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AN ORTHO-PINION

Matthew J. Matava, MD

Any views or recommendations shared in the Ortho-pinions blog are solely those of the authors and do not necessarily represent those of the American Academy of Orthopaedic Surgeons.

 American tackle football has become one of the most popular sports in the United States. Approximately, 2.8 million children age 6 to 14 play organized youth tackle football and another 1.1 million play at the high school level, making it among the most popular youth sports in the United States.

Despite the millions of children and adolescents who gain the physical, social and psychological rewards that youth football provides, many parents and other interested adults continue to ask, “Is youth football safe?” While no sport is perfectly safe, the question is whether it can be made relatively safe and if the long-term consequences of any sport are worth the risk.

It may surprise parents to know that, at the youth level, organized football among 5- to 15-year-olds has 12% fewer injuries per player than organized soccer in the same age range, 50% fewer injuries than bicycle riding, and 74% fewer injuries than skateboarding. In general, football-related injuries tend to vary inversely with the players’ age (and associated size and force exerted through contact) in that youth players sustain less than one-third the injuries of high school football players, less than one-fifth the injuries of collegiate players, and less than one-ninth those seen in professional football players.

Despite the perception that the majority of football participants will eventually sustain an injury, a recent study by USA Football found that more than 90 percent of the youth players did not suffer an injury that restricted participation. Contusions were the most common injuries (35%), followed by ligament sprains (15%). Fewer than 4% of the youth players sustained a concussion.

The majority of football-related injuries occur to the musculoskeletal system, most notably the lower leg, ankle, and foot. The most common injuries among high school football players are ligament sprains. Fortunately, most of these are relatively minor and are effectively treated by nonoperative means of rest, ice, compression, and elevation of the injured area. Some ligament injuries may be season-ending for a number of youth football players. Ligament tears of the knee, such as the anterior cruciate ligament (ACL), often require reconstructive surgery in order to reestablish joint stability and prevent instability-related damage to the articular cartilage of the knee.

Fractures may also occur in young players and may involve the growth plates located at the ends of most bones until the player reaches skeletal maturity. A number of these fractures can be treated nonoperatively with casts or splints. Those fractures with displacement often require surgical reduction and fixation to achieve a favorable long-term prognosis.

Spinal cord injuries, though uncommon, still represent an area of significant concern due to the forceful nature of tackling and blocking in football, which is associated with the highest number of cervical spine injuries of any sport. Rule changes prohibiting “spear tackling” and improved equipment have been instrumental in reducing the number of serious cervical spinal cord injuries. USA Football’s Heads Up Tackling℠ is a step-by-step method to teach and reinforce proper tackling mechanics with a focus on reducing helmet contacts.

Sports-related concussions, also known as mild traumatic brain injury, have garnered widespread attention among healthcare professionals at every level of sports medicine. Football is consistently near the top in terms of the highest concussion rate of all high school sports. High school athletes who have been concussed are three times more likely to suffer another concussion in the same season. Young athletes are at risk for the so-called “second impact syndrome” — brain injury caused from a premature return to activity after suffering a concussion. This syndrome can result in severe long-term damage to the developing brain. Therefore, prompt recognition of the signs and symptoms of concussion is imperative with removal from play once the diagnosis of a concussion is made. Baseline neuropsychological testing has been a useful tool to detect subtle residual reductions in mental processing even after the athlete becomes symptom-free.

In conclusion, football, under its current rules, will never be entirely free of the risk for injuries. Instruction in proper tackling and blocking techniques, use of well-fitted equipment, and adherence to the rules of the game, are necessary to reduce the risk for serious injury. There is an increased need for medical professionals, especially certified athletic trainers, to be on site for games. At a minimum, first-aid training should be considered for at least one coach or league official present at all youth football practices and competitions.

Given the limited resources of many youth leagues, it is imperative for those healthcare professionals with an interest and expertise in sports medicine to do what they can at the local level to help maintain the safety of the game so that today’s youth players can continue to enjoy all of the positive benefits of American football.

Learn more about High School Sports Injuries.

This Ortho-pinion was originally written for A Nation in Motion, the AAOS's award-winning public awareness campaign dedicated to sharing the stories of people whose lives were improved by orthopaedic surgery.