Head injuries are the most concerning injury risk in football, so prevention strategies are important. Concussion education is one of the easiest and best strategies for concussion prevention. This education must be for players, parents, and coaches because all participate in concussion identification and player disclosure. Along with concussion education, another concussion prevention strategy is coaching proper techniques in football.

Teaching and using proper techniques in football can help reduce head impacts and concussions. This starts with the coaches’ education, transferring that knowledge to players, and players adhering to correct techniques. It involves everything from helmet fitting to helmet use, tackling to blocking.

This article will focus on the research supporting how coaching proper techniques in football can decrease concussion risk. Below are the topics:

Teaching Proper Helmet Fit is the Coach’s Responsibility

Coaches Must Ensure Players Understand Proper Helmet Use

Players Use Proper Techniques in Football when Stressed by Coaches

Using Proper Techniques in Football Begins with Coaches’ Education

Educational Programs for Coaches can Decrease Injury Rates

Coaches Must Understand the Importance of Reviewing Proper Techniques in Football

Teaching Proper Helmet Fit is the Coach’s Responsibility

Helmets are not the best concussion prevention strategy. While helmets can decrease moderate and severe brain injury, they are not effective at preventing concussions. At the same time, improperly fitted helmets have been shown to increase the severity of concussions leading to longer recovery times.¹

Players need to know what a properly fitted helmet feels like and maintain this fit while playing football. This may include appropriate helmet size for one’s head, adding air to specific bladder-inserts within the helmet, and ideal chinstrap tightness.

Every coach is required to understand how to fit a helmet to each player and stress the importance of maintaining proper fit to them. Then, the coaches must periodically check helmet fit to ensure that players are maintaining the necessary requirements.

Evidence shows that up to 80% of both youth² and high school³ football players do not maintain adequate fitting of helmets over the course of a football season. This exploits the large area for growth that can be improved regarding concussion prevention in youth and high school football.

Because it is the job of the coach and possibly league organization to ensure properly fitted helmets throughout a season, these people need to be trained at the start of each year. The coaches are then responsible for teaching proper helmet fit to their players.

Coaches Must Ensure Players Understand Proper Helmet Use

Just because a helmet is fitted properly, does not mean that players know how to use a helmet. Players must be taught the purpose of the football helmet, which requires proper instruction from coaches to players.

All helmets are certified by the National Operating Committee on Standards for Athletic Equipment (NOCSAE), and they require a proper warning label.⁴ Each year while playing tackle football, I remember being required to read that warning label aloud as a team to start each season. That warning label includes the dos and don’ts while wearing a football helmet, injuries a football helmet cannot prevent, and risks of playing football:

WARNING

Keep your head up. Do not butt, ram, spear, or strike an opponent with any part of this helmet or faceguard. This is a violation of football rules and may cause you to suffer severe brain or neck injury, including paralysis or death and possible injury to your opponent. Contact in football may result in Concussion/Brain Injury which no helmet can prevent. Symptoms include loss of consciousness or memory, dizziness, headache, nausea or confusion. If you have symptoms, immediately stop and report them to your coach, trainer, and parents. Do not return to a game or contact until all symptoms are gone and you receive medical clearance. Ignoring this warning may lead to another and more serious or fatal brain injury.

NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.

While these uses and potential consequences are made very clear to players, some choose not to follow the rules and make risky behaviors during competition.

A survey of 177 high school football players from Hawaii showed that 90% of players were aware of head injury consequences.⁵ Yet, 46% of them said they intentionally initiated helmet to player contact at least once during a game the previous season.

For this reason, coaches must not only teach proper techniques that decrease helmet contact, but they also must continually demand players to use these techniques through constant coaching, reinforcement, and punishment.

Players Use Proper Techniques in Football when Stressed by Coaches

Despite some evidence showing players will intentionally use their helmet incorrectly, a very high percentage of tackles are likely performed correctly in youth and high school football games. One large study assessed tackling techniques that coaches were teaching and those used during games from youth, middle school, and high school football teams in Texas.⁶

A total of 136 coaches were surveyed regarding their teaching and phrases used while coaching tackling. Over 80% of coaches taught the “head across the bow” technique, which uses one shoulder to hit the opposing player while the head is in front of the ball carrier. The authors of this study state that this technique can cause nerve injuries in neck and shoulder.

Instead, the authors say the “head-up shoulder tackle” is the preferred style, but this choice was not included in the survey. These coaches may have chosen their answers because it was closest to the style that they taught. This particular finding is not a good representation.

More importantly, over 85% of coaches used the phrase “keep your head up,” and the majority used phrases like “see what you hit” and “hit, wrap, and drive.”⁶

Then, a single orthopedic resident assessed 1000 consecutive tackles from each age group for proper tackling technique from the game film that coaches provided.⁶ It was found that 88% of the tackles were attempted with one’s head up, and this was as high at 93% at the youth level.

However, the youth and middle school levels had the most missed tackles at around 25% compared to the high school level at only 12%. This may be due to skill level differences in these age groups.

From a success standpoint, head-up tackling had an 81% success rate of finishing the tackle verses a 63% success rate from head-down tackling.⁶ This can be used to convince kids that keeping their head up will improve their tackling skill on top of the safety benefits. Moreover, 92% of head-up tackles occurred at or above the waist.

A high percentage of coaches are teaching proper tackling techniques and using correct phrases. More importantly, even a higher percentage of tackles are being performed properly in youth through high school football games.

Using Proper Techniques in Football Begins with Coaches’ Education

Players using proper techniques to block and tackle in football is important for safety. This must start with coaches’ education for proper blocking and tackling techniques in addition to concussion education.

USA Football instituted the Heads Up Football (HUF) educational program in 2012. Now called the League Excellence Program, it includes many objectives: hands-on training of equipment fitting, tackling technique, strategies for reducing player-to-player contact, concussion recognition and awareness information, and identification and management of exertional heat illness and sudden cardiac events.⁷

Each USA Football League was required to have a Player Safety Coach (PSC) who worked to distribute and monitor safety strategies to the other coaches in the league.⁸ The PSC for each league did not coach a particular team.

Rather, the PSC ran a clinic at the beginning of the season to introduce and review HUF concepts. This individual urged all league coaches to get USA Football coaching certification online. During the season, the PSC was required to be at all league practices to ensure proper HUF protocols were maintained.

It should be noted, the League Excellence Program now has different levels, and they do not all require a PSC.⁷ USA Football also has courses and certifications for coaches independent from the league program: Youth Tackling and Contact, High School Tackling, High School Contact, and Shoulder Tackling.⁹

USA Football has also teamed up with TeachAids CrashCourse for athlete concussion education. Moreover, the site has a Youth Football Parents 101 course for parents’ role within a football team. These courses are valuable tools for all coaches no matter their experience and level of coaching.

Educational Programs for Coaches can Decrease Injury Rates

The HUF educational program has been shown to decrease injury rates, concussion rates, and head impact exposure.

One study looked at injury rates for three Indiana high school football teams that had a Player Safety Coach verses three teams that the coaches only used online education.¹⁰ From the overall 25,938 athlete exposures, there were 149 total injuries, 54 from the teams using the PSC verses 95 from teams using education only. Both the practice and game injury rates were lower in the PSC teams along with only 2 concussions reported compared with 15 in other teams.

A similar study looked primarily at concussion rates among 14 high school teams with a PSC compared with 10 teams without one.¹¹ There were 2,514 football players in total with 117 concussions over the season. The HUF players had a significantly lower concussions rate than the non-HUF players (4.1 vs. 6.0 concussions/100 players).

They also returned to play faster, on average, within 18 days compared with over 25 days. Hence, the education program and PSC may decrease concussion rates by 33%.

Another study was performed on youth football players from multiple different leagues and teams, some that used HUF and a PSC verse some that did not.¹² The youth players aged 8-15 wore head impact sensors to track head impacts during practices and games. It was found that the players who participated in the HUF leagues accumulated fewer head impacts per practice than the players in the other leagues.

These studies show that coaching education on both proper techniques and concussion awareness can have a great influence on injury and concussion prevention.

Coaches Must Understand the Importance Reviewing Proper Techniques in Football

Some coaches may feel that they do not need any additional training. They assume they have all the knowledge they need about football technique and safety. Unfortunately, this stubborn attitude can put players at risk.

Many fields require continuing education for workers. Even high school coaches have yearly requirements to complete courses on hazing, sexual harassment, and concussions. Therefore, it should not be difficult nor trivial to add education reviewing the proper blocking and tackling techniques that optimizes player safety.

Already, many coaches voluntarily attend conferences in the offseason to increase their knowledge of football strategy and player development. Requiring a short course specific to appropriate techniques that emphasize player safety could be easily implemented.

A study doing phone interviews with 18 youth football coaches found mixed feelings regarding the concerns for concussions and subconcussive head impacts.¹³ Some coaches are not concerned due to their lack of concussion education and previous held beliefs on head injuries. Some people will never change their mindset, but education can help more coaches become aware of head impact risk.

In my opinion, concerns should be high enough to change coaching and practice styles to improve safety, but not enough to prevent children from playing football.

To this degree, most coaches were receptive to rule and policies changes to make football safer.¹³ Also, most thought that learning tackling at a young age helped prepare them for their later playing years. They believed that kids should start playing tackle football at a young age.

Being a former player that played from 2^nd grade through high school and now coaching high school football, I can support this belief. However, coaches and parents must understand the goals of youth football. This age group is about the kids having fun and learning. They should learn football-related skills, build character, utilize time-management, and experience teamwork. I urge coaches and parents to maintain this perspective.

Summary

Using proper techniques in football is necessary to reduce concussion risk. Football coaches are responsible for ensuring players use proper blocking and tackling techniques. Coaches at all levels should undergo training that emphasizes player safety.

Each team or league would also benefit from using a player safety coach whose job is to teach other coaches about safe techniques and concussion education, update drills and practice schedules to decrease head impacts, and oversee proper execution of this training.

Continuous learning and reviewing of proper techniques and concussion information cannot only make one a better coach but can also keep players safer. Coaching proper techniques is effective at reducing concussions and head injuries in football.

References

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2. Yeargin SW, Lininger MR, Coughlin M, et al. Improper Fit in American Youth Football Helmets Across One Competitive Season. Ann Biomed Eng. 2021;49(10):2924-2931.
3. Faure CE. An examination of football helmet fit and players’ helmet air maintenance habits in relation to concussion in high school football programs. Appl. Res. Coaching Athletics Annu. 2015;30(1):56–83.
4. National Operating Committee on Standards for Athletic Equipment (NOCSAE). Statement on Shared Responsibilities. Accessed January 22, 2023. https://nocsae.org/standards/statement-on-shared-responsibilities/
5. Kuriyama AM, Nakatsuka AS, Yamamoto LG. High School Football Players Use Their Helmets to Tackle Other Players Despite Knowing the Risks. Hawaii J Med Public Health. 2017 Mar;76(3):77-81.
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7. USA Football. League Excellence Program. https://usafootball.com/programs/league-excellence-program/. Accessed July 8, 2023.
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9. USA Football. Certifications. https://footballdevelopment.com/courses-certifications/. Accessed July 8, 2023.
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13. Sarmiento K, Waltzman D, Borradaile K, Hurwitz A, Conroy K, Grazi J. A Qualitative Study of Youth Football Coaches’ Perception of Concussion Safety in American Youth Football and Their Experiences With Implementing Tackling Interventions. Int Sport Coach J. 2021;1(9):10.1123/iscj.2020-0004.