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. 2015 Jul 15;3(7):2325967115594578.
doi: 10.1177/2325967115594578. eCollection 2015 Jul.

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

Zachary Y Kerr  1 , Susan Yeargin  2 , Tamara C Valovich McLeod  3 , Vincent C Nittoli  4 , James Mensch  2 , Thomas Dodge  5 , Ross Hayden  1 , Thomas P Dompier  1
Affiliations

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

Zachary Y Kerr et al. Orthop J Sports Med. .

Abstract

Background: Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice.

Purpose: To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated.

Study design: Cohort study; Level of evidence, 2.

Methods: Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non-Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs.

Results: A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found between the practice concussion rates among 11- to 15-year-olds in the HUF+PW (0.14/1000 AEs) and NHUF groups (0.79/1000 AEs) (IRR, 0.18; 95% CI, 0.04-0.85).

Conclusion: These findings support comprehensive coach education and practice contact restrictions as effective methods of injury mitigation. Future research should continue evaluating similar programming within other levels of competition and sports.

Keywords: epidemiology; pediatrics; prevention.

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Conflict of interest statement

One or more of the authors declared the following potential conflict of interest or source of funding: Funding for this study was provided by USA Football.

Figures

Figure 1.
Figure 1.
Injury rates in youth football teams in the 2014 season by implementation of Heads Up Football (HUF), affiliation with Pop Warner Football (PW), event type, and type of injury. Players in the non–Heads Up Football (NHUF) group were also not affiliated with Pop Warner Football. Time-loss injuries are those that restrict participation for at least 24 hours. AE, athlete-exposure, defined as 1 athlete’s participation in 1 practice or 1 competition.
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