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.

Take 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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