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Youth Football Concussion Study Criticizing Limits On Contact Practices As 'Shortsighted' Generates Controversy

Concussion experts disagree that limiting contact in practice leads to high concussion rate in games

Youth football players sustain concussions at about the same rate in practice and overall as high school and college athletes, but are injured at a rate 3 to 4 times higher than older players during games, reports a 2013 study.  (1)

It was the study's suggestion that recent limits placed by some youth football organizations on the amount of full-contact practice may be counterproductive, however, that has proven the most controversial, generating a firestorm of protest from concussion researchers and youth football organizations.

Pop Warner football line of scrimmage


Researchers from the University of Pittsburgh and Cornell University tracked 468 participants, 8-12 years of age, from 4 youth tackle football leagues in Western Pennsylvania over the course of a single season.  Here's what they found:

  • No multiple concussions: Researchers recorded 20 medically-diagnosed concussions involving 20 different participants; 
  • Most in games: Of the total, only 2 occurred during practice while 18 were sustained during games;
  • Higher overall concussion rate than in high school or college football.  The overall concussion injury rate for youth football games was 1.76 per 1,000 AEs (athletic exposures; 1 AE = participation in a game or practice). This is a rate higher than reported for high school (2,3,4) (see table below) and college football (2,5)
  • Comparable injury rate for practices: The injury rate for practices (.24 per 1,000 AEs) was comparable or even lower than for high school players (.21 to .31 per AEs) (2,3,4) and college players (0.39 per AEs)(2);
  • Dramatically higher injury rate during games: 
    • The injury rate for games (6.16 per 1,000 AEs) was much higher than for high school players (2,3) and and those playing college football (2)
    • Overall, youth football players were an astounding 26 times more likely to suffer a concussion in a game than in practice.  By comparison, the ratio for high school and college football players was around 7 times more likely (2,3);
  • Older players injured at a higher rate:
    • 15 of the 20 concussions were suffered by 11- and 12-year-old players;
    • The combined practice and game injury rate for 8- to 10-year olds was .93 per 1000 AEs, slightly higher than the rates found in three prior studies for high school players (.47, .60 and .64 per 1,000 AEs respectively)(2,3,4) and in two studies of college players (.37 and .61 per 1,000 AEs)(2,5)
    • 11- and 12-year old players were almost 3 times more likely to sustain a concussion than players aged 8 to 10 years;
  • Players at skilled positions most vulnerable: All but one of the 20 concussions involved players in skilled positions (eg, running back, quarterback, linebacker).  Researchers observed that there were 1-2 players on the teams in the study who accounted for the majority of tackle and contact/collisions.  Identifying such players, and possibly player rotations, were suggested as ways to possibly mitigate concussion risk.
  • Helmet-to-helmet contact was principle injury mechanism: 
    • 45% of concussions involved head-to-head contact;
    • 5% were head-to-ground
    • 5% were head-to-body
    • 45% involved an unknown injury mechanism due to context of play (i.e. large group tackling with unclear mechanism)

Comparison of published concussion IRs and IDRs in American football 


Study/date                               Age                         Practice IR      Game IR     Overall IR        IDR games/practice                   
Current study/2013 (1)  Youth (8-12 y)  0.24 6.16 1.76 25.91
Gessell et al (2)  High school  0.21 1.55 0.47 7.38
Marar et al (3)  High school  0.31 2.29 0.64  7.39 
Lincoln et al (4)   High school  NR NR 0.60  NR
Hootman et al (5)  College  NR NR 0.37   NR
Gessell et al (2)  College  0.39 3.02 0.61  7.74


Youth football deemed 'generally safe'

From the data, lead author Anthony Kontos, assistant research director for the University of Pittsburgh Medical Center (UPMC) sports concussion program, and colleagues concluded that "youth football is a generally safe activity with regard to concussions for children aged 8-12 years, particularly during practice."

More significant than the study's actual findings, however, was the assertion by Kontos and his colleagues that reducing contact exposures in youth football during practice - such as done in 2012 by Pop Warner (6) - "may not only have little effect on reducing on reducing concussions but may also actually increase the incidence of concussions in games via reduced time learning proper tackling in practice" (emphasis supplied).  A  "better approach to reducing concussions in youth football," they suggested, "may be to focus on awareness and education" such as via the CDC's and USA Football's Heads Up concussion programs.