Background: There is growing fear among healthcare professionals and parents regarding youth tackle football, likely due to highly publicized concerns about potential long-term physical and cognitive health of professional football players. Parents and advocacy groups are pushing for state legislation to ban youth tackle football in favor of flag football to avoid repetitive head impacts that are potentially associated with late-life cognitive deficits. Although the head impact burden experienced during flag football is likely lower than tackle, no research has compared head impact exposure between youth tackle and flag football. Therefore, our purpose was to examine head impact exposure and magnitudes between youth tackle and flag football players. Methods: Twenty-seven tackle (age=11.0±1.5y, height=145.8±11.9 cm, mass=45.0±14.9 kg) and 29 flag football players (age=8.6±1.1y, height=133.9±8.4 cm, mass=33.9±9.5 kg) were enrolled in this prospective cohort study. Participants were fitted with head impact sensors (Triax Sim-G) worn throughout the entire 2017 season that recorded impact frequency and magnitude (linear [g] and rotational acceleration [rad/s2]). Athlete exposure was defined as one player participating in one session. Impact rates (IR) were calculated as impacts per one athlete exposure. Game, practice, and combined IR were compared between groups using impact rate ratios (IRR). IRR with 95% confidence intervals (CI) not containing 1.0 were considered statistically significant. Acceleration values were binned into low- and high-magnitude categories (linear split at 40 g, rotational split at 4,600rad/s2). Magnitude category frequencies were compared between groups using Chi-square test of association (p&0.05), and 90th percentile acceleration values are presented. Results: One-thousand nine-hundred and eight tackle (735 game, 1173 practice; 70.66 impacts/player) and 169 flag (101 game, 68 practice; 5.83 impacts/player) football head impacts were recorded. Tackle players experienced a higher impact rate during games versus practices (IRR=1.41; 95%CI:1.29 -1.55) while flag players experienced a lower impact rate (IRR=0.60; 95%CI:0.44-0.81). Practice and game head impacts combined resulted in tackle players (IR=3.06) accruing 4.61 times the impact rate (95%CI:3.94-5.40) of flag players (IR=0.66). Tackle players sustained a significantly greater head impact rate than flag players during games (tackle IR=3.83, flag IR=0.55; IRR=6.90; 95%CI:5.60-8.49) and practices (tackle IR=2.72, flag IR=0.93; IRR=2.91; 95%CI:2.28-3.72). Tackle 90th percentile linear acceleration was 53.32 g (median=32.50 g) and flag was 53.32 g (median=32.65 g). Tackle 90th percentile rotational acceleration was 7,000 rad/s2 (median=3,200rad/s2) while flag was 8,300 rad/s2 (median=4,100rad/s2). Tackle experienced a significantly higher frequency of low-magnitude rotational acceleration impacts (71.6% vs. 57.4%) and lower frequency of high-magnitude impacts than flag (28.4% vs 42.6%;?2=15.15, p&0.001). There were no significant associations for linear acceleration (p=0.75). Conclusions/Significance: Our results indicate youth flag football head impact rates are 82%-88% lower compared to tackle. Contrary to general belief, youth flag football players experienced numerous head impacts with a greater tendency for high-magnitude rotational acceleration head impacts. Although fewer head impacts occur during youth flag football, parents and coaches should be aware that head impacts do occur during practices and games. Whether high-magnitude or high-frequency head impacts influence long-term health remains unknown. Our findings provide novel evidence into the head impact exposure occurring during youth tackle and flag football. Longitudinal studies examining head impact biomechanics and advanced neuroimaging in youth tackle and flag football players nationwide is warranted to ensure long term cognitive health.
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