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  1. Y Kaplan1,4,
  2. E Witvrouw1,
  3. G Myklebust2,
  4. M Nyska3,
  5. E Palmanovich3,
  6. J Victor5
  1. 1Department of Rehabilitation Sciences & Physiotherapy at the Ghent University, Ghent, Belgium
  2. 2Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3Department of Orthopedic Surgery, Meir Hospital, Kfar Saba, Israel
  4. 4Lerner Sports Center, Jerusalem, Israel
  5. 5Department of Physical medicine and Orthopaedic surgery, Ghent, Belgium


Background American Flag football (AFF) is a version of American Football that has become very popular worldwide, but lacks high quality research into the epidemiology of injuries.

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 1 492 players,consisting of men (n=1 252, 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.

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