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The Epidemiology of Injuries in Contact Flag Football

Kaplan, Yonatan PT, MSc (Med)*; Myklebust, Grethe PT PhD; Nyska, Meir MD; Palmanovich, Ezequiel MD; Victor, Jan MD§; Witvrouw, Erik PT, PhD*

Clinical Journal of Sport Medicine: January 2013 - Volume 23 - Issue 1 - p 39–44
doi: 10.1097/JSM.0b013e3182694870
Original Research

Objective: To characterize the epidemiology of injuries in post–high school male and female athletes in the rapidly growing international sport of contact flag football.

Design: Prospective injury-observational study.

Setting: Kraft Stadium, Jerusalem, Israel.

Participants: A total of 1492 players, consisting of men (n = 1252, mean age, 20.49 ± 5.11) and women (n = 240, mean age, 21.32 ± 8.95 years), participated in 1028 games over a 2-season period (2007-2009).

Main Outcome Measures: All time-loss injuries sustained in game sessions were recorded by the off-the-field medical personnel and followed up by a more detailed phone injury surveillance questionnaire.

Results: One hundred sixty-three injuries were reported, comprising 1 533 776 athletic exposures (AEs). The incidence rate was 0.11 [95% confidence interval (CI), 0.09-0.12] per 1000 AEs, and incidence proportion was 10.66% (95% CI, 9.10-12.22). Seventy-six percent of the injuries were extrinsic in nature. Thirty percent of the injuries were to the fingers, thumb, and wrist, 17% to the knee, 17% to the head/face, 13% to the ankle, and 11% to the shoulder.

Conclusions: Contact flag football results in a significant amount of moderate to severe injuries. These data may be used in the development of a formal American flag football injury database and in the development and implementation of a high-quality, randomized, prospective injury prevention study. This study should include the enforcement of the no-pocket rule, appropriate headgear, self-fitting mouth guards, the use of ankle braces, and changing the blocking rules of the game.

*Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium

Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway

Department of Orthopedic Surgery, Meir Hospital, Kfar Saba, Israel

§Department of Physical Medicine and Orthopaedic surgery, Ghent University, Ghent, Belgium.

Corresponding Author: Yonatan Kaplan, PT, MSc (Med), Jerusalem Sports Medicine Center, Lerner Sports Center, Hebrew University, Mount Scopus, Jerusalem, 64460, Israel (

The authors report no conflicts of interest.

This manuscript was submitted in partial fulfillment of Yonatan Kaplan's doctoral dissertation.

Received October 6, 2011

Accepted July 11, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.