Injuries can be prevented in contact flag football!

Purpose This original prospective cohort study was conducted in an attempt to significantly reduce the incidence and the severity of injuries in an intervention cohort as compared to a two‐season historical cohort, and to provide recommendations to the International Federation of Football (IFAF) pertaining to prevention measures to make the game safer. Methods A total of 1,260 amateur male (mean age: 20.4 ± 3.9 years) and 244 female (mean age: 18.5 ± 1.7 years) players participated in the study. Four prevention measures were implemented: the no‐pocket rule, self‐fitting mouth guards, ankle braces (for those players with recurrent ankle sprains) and an injury treatment information brochure. 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 There was a 54 % reduction in the total number of injuries and a significant reduction in the incidence rate and incidence proportion between the intervention cohorts as compared to the historical cohort ( p < 0.001). There was no statistically significant reduction in the number of injuries in any of the body parts, except for in hand/wrist injuries related to the use of pockets ( p < 0.001), as well as the severity of mild‐moderate injuries ( p < 0.05). Conclusion This study provided evidence that hand/wrist injuries can be significantly reduced in flag football. Recommendations to the IFAF include strict enforcement of the no‐pocket rule, the use of soft headgear, comfortable‐fitting ankle braces and mouth guards and additionally, to change game rules concerning blocking. Level of evidence II.