Football and the Young Athlete

By: Matthew J. Matava, MD
Washington University Orthopedics

American tackle football has become one of the most popular sports in the United States replacing baseball in the minds of many Americans as the “national pastime”. Approximately, 2.8 million children age 6 to 14 play organized youth tackle football and another 1.3 million play at the high school level, making it among the most popular youth sports in the U.S.

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?” This seemingly simple question is one that does not have a simple answer. Parents and administrators are debating this openly – a testament to the major shift in public sentiment recognized over the past three years. 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 that the majority of football participants will eventually sustain an injury, a recent study by USA Football which included more than 60,000 individual athletic exposures (participation in a practice or game) for nearly 2,000 youth football players, found that more than 90 percent of the youth players did not suffer an injury that restricted participation; fewer than 10 percent of players incurred an injury, and of those injuries, two-thirds were minor allowing athletes to return to play on the same day.

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.

Non-orthopedic conditions are also seen in football. With summer training camps comes an increased awareness and vigilance for exertional heal illness. Young athletes account for approximately half of all heat-related injuries. High school athletes, especially males, are at the highest risk for requiring emergency treatment for this avoidable condition. Unfortunately, approximately two-thirds of football players sustaining heat illness are either overweight or obese. Other risk factors for heat illness include: practicing in the mid-day heat, wearing dark-colored uniforms, donning full pads and helmet at all times, limiting water breaks, diabetes, and sickle cell trait in African Americans. Frequent water breaks to replenish lost fluid are imperative to prevent heat-related illness. Athletes should be weighed before and after activity to replace fluid losses. An athlete should not be allowed to return to play if he has lost over 3% of his body weight following activity until those fluid losses replaced. In conclusion, football, under its current rules, will never be entirely safe and free of the risk for injuries. Therefore, it is important that there is always the proper available care to treat mild injuries with continued surveillance for more significant injuries. Instruction in proper tackling and blocking techniques, use of well-fitted equipment, and adherence to the rules of the game, are necessary means to reduce the risk for serious injury to youth players. 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 health care 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.