A Helmetless-Tackling Intervention in American Football for Decreasing Head Impact Exposure: A Randomized Controlled Trial
Swartz EE, Myers JL, Cook SB, Guskiewicz KM, Ferrara MS, Cantu RC, Chang HC & Broglio SP. Journal of Science and Medicine in Sport. doi: 10.1016/j.jsams.2019.05.018. https://www.sciencedirect.com/science/article/pii/S1440244018310673?dgcid=rss_sd_allTake Home Message: Helmetless tackling and blocking training may reduce the number of head impacts among high-school American football players.
Innovation in helmet design has made American football safer regarding catastrophic injuries; however, helmet use is related to more head impacts, likely due to a false sense of brain safety. These authors recently demonstrated that 5-minute sessions of helmetless-tackling skills reduced head impact frequency by 28% among a small group collegiate American football players. Despite promising results, it remains unclear if this type of intervention could help high school football players. Therefore, the authors aimed to determine if helmetless tackling and blocking skill training would decrease head impacts in high-school American football players. They conducted a randomized control trial on four American football teams split equally into either the helmetless (intervention) group or control group over two athletic seasons. A total of 59 out of 89 athletes completed the study in the helmetless group and 56 out of 91 athletes completed the study in the control group. The most common reason for losing athletes during the study was if a person quit the team (55 out of 65 athletes). The helmetless group participated in an established helmetless tackling and blocking training program. The 10-minute program was performed 4 times per week during pre-season and two times per week in-season. The control group completed their normal practice regimen. The authors recorded athlete participation in games and practices to examine exposures. They also monitored head impact frequencies with head-impact sensors (Triax SIM-G) attached to each athlete’s head during all practices and games. Overall, the authors found that the helmetless group experienced a 26 to 33% fewer head impacts per exposure compared to the control group during games. The two groups had a fairly similar number of impacts during practices when all players typically experienced fewer impacts than games. Furthermore, the helmetless training had little or no benefit among the younger players and at the end of a season.
These findings are the first randomized control trial to assess how a helmetless tackling and blocking training program can reduce cumulative head impacts among high school American football athletes. The training program reduced the number of head impacts during games, which suggests the training program is effective. However, more work may be needed to improve the program’s effect towards the end of a season and among younger players. The optimal frequency and duration of helmetless tackling and blocking training is unknown and may explain why the program was less effective at the end of the season or among younger players. Future larger clinical trials could help address these issues and clarify if the large number of athletes who quit their team influenced the results of the clinical trial. Regardless, these findings have direct clinical implications as they suggest a minimal training program (10-minutes, two times a week in-season) can reduce the number of head impacts in American football players. There are many uncertainties regarding the relationship between long-term neurocognitive health and repetitive head impacts. However, starting this training program has minimal negative health consequences and potential for positive long-term health outcomes. Clinicians could consider using these findings to discuss with their stakeholders the merit of starting a similar training program to help promote athlete safety.
Questions for Discussion: Is helmetless tackling training a practice change you would feel comfortable implementing or occurring in your clinical practice? What are some barriers to implementing practice modifications like this, and how could you address them? In your opinion, do you think these training programs may be more effective in youth American football where children are first developing their skills?
Written by: Landon B. Lempke, MEd, LAT, ATC Reviewed by: Jeffrey Driban
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As an athletic training student, I have worked with various football teams during my clinical rotations, either high school or college teams. Many of the teams that I have seen/worked with do not emphasize tackling techniques and rarely slow practice down to focus on the basics and allow players to learn to safely tackle. I agree with these findings from this article that helmetless tackling will reduce the number of head impacts and that teams should start working on this tackling technique at a minimum of two times per week. Football can be extremely dangerous if the players do not know how to properly tackle someone and practicing proper form, the safety of the sport may increase. Do you think that it would be beneficial to incorporate this helmetless tackling technique in college sports and not just younger players/high school teams that the article was alluding to?
Scott,
Thanks for providing your viewpoints on tackling technique emphasis in your clinical practice. I agree that avoiding improper tackling techniques, such as head-down or “spear” tackling is beneficial for reducing injury risk. I believe that implementing rule changes in addition to tackling training programs like the one described above may help reduce head impacts and injury risk.
In my opinion, I believe implementing this helmetless training program in older/more experienced athletes would likely be beneficial. Tackling, like many sport movements, likely requires repetition in order to maintain efficiency and form. A tackling training program could help reduce cumulative head impacts for more elite athletes, which is the driving correlative risk factor in research for long-term consequences such as Chronic Traumatic Encephalopathy (CTE) in American football. To me, there are minimal negatives to implementing a tackling training program like this one, but many potential positives. One caveat however is that this specific training program did not significantly reduce head impacts among younger players or in the mid- to late-season. My anecdotal rationale for these findings might be because: 1) their tackling training program reached a peak in head impact reduction effectiveness or 2) there was decreased buy-in among coaches/athletes as the season continued on.
I love that this research was done on youth football players! We can definitely use this study if we revamp it like to increase the time of helmet-less tackle program and the duration we could maybe see an even lower percentage of head impacts. I believe that even if its that slight of a decrease in head impacts we can see that it’s only helping these athletes in their long-term wellness and not worsening it in any way. At my current clinical site I am working football and my first game I witness three concussions. I found this study extremely helpful and is something I would bring to the attention of the coach knowing that he is understanding enough to try this new approach out. I’m extremely lucky to have a coach who cares solely about the wellbeing of not only his athletes but his staff too. He is open-minded and is certainly willing to try this study as well, after all, there’s nothing to lose. Other athletic training students may face some issues, a lot of times coaches are very close-minded and have been taught to a certain way of playing football but this kind of coaches lack knowledge of brain injuries, after all, we are the licensed health care providers, we know better. Because this was done on youth football players which is the perfect time to teach them how to decrease head impact when these are the first type of skills they are taught, they will grow up following the same skills. Now a lot of older football players still tackle headfirst even though it’s a rule not to but this is what they learned when they started playing football. Overall I’m very excited about this new research and it will definitely encourage me to do more research and talk to my coach at the site.
Andriana,
Thank you for your thoughtful reply and insights. Your points are valid in that implementing these tackling intervention programs have minimal risk/cost, suggesting implementation may worth it regardless of small or large head impact reductions. Something the study did not examine, and would take numerous sites and years to examine, would be observing the incidence of acute, traumatic injuries between a control and tackling intervention group. There may be additional value of these programs not observed yet, further suggesting their clinical utility. I believe implementing this type of intervention program with increased session duration, weekly frequency, and/or total program duration could be fruitful clinically. I wish you success in your endeavor to discuss with your colleagues the possibility of implementing this type of program.