Injury Incidence• Athletic Trainers attended all

practices and games

• Recorded de-identified injury and exposure information

• Provided care for injured players

• Reported data electronically via online injury surveillance tool

• 100 Youth Football Teams, 12 Leagues, 4 states, >2000 kids

Injury Rates by Group and Severity

0.97 0.68

2.731.89

7.32

2.77

0.00

2.00

4.00

6.00

8.00

All injuries Time loss injuries

HUF+PW vs. NHUF RR=0.13 (0.08-0.21) HUF+PW vs. NHUF RR=0.25 (0.14-0.44)

HUF-Only vs. NHUF RR=0.37 (0.26-0.53) HUF-Only vs. NHUF RR=0.68 (0.43-1.07)

HUF+PW HUF-Only NHUF

Kerr et al. 2015

87% ↓

63% ↓

75% ↓

32% ↓

Comprehensive Coach Education Reduces Head Impact Exposure in American Youth Football

Kerr ZY, Yeargin SW, Valovich McLeod TC, Nittoli VC, Mensch J, Dodge T, Hayden R, Dompier TP.

Published in 2015

Methods – Head Impact Exposure• Players wore xPatch accelerometer during

practices and games

• Applied behind ear as shown in picture, didn’t cause any issues

• Minimum impact exposure was set at 10gs but included 20g in analyses

• 32 to 38 kids in the NHUF and HUF groups, respectively

Head Impact Exposure in Youth Football

34.7

91.7

0

20

40

60

80

100

Heads UpCertified

Not Heads Up

Average Practice Head Impacts per Player per

Season

Impacts >10g during practice

Players in Heads Up Football certified

organizations had 3 FEWER >10g impacts

per practice

Kerr et al. 2015

Comparison of Indiana high school football injury rates by inclusion of the USA Football “Heads Up Football” Player Safety Coach

Kerr ZY, Dalton S, Roos K, Djoko A, Phelps J, Dompier TP

In-review, March 2016

Player Safety Coach Reduces Injuries in Indiana HS Football

• Indiana Football Coaches are Required to Complete all Components of Heads Up Football but are not required to have a Player Safety Coach (PSC)

• 3 high schools with a PSC and 3 high schools without a PSC matched for size and location

• 38% lower all-injury rate in Indiana high school football programs with a Player Safety Coach

• 43% lower time loss (more severe) injury rate in Indiana high school football programs with a Player Safety Coach

• 88% lower rate of concussion in Indiana high school football programs with a Player Safety Coach

Kerr et al, in review

11.4

3.06.0

1.7 0.6 0.1

26.4

4.8

9.4

3.04.4

0.70.0

5.0

10.0

15.0

20.0

25.0

30.0

Game Practice Game Practice Game Practice

RR=0.43(0.25 , 0.74)*

RR=0.62(0.40 , 0.95)*

RR=0.64(0.29 , 1.41)

RR=0.57(0.33 , 0.99)*

RR=0.14(0.02 , 1.11)

RR=0.12(0.01 , 0.94)*

All injuries TL injuries only Concussions only

Rat

es p

er 1

000

expo

sure

s

Injury Rates in Indiana High School Football Teams with and without a Player Safety Coach (PSC)

PSC Non-PSC

Kerr et al, in review

Findings Replicated in Other Labs

The four high school football programs in South Bend, Ind., saw a 40-percent decrease in concussions among its players during the 2015 season compared to the year before.

“We have seen the number of injuries drop 16 percent and the number of concussions drop from 28 to 36 percent.”

The Scientific Method:a hypothesis is an idea that hasn't been proven yet. If enough evidence accumulates to support a hypothesis, through different samples and replication in different labs, it moves to the next step known as a theory, and becomes accepted as a valid explanation of a phenomenon.

Datalys Center’s Position• We are not advocates for-or-against tackling in youth football,

however: – Based on these data and others’ data, it is the position of the Datalys

Center that coaches should be educated & certified through Heads Up Football, and follow Pop Warner’s or USA Football’s Youth Practice Guidelines, doing so reduces both injuries and head impact exposure during practice.

– Also, Indiana High Schools should be encouraged to identify and seek training for a USA Football certified Player Safety Coach, doing so reduces injuries during practice in high school football and likely youth also.

Acknowledgements• Thank you for the invitation to speak

– Douglas Casa, PhD, ATC, FACSM, FNATA, Korey Stringer Institute– Jonathan Drezner, MD, Center for Sports Cardiology, University of WA– Jon Divine, MD, AMSSM President, University of Cincinnati– Scott Sailor, EdD, ATC, NATA President, Fresno State University– Brian Hainline, MD, NCAA Sport Science Institute, CMO

• Thanks to our program sponsors– USA Football– National Collegiate Athletic Association (NCAA)– National Athletic Trainers Association (NATA) – BioCrossroads of Indiana

• Thank you Athletic Trainers!

• For copies of any studies– tdompier@datalyscenter.org– www.datalyscenter.org– Follow us on Twitter and Facebook