Behavioral Tackling Interventions Decrease Head Impact Frequency in American Football Players: A Critically Appraised Topic

in International Journal of Athletic Therapy and Training
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  • 1 Duquesne University
  • 2 The Steadman Clinic and Steadman Philippon Research Institute
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Context: The rate of sport-related concussion diagnosis has significantly increased in recent years, which has created a need for injury prevention initiatives. There have been efforts put forth by researchers and American football organizations to teach athletes how to tackle properly in order to decrease the number of subconcussive head impacts and concussions. Clinical Question: Does the implementation of a behavioral tackling intervention decrease the head impact frequency in American football players? Clinical Bottom Line: There is moderate SORT Level B evidence to support the use of behavioral tackling interventions as a means for reducing head impact frequency in football athletes. All four included studies found a significant reduction in head impacts following a behavioral tackling intervention with study findings ranging from a 26–33% reduction in impact frequency. These findings were consistent in youth, high school, and college football players and for different types of behavioral tackling interventions. Therefore, these results indicate that behavioral tackling interventions have the potential to reduce the number of head impacts sustained by American football players, which may ultimately lead to a reduction in concussion occurrence as well.

Evans, Curtis, and Beidler are with Duquesne University, Pittsburgh, PA, USA. Montjoy is with The Steadman Clinic and Steadman Philippon Research Institute, Vail, CO, USA.

Beidler (johnsone1@duq.edu) is corresponding author.
  • 1.

    Murphy AM, Askew KL, Sumner KE. Parents’ intentions to allow youth football participation: perceived concussion risk and the theory of planned behavior. Sport Exerc Perform Psychol. 2017;6(3):230. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    National Federation of State High School Associations. High school participation survey archive. August 28, 2019. https://www.nfhs.org/sports-resource-content/high-school-participation-survey-archive/. Accessed January 24, 2020.

    • Export Citation
  • 3.

    Broglio SP, Eckner JT, Paulson HL, Kutcher JS. Cognitive decline and aging: the role of concussive and subconcussive impacts. Exerc Sport Sci Rev. 2012;40(3):138144. PubMed ID: 22728452 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Gavett BE, Stern RA, McKee AC. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clin Sports Med. 2011;30(1):179188. PubMed ID: 21074091 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    McKee AC, Cantu RC, Nowinski CJ, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709735. PubMed ID: 19535999 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Crisco JJ, Fiore R, Beckwith JG, et al. Frequency and location of head impact exposures in individual collegiate football players. J Athl Train. 2010;45(6):549559. PubMed ID: 21062178 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Stemper BD, Shah AS, Harezlak J, et al. Repetitive head impact exposure in college football following an NCAA rule change to eliminate two-a-day preseason practices: a study from the NCAA-DoD CARE Consortium. Ann Biomed Eng. 2019;47(10):20732085. PubMed ID: 31388849 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):20692078. PubMed ID: 21787201 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Urban JE, Kelley ME, Espeland MA, et al. In-season variations in head impact exposure among youth football players. J Neurotrauma. 2019;36(2):275281. PubMed ID: 29921164 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Marar M, McIlvain NM, Fields SK, Comstock RD. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40(4):747755. PubMed ID: 22287642 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250258. PubMed ID: 23479479 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery. 2007;61(6):12291235. PubMed ID: 18162902 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Stemper BD, Shah AS, Harezlak J, et al. Comparison of head impact exposure between concussed football athletes and matched controls: evidence for a possible second mechanism of sport-related concussion. Ann Biomed Eng. 2019;47(10):20572072. PubMed ID: 30362082 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Bahrami N, Sharma D, Rosenthal S, et al. Subconcussive head impact exposure and white matter tract changes over a single season of youth football. Radiology. 2016;281(3):919926. PubMed ID: 27775478 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Bazarian JJ, Zhu T, Zhong J, et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One. 2014;9(4). doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Davenport EM, Apkarian K, Whitlow CT, et al. Abnormalities in diffusional kurtosis metrics related to head impact exposure in a season of high school varsity football. J Neurotrauma. 2016;33(23):21332146. PubMed ID: 27042763 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    McAllister TW, Ford JC, Flashman LA, et al. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology. 2014;82(1):6369. PubMed ID: 24336143 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Munce TA, Dorman JC, Thompson PA, Valentine VD, Bergeron MF. Head impact exposure and neurologic function of youth football players. Med Sci Sports Exerc. 2015;47(8):15671576. PubMed ID: 25437194 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Tarnutzer AA, Straumann D, Brugger P, Feddermann-Demont N. Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature. Br J Sports Med. 2017;51(22):15921604. PubMed ID: 27815240 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    McAllister T, McCrea M. Long-term cognitive and neuropsychiatric consequences of repetitive concussion and head-impact exposure. J Athl Train. 2017;52(3):309317. PubMed ID: 28387556 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Nilsson KJ, Flint HG, Gao Y, et al. Repetitive head impacts in youth football: description and relationship to white matter structure. Sports Health. 2019;11(6):507513. PubMed ID: 31433735 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Rose SC, Yeates KO, Nguyen JT, McCarthy MT, Ercole PM, Pizzimenti NM. Neurocognitive function and head impact burden over two seasons of youth tackle football. J Neurotrauma. 2019;36(19):28032809. PubMed ID: 31084394 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Alosco ML, Stern RA. Youth exposure to repetitive head impacts from tackle football and long-term neurologic outcomes: a review of the literature, knowledge gaps and future directions, and societal and clinical implications. Semin Pediatr Neurol. 2019;30:107116. PubMed ID: 31235012 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Broglio SP, Williams RM, O’Connor KL, Goldstick J. Football players’ head-impact exposure after limiting of full-contact practices. J Athl Train. 2016;51(7):511518. PubMed ID: 27333460 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Garrett W, Konz S. A comparison of football and rugby tackling during spring ball. Neurology. 2019;93(14 suppl 1):S5S5.doi:

  • 26.

    Swartz EE, Broglio SP, Cook SB, et al. Early results of a helmetless-tackling intervention to decrease head impacts in football players. J Athl Train. 2015;50(12):12191222. PubMed ID: 26651278 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Schussler E, Jagacinski RJ, White SE, Chaudhari AM, Buford JA, Onate JA. The effect of tackling training on head accelerations in youth American football. Int J Sports Phys Ther. 2018;13(2):229237. PubMed ID: 30090681 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Swartz EE, Myers JL, Cook SB, et al. A helmetless-tackling intervention in American football for decreasing head impact exposure: a randomized controlled trial. J Sci Med Sport. 2019;22(10):11021107. PubMed ID: 31204104 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Champagne AA, DiStefano V, Boulanger M-M, et al. Data-informed intervention improves football technique and reduces head impacts. Med Sci Sports Exerc. 2019;51(11):23662374. PubMed ID: 31269008 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    OCEBM Levels of Evidence Working Group. The oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. 2011. https://www.cebm.net/2016/05/ocebm-levels-of-evidence/. Accessed January 20, 2020.

    • Search Google Scholar
    • Export Citation
  • 31.

    Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Am Board Fam Pract. 2004;17(1):5967. PubMed ID: 15014055 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Schussler E, Jagacinski RJ, White SE, Chaudhari AM, Buford JA, Onate JA. Inter-rater agreement and validity of a tackling performance assessment scale in youth American football. Int J Sports Phys Ther. 2018;13(2):238246. PubMed ID: 30090682 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train. 2014;49(2):245265. PubMed ID: 24601910 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Kerr ZY, Yeargin S, Valovich McLeod TC, et al. Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthop J Sports Med. 2015;3(7):2325967115594578. PubMed ID: 26674011 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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