Miriam E. Tucker

October 27, 2015

WASHINGTON, DC — The catastrophic head and neck injuries in football players of all ages that have been the subject of recent media attention have prompted the American Academy of Pediatrics (AAP) to issue a policy statement aimed at reducing tackle-related injuries in young football players.

The statement, however, stops short of recommending a ban on the practice or setting a minimum age for tackling, which some experts have called for.

"At this point in time, based on the limited evidence available, we could not make a case for banning tackling in youth football," said Gregory Landry, MD, a sports medicine specialist from the University of Wisconsin–Madison, who was involved in the development of the statement.

"We want proper technique to be taught. Parents need to seek out coaches who are doing that," he told Medscape Medical News.

Dr Landry presented the Tackling in Youth Football statement, which was published online October 25 in Pediatrics, here at the AAP 2015 National Conference.

Tackling and Head Injuries

To develop the policy statement, members of the AAP Council on Sports Medicine and Fitness reviewed the literature on the incidence of injuries in youth football, the relation between tackling in youth football and concussion and other injuries, and the evidence supporting various strategies to mitigate the risks, such as keeping the head up when tackling.

In high-school and college football players, and probably in youth as well, about half of all injuries and the majority of concussions are related to tackling, or being tackled, Dr Landry explained.

The council recommends that officials and coaches enforce current rules against head-to-head hits and leading with the head, also known as "spearing," and do what they can do to reduce the number of hits to the head overall. They also suggest that football leagues hire athletic trainers and offer nontackling alternatives, such as flag football.

Although removing tackling would lead to fewer injuries, the council acknowledges that doing so would fundamentally change the game. Therefore, they advise that stakeholders need to weigh the risks of tackling against the recreational benefit.

 
There's no reason for kids to be involved in the single most dangerous activity in football.
 

The council cautions that the risk for injury with nontackling alternatives has not been well studied, and notes that delaying the age at which tackling is taught — as some have proposed — could make tackling more dangerous, because at that point, the athletes would be faster and stronger. Dr Landry acknowledged that there is no evidence for the latter, but it is a concern some people have raised.

"I think the AAP is taking an important position, advocating for education of coaches and players in ways to play most safely. The evidence isn't there to support a ban on tackling or restricting it to certain age groups," said Jennifer Bram, MD, from the division of general pediatrics at the University of Massachusetts Medical School in Worcester.

"I don't think that the AAP can get into the business of regulating youth sports, as there are many sports in which children can sustain injuries and concussions," she told Medscape Medical News. "However, we are in the business of advocacy for our patients, and I think promoting education and responsibility in youth sports is a role we all embrace as pediatricians."

But the statement could have gone further, said Robert Cantu, MD, from the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine.

"I think tackling should be removed until high school. There's no reason for kids to be involved in the single most dangerous activity in football, which contributes to more than two-thirds of the catastrophic injuries in football," he said.

 
We're not saying don't learn the techniques, we're just saying don't tackle each other at the youth level.
 

"You can still play the sport, just play in a modified manner. You reduce most of the concussions and you certainly reduce the great majority of the subconcussive blows," Dr Cantu told Medscape Medical News.

Dr Cantu, who also serves as director of sports medicine at Emerson Hospital in Concord, Massachusetts, and senior advisor to the Head, Neck and Spine Committee of the National Football League, said he does not think delaying the age at which tackling is taught will increase the risk for injury.

Young kids can be taught proper tackling techniques without actually doing it in games. For example, they can practice with mannequins, he said. "I'm not buying the nonsense that you need to learn to tackle at a very early age or when you start playing in high school, you're suddenly going to be at risk. There's no proof behind any of that. We're not saying don't learn the techniques, we're just saying don't tackle each other at the youth level."

But beyond that, Dr Cantu said he agrees with the rest of the recommendations. "I totally support everything else. I just think it doesn't go far enough."

Dr Bram said she thinks the recommendations are fine as is.

"I don't think there was anything that was left out," she told Medscape Medical News. "I do think it will be helpful to have this policy statement that we can share with our parents and communities to provide guidance about safety measures that can be taken to improve our patients' health.

"I also think it is helpful for us, as pediatricians, to advocate for more research and study to determine the safest way for kids to enjoy physical activity and youth sports," she said.

Dr Landry is the son of a high-school football coach, paid his college tuition by playing football, and was a team physician for the University of Wisconsin football team for 25 seasons. Dr Cantu is vice president of the National Operating Committee on Standards for Athletic Equipment, cofounder and medical director of the Sports Legacy Institute, and senior advisor to the NFL Head, Neck and Spine Committee; he has received support from the Andlinger Foundation; and he receives royalties from the publication of several books. Dr Bram has disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2015 National Conference. Presented October 25, 2015.

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