Background Although AFF is considered a non-tackle sport, many moderate-serious contact-type injuries have been reported. There are no studies describing neither the epidemiology nor the prevention of injuries in this international sporting activity.

Objective To conduct a 2- season prospective injury-exploratory study in the AFF league, followed by a 2-season prevention trial.

Design All time-loss injuries sustained in game sessions were recorded by the off-the-field medical personnel. This was followed up by a more detailed phone questionnaire by the author, 7–14 days following the injury.

Setting American Flag Football league in Israel.

Participants Male and female amateur league players.

Main outcome measurements Epidemiological data.

Results 1791 players participated in 1005 games over the two seasons. Athlete-exposures=1799955. There were 179 injuries recorded, with an injury rate=0.099 per 1000 athlete-exposures (95% CI 0.08 to 0.11). 98% of the injuries were traumatic in nature. Over 75% of injuries were caused by contact with the ground. 30% of the contact injuries were to the fingers, thumb and wrist. Many of the finger injuries occurred as a direct result of the player's fingers being caught in the pockets of the opposing player. 20% of the injuries were to the knee, 16% to the head and face and 12% to the ankle.

Conclusion As a result of the epidemiological study, a two- season (2010–2012) prospective, longitudinal, randomised controlled injury prevention trial will be conducted, where the players will be randomly divided into those teams that will make up the experimental group (n=+180) and those in the control group (n=+180). The experimental group will be instructed to wear mouth guards and air casts. The control group will be instructed to wear pocket less pants. Following the data collection, the results will be analyzed, conclusions drawn and recommendations suggested for inclusion in future league games.