Head Impact Exposures Among Youth Tackle and Flag American Football Athletes

Head Impact Exposures Among Youth Tackle and Flag American Football Athletes

Published: Sep 01, 2021
Publisher: Sports Health: A Multidisciplinary Approach, vol. 13. issue 5

Dana Waltzman

Kelly Sarmiento

Owen Devine

Xinjian Zhang

Lara DePadilla

Marcie-jo Kresnow

Ravi Goyal

Matthew J. Breiding


Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited.


Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes.

Study Design

Cohort study.

Level of Evidence

Level 4.


Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes.


There were 186,239 head impacts recorded during the study. Tackle football athletes were 14.67 (95% CI 9.75-21.95) times more likely to sustain a head impact during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15g (17.95-18.34) and 52.55g (51.06-54.09) for a tackle football athlete and 16.84g (15.57-18.21) and 33.51g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40g) per athletic exposure compared with a flag football athlete.


This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes.

Clinical Relevance

These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.

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