Injuries and their prevention in American football

CHALLENGING ASPECTS IN THE PREVENTION OF AMERICAN FOOTBALL INJURIES Competitive American football continues to expand with an ever increasing popularity particularly throughout the United States of America. The adventurous and challenging nature of this sport attracts participants from a young age in the elementary schools through the higher levels of tertiary education. There is an indication that in excess of 15 000 public and private secondary schools in the USA enter the sponsor organised competitive football programmes during the autumn with approximately 1.2 million young people partaking. Participation at the college or university level has proved to be popular for some 1.2 million spread throughout the nation. There is also substantial evidence that communities contribute to an estimated 200 000 boys supported by various social agencies that have a particular interest in wholesome athletic competitive youth programmes. Additional consideration for football participation on sandlots on a semi-organised basis would probably contribute to a total in the vicinity of two million participants in the USA alone. The game is also significantly popular in Canada and Japan as well as being played in some South American countries.

There is an indication by the medical profession that at least 50 per cent of the football participants are subjected to injuries of a low grade of severity each year. Obviously, this outcome presents a health problem resulting from competition generated in football participation. In recognition of this exposure to potential injury, the health problem is of significant magnitude to concern school administrators, athletic directors, coaches, team physicians, physical educators, athletic trainers, and, most certainly, parents of the athletes.

A description of football immediately identifies a contact sport that may also be categorised as a collision sport . Observations have revealed that the athlete with a larger body type who has the ability to move more rapidly will activate increased energy and therefore establish contact with a greater degree of force. This form of movement has a potential for inflicting injury either to a lesser or greater degree of severity. The innovative developments in coaching technology continue to produce an improved athlete with more speed and force to the extent that certain types of football injuries have increased in both frequency and severity. With the inclusion of specific rules to protect the participant, the prevalance of other forms of injury indicates a reduction in the injury rate. A major concern of all football enthusiasts is to control the sport to the extent that injuries will be reduced to a minimum without detracting from the gratification derived from participation.

The availability of valid and reliable statistics will be valuable for a variety of purposes. At the secondary school level, statistics can be of inestimable value in evaluating and analysing the contributory factors in injury causation. When the indirect and direct causes of athletic injury become apparent, the possibility exists for creating corrective and remedial controls for the prevention and reduction of similar injuries in the future. The National Federation of State High School Athletic Associations has been actively involved in the formulation of significant data to assist in a scholarly understanding of injury control in competitive football. Frequently many injuries in football are not reported. How to determine the extent and significance of an injury presents variable factors to compound the problem of data considered to be valid and reliable with nation-wide implications.

When considering the movement and exposure in football there is a general acceptance that it is inevitable that injuries will result from participation in the sport. In a game requiring direct bodily contact in a designated area for 48 to 60 minutes in playing time, it is easy to understand that a potential for injury most certainly exists. This is not to infer that injuries cannot be controlled, prevented and reduced to a minimum. The following sections present in some detail the considerations that will contribute to a reduction in football injuries.

The coach

From the standpoint of priority, the selection of a competent coach is of paramount importance. An efficiently qualified coach is an essential prerequisite in the prevention of injuries which may be incurred through participation in football. Coaching responsibilities require an individual with a variety of capabilities and characteristics that will ultimately contribute to success both for his players and for himself. The coach initially should possess excellent teaching and leadership qualities. Emotional stability and sound moral character are exceedingly important traits. A firm dedication in applying conditioning and training methods must be stressed by the coach in enhancing skill and motivating the control of athletic injuries. This will be of concern to individual needs and team play involving all personnel on the squad.

The coach must be certain that all participants have the proper personal protective equipment in quality and fit and a knowledge of how to use the equipment according to designated standards. A coach has the responsibility of instilling in athletes a sensitivity and awareness for accident prevention and injury control. Any movements or contact that may inflict injury must be eliminated without reservation. The coach as an administrator and organiser should arrange planned practice sessions of desirable time periods as a means of eliminating and reducing injuries that may result from fatigue. A fatigued athlete is more susceptible to the possibility of injury to himself and other participants.

Effective coaching methods necessitate the teaching of skills and imparting player knowledge that will be instrumental in injury control. Desirable attitudes and behaviour need to be developed for competitive sport participation and must be emphasised in all practice sessions and game conditions. A desire to win must never take place at the sacrifice of players being unnecessarily injured to achieve victory. A successful coach and football programme will always be in rela- tionship to the highest level of efficiency that can be applied in the process.

Personal health of the athlete

In the secondary school this is essentially the responsibility of the coach or team physician with assistance from either a professional or student trainer. At the college level this is usually the task of a team physician who is qualified in sports medicine and a professionally qualified athletic trainer. A coach needs to understand and apply the many ramifications of health care to assure that his athletes receive the proper attention for their well-being on and off the athletic field. All ultimate medical decisions become the responsibility of a team physician. By the application of appropriate health practices there should be a reduction of the injuries that take place in football. The medical and athletic training professions continue to make a commendatory contribution in this sport that has a significant place particularly in American society.

CONTRIBUTIONS OF THE ALLIED HEALTH PROFESSIONS Numerous scientific and professional individuals are applying themselves diligently to research and study in approaching solutions to the prevention of injuries in football. In addition to the medical profession, there are exercise physiologists, psychologists, engineers, sports sociologists and members of other related professions applying themselves to the problems of sports injuries. A variety of professional organisations such as the American College of Sports Medicine, the Committee on the Medical Aspects of Sports of the American Medical Association, the American Academy of Orthopaedic Surgeons, the National Athletic Trainers Association, and State and County Medical Societies continue to provide valuable assistance in health care and injury prevention in sports participation. Comparable national organisations elsewhere include the British Association of Sport and Medicine, the Society of Sports Sciences (in Great Britain), the Canadian Association of Sports Sciences, the Japanese Society of Sports Medicine, the Japan Union of Sports Sciences, the Australian Association of Sports Medicine and the New Zealand Association of Sports Medicine. International bodies concerned include ICSPE, ICHPER and FIMS.



The selection and proper fit of football protective equipment are essential factors in the control of foot- ball injuries. When proper decisions are made in outfitting participants with adaptable protective equipment, the health and welfare of the athlete is receiving a type of consideration that is of primary importance.

The concern for standards related to the design and manufacture of protective equipment has been receiving consideration by various professional individuals and organisations. Standards devoted to material durability, manufacture of equipment through mass production, establishing standards and scientific testing procedures require deliberation and study by appropriately qualified authorities. The requirements for the proper use of protective equipment are being defined through application of rules and regulations governing the sport at various levels of participation. There is also concern that equipment designed for the protection of an athlete may be used against an opponent.

There is also a need for formulating standards in the conditioning and rehabilitation of athletes and when to dispose of protective equipment. The practice of utilising worn out university equipment for the reserves and players with fewer skills will frequently add to the injury and risk syndrome. While appearance, colour, and style will sometimes be a concern of coaches, the most important aspect is the adaptability of equipment in the prevention of injury.

Guidelines for purchase of protective equipment

In purchasing football protective equipment, the following suggestions are intended to serve as a guide to prospective purchasers for varying age levels of football participants: 1. The sporting goods manufacturer should have a reputation for quality merchandise, and warranty is favourably recognised by the coaching profession. 2. The very best equipment meeting the highest level of quality standards should be purchased. 3. All equipment for the football participant should be properly fitted to meet the individual’s needs. 4. Equipment should be specifically designed to provide protection against hazards, by establishing a buffer between the hazard and the participant. 5. No new hazards should be created from the use of protective equipment. 6. Without exception the use of protective equipment as set forth in the rules, regulations and existing standards of governing organisations, should be insisted upon.


As an integral aspect of protective equipment the football helmet deserves maximum deliberation. Many different types of helmets are being used in a variety of football programmes. For the most part, helmets will be placed in three essential categories, I.e. padded, air, or fluid and suspension. A combination of all three is also available. There should be conformity to the following fit standards and specifications: 1. The base of the skull should be adequately covered. 2. There should be no shifting of the helmet when manual pressure is applied. 3. The helmet should not come down and impair visibility. 4. There should be no recoil upon impact. 5. The ear, the ear cut-out should match and be in proper alignment. 6. The shell of the helmet’s front edge should fit 1.9cm (5 inch) above a player’s eyebrows. 7. The chin strap should be equally distant from the midpoint of the helmet. Equal tension is required on both sides of the chin strap. 8. Jaw pads should fit against the sides of the face without any space in between. This should prevent any movement in the form of lateral rocking.

The purpose of the face-bar is to provide the maximum of protection from either soft tissue injury or fractures to the facial bone structure. The prevention of injuries to the teeth has been reduced through proper use of the face-bar. There has been criticism on occasion that the face-bar impairs vision and has been used by tacklers as a handle for stopping the forward progress of a runner. Apparently, injuries of low severity to severe neck injuries have taken place from this practice. However, the protection afforded to the facial area outweighs the potentiality for injuries with varying degrees of severity. Face-bars can be either the ‘bird-cage’ type used essentially by linemen or the double-bar type assigned predominantly to ball handlers. Most important is that a good face-bar should extend forward for more than 7.6cm (3in). Under no circumstances should face protection be less than two bars properly fitted to the helmet with approved mountings.

ADHERENCE TO RULES AND REGULATIONS Exceedingly important in the prevention of football injuries is the promulgation and enforcement of well-designed rules and regulations. Unnecessary injuries may be experienced from an ineffective rule; no rule to apply in a particular situation; or failure to enforce existing rules. Football officials with concern for the participants can be instrumental in reducing injuries. Athletic administrators should exert a concentrated effort in obtaining only competent officials with an established competency record. Coaches have a significant responsibility in instructing their athletes to participate within the confines of established rules and not abuse regulations by the use of unauthorised and dangerous manoeuvres employed in practice sessions or actual game conditions. Representative athletic authorities from higher education institutions and secondary schools meet annually to motivate research as a means of determining the contributory factors and causation of football injuries. A significantly important consideration is the responsibility placed on officials for rule enforcement and, through the various state and national organisations, for a continuous evaluation concerning applicability and effectiveness of the rules. Coaching technique and strategy must always be directed to complete compliance with the established rules.


Coaches and athletic trainers are convinced without question that an absence of proper physical conditioning is a major contributory cause related to athletic injuries. Lack of the appropriate coordination, reflex action, muscular imbalance, neuromuscular deficiencies, low grade ligamentous or tendonous strength and insufficient muscle bulk represent some of the contributory aspects in accident causation resulting from improper and insufficient physical conditioning. Nutritional requirements and psychological preparedness are also of concern in the preparation of athletes for sports participation.

Pre-season and in-season conditioning

The quantity of time allocated to pre-season and in-season conditioning is dependent upon both the type of activity and the status of the athlete’s physical fitness at the inception of the conditioning activities. In applying this concept to the football athlete who, at the beginning of the practice sessions, reports in an overweight flabby condition, there will be a need for a more comprehensive schedule over an extended period of time as compared to the athlete who has maintained a desirable condition of fitness applicable to participation in foot- ball. Obviously, the latter will not require the same programme of physical conditioning.

Warm-up procedures

Precautions must be applied by the athlete who should undertake the appropriate warm-up activity to eliminate possibility of strains or muscle injuries. Deep body temperature and muscle thermal conditions must be at their most desirable levels. For effective motor performance, neuromuscular skills need to be developed to include both speed and endurance. The athlete who is slow, easily fatigued, or awkward will be more susceptible to injury.

Weight training for football

The footballer should adhere to an approved general weight training programme as a means of acquiring a high level of overall development. Punters and place kickers can use weighted shoes in the practice of the high kick. This should contribute to desirable results in skill development. A weighted ball can be of assistance for passing, punting and centring, in that certain muscles that have a relationship to these skills are developed. For construction, merely stuff a ball with preferably sponge rubber scraps to a weight of approximately 1.36kg (31b). A lineman can advantageously use a press bar for increased effort with the shoulder shrug and leg lift. This should be performed both isotonically and isometrically. An effective activity for the lineman is to execute the wrestler’s bridge and pivot while supporting on the chest a weight of 9 to 18kg (20 to 401b).

GUIDELINES FOR THE PREVENTION OF INJURIES IN TACKLING SKILLS Maintain good physical condition throughout the year An efficient football player maintains a desirable physical condition throughout the entire year. Endurance, stamina, reflexes, and strength should be kept up to standard on a daily basis. The trainer can be of assistance relative to weight training and isometric exercises.

Spring or summer training programmes

In the spring and summer workouts the use of heavy gear should be eliminated. Football gear should include helmets and lightweight shirts and shorts should be used during these practices. Running will prove to be of inestimable value but running on hard surfaces should be omitted. The use of turf is desirable and the use of tennis or gym shoes will contribute to foot comfort. Endeavour to stretch all muscles, with particular emphasis on the thighs.

Avoid head injuries

Be certain to check all protective equipment and have the manager or trainer immediately inspect any deficient equipment. Always wear a mouthguard for practice and games. The proper development of neck muscles will aid in the prevention of head and neck injuries. When tackling, keep the eyes wide open and set your vision on the ball handler. In making contact, keep the chin elevated and both feet firmly on the ground when making contact. Avoid diving tackles and straight-on tackles.

Never totally leave the ground when tackling

One foot should be maintained on the ground at all times when executing a tackle. This will assist in controlling body momentum in the desired direction. The bodyweight should be maintained in a forward thrust position. Maintaining control will contribute in preventing back, shoulder, arm, neck and leg injuries.


In the approach to contact, don’t pause; impetus is an injury prevention technique. Use body momentum to the best possible advantage. Endeavour to stay on top when executing a head-and-shoulder tackle. When contact has been established and the tackle completed do not permit your legs to drag. This can be accomplished by drawing the knees in close to the body.

Early season tackling

Tackling techniques in early season drills can be efficiently performed on the tackling dummies prior to working with human targets.


Endeavour to use your full weight and make contact at chest height by grasping the ball handler with your arms.

Muscular and tendon tension should be maintained throughout the tackling procedure. Avoid a driving tackle with the use of one arm or leg. Contact should be made with the shoulder or hip padding.

Complete and efficient equipment is essential; participation in football necessitates every item of protective equipment as stipulated by the regulations and policies set forth by the coaching staff.

The prevention of football injuries can be achieved by placing a continued emphasis on having professionally trained athletic leadership, desirable facilities in compliance with acceptable standards and equipment that is designed with safety receiving the highest priority of consideration.


American Alliance for Health, Physical Education, and Recreation, C. P. Yost (ed) (1971). Sports safety. AAHPER Publication-Sales, Washington, DC.

American School and Community Safety Association, D. A. Morehouse (ed) (1977). Sports safety II. AAHPER Publication-Sales, Washington, DC.

Cerney, J. V. (1976). The prevent-system for football injuries. Prentice-Hall, Englewood Cliffs.

Klafs, C. E. and Arnheim, D. D. (1977). Modern principles of athletic training, 4th edition. C. V. Mosby, Saint Louis.

Olson, O. C. (1971). Prevention of football injuries. Lea and Febiger, Philadelphia.

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