By Tyler Blum

At the risk of sounding like a politician, the mass media got it wrong when reporting the results of a recent University of Iowa study on injury rates in youth football. Headlines and reports of the data were spun to grab readers’ attention, but didn’t quite hit the mark in reporting what the results actually indicate. After carefully reading the article published by the Orthopedic Journal of Sports Medicine, I sat down with lead researcher and author Dr. Andrew R. Peterson, MD, MSPH at the University of Iowa to understand more clearly what the research tells us.

Full disclosure, I run the lone flag program that participated in this study which means I have a vested interest in this research. But I’m also a big fan of football in general, and have dedicated my livelihood to coaching young players, serving the sport’s improvement in the modern era, and promoting its continued role in our lives. I’m not here to attack tackle football; I support tackle programs across the state and directly coach hundreds of tackle players at camps throughout the entire year. There is certainly an appropriate time and place for tackle football.

After surveying headlines that suggested tackle football is safer than flag— I’ll deal with safer in a moment, I asked Dr. Peterson if the news outlets were on target with their analysis. “The big takeaway from this data is that youth football in general is remarkably safe and has a low overall injury rate. The difference in injury rates between youth tackle and flag football is trivial. I recommend for parents to consider non-injury related factors when choosing a youth football program such as the organization of the league, quality of the coaching, ease of access, and where their children’s friends are playing.” He notes that media is still operating under the assumption that youth tackle football is dangerous; however, his study, the largest of it’s kind and the only one to include both flag and tackle participants, shows an overall injury rate of less than 1% (2.76 injuries per 1,000 exposures). This is similar to youth soccer.

The safety of football continues to be a hot topic across the country. The expanding popularity of the sport is at constant odds with the sensitivities of injury and concussion. This is why it’s big news when the latest injury-related information becomes available. Headline writers seize the opportunity to grab reader attention with provocative, perhaps semi-true, statements. In this case, the prevailing media message was ‘flag football is not safer than tackle.’ This is not what the research article presented. In fact, Peterson et al went so far to write, “This presents a paradox in trying to determine which type of league is ‘safer’ ”. You see, even the researchers handle the term safer with care. So, what is the ‘this’ they’re talking about?

For the study, an injury was considered to be any ailment that caused a time-loss, meaning the player did not return to play on the same calendar day he experienced the injury. All sprains, strains, and contusions were classified equally to fractures, ligament tears, and concussions when determining the injury rate. The media largely based reporting on this metric alone which showed flag football to have a higher injury rate. However, the researchers went further to break down the injuries into subcategories— those that qualified as severe and those that were deemed to be minor. What you likely didn’t read is that the rate of severe injury was higher among tackle players and that they took longer to return to play than their flag peers. Shouldn’t this also be considered when labeling one ‘safer’ than the other?

The researchers also acknowledge some limitations to the study that went largely unmentioned in media reports. A truly unlimited study would likely require a collaborative effort with greater human and financial resources than was available to collect this data. It would be quite expensive to hire the necessary medical personnel for this and the geographic area of research would need to expand due to a large disparity in the ratio of flag to tackle football players in eastern Iowa. Although the researchers took scientific measures to mitigate these limitations, there remained factors with potential to skew the results.

The method of recording data was “dependent on semivoluntary attendance and injury reporting” mostly by non-medical personnel although the article states, “Some teams had athletic trainers who filled out injury reports…” According to the data, 90% of the flag teams recorded at least one data point, a single practice or game, while only 69% of tackle teams met this mark. Every team was to submit a report that included attendance and injury information from every practice and game. This determined the total number of exposures, opportunities to be injured, that occurred during the season.

As the flag league organizer, I can confirm that all flag teams had a coach (parent) submit the reports. I often fielded questions about what needed to be reported as an injury and what did not. Many flag coaches did not complete a report on the same day that each practice or game occurred. More often, they entered data for multiple dates at once after being prompted to get up caught up. This timespan, several weeks in some cases, between the date of an exposure and when the data was actually recorded could have inhibited reporting accuracy. I have no knowledge regarding the timeliness of reporting by the coaches or, in some cases, athletic trainers of the tackle teams.

There is a possibility that any coach, flag or tackle, could have censored or falsified data in an attempt to bias results to align with his or her particular side of the issue. This is a sinister presumption, but the flag versus tackle debate is intense among youth football parents and organizers. A positive outcome would surely provide fodder for one side in the matter. Due to inconsistencies in reporting by a mixture of non-qualified and qualified medical personnel, the researchers declare, “there may still be variability between coaches and team personnel in attendance and injury reporting.” Consistent reporting from qualified, neutral personnel would strengthen the data.

The researchers also note the difference in the number of tackle participants (3,525 or 93%) versus flag participants (269) included in the study. They state, “the number of injuries seen in the flag football league was relatively small, and the number of participants in the flag league was much smaller than the number of participants in the flag leagues. For these reasons, comparisons made between leagues are somewhat limited.”

Furthermore, a deeper exploration of the intrinsic values within players and parents who choose flag football over tackle would provide meaningful insight to the comparison. It’s not unreasonable to hypothesize that players opting for flag could be more likely to report a minor injury than a tackle player or that flag parents could be more cautious in managing them.

It’s important to note the term of this research— it covers exposure and injury over the course of one season. Long-term effects of football participation are a completely different element to contemplate, as are head (brain), neck, & spine injuries apart from those to other parts of the body. I recently read the book, League Of Denial, detailing the emergence of traumatic brain injury conversation in the NFL. As a result, I am concerned about the accumulation of even sub-concussive impacts that occur throughout one’s football lifetime—especially when those impacts start happening while a young player’s body and brain are still developing most. This goes beyond my strictly coaching-based opinion that flag football is more beneficial for youth players, injury discussion aside. Long-term football consequence is still a relatively new area of study with early discovery pointing to a range of analysis.

Look, I love football and think every kid should experience it. I have great respect for the work the researchers at the University of Iowa Sports Medicine facility are doing—it’s greatly needed in the present era of the sport. I’m proud to be in position to contribute to the research. My effort here is to produce a broader understanding of the research and to clarify the results versus how the mass media portrayed it. More accurate reporting was done by the likes of MedPage Today and other medical industry outlets.

In order to make the most informed decisions for your children, you should be offered more substance on the issue— not have your perception shaped by the agendas of mass media. Perhaps most appropriate, you should read the research article for yourself; it can be accessed for free on the Orthopedic Journal of Sports Medicine website. I encourage that you continue to seek unfiltered scientific information and solicit further advice from people in the medical and football profession when considering your stance on the issue.


Tyler Blum is the owner of Taking Back Football and director of the RedZone Football Academy. Based in Iowa City, he is a former member of the University of Iowa Football team and serves as the camp coordinator for the Iowa Football Club. He coaches youth through high school players throughout the year, serving athletes and programs across the state of Iowa.