As the sport skyrockets in popularity, a study analyzes injury patterns in female players over a 10-year span, recommending helmets for improved safety
Pigskin passers are invading athletic fields once dominated by soccer and lacrosse teams. But these blitzers aren't suited up like gladiators.
Flag football is exploding in popularity and will make its Olympic debut at the 2028 Games in Los Angeles. The National Football League is launching two pro leagues - one for women and one for men. The sport's perceived safety, compared to rough-and-tumble tackle football, is a big part of the appeal.
But it's still a game of relatively hard knocks, as researchers found in a study of injuries sustained by female players from 2014 to 2023. The researchers, including Rachel Frank, MD, an orthopedist at the CU Anschutz School of Medicine, analyzed flag football-specific injuries captured in the National Electronic Injury Surveillance System (NEISS), a database of emergency department injuries.
Key takeaways:
- Flag football is exploding in popularity, especially among female players.
- A national study examined injuries sustained by female players, ages 6 to 47, over a 10-year span (2014 to 2023).
- Muscle strains and sprains were the most common injuries. While concussion frequency paled in comparison to tackle football, the researchers, including an orthopedist at CU Anschutz, recommended helmets and other protective equipment for players.
The research team extrapolated the injuries of 605 female players - ages 6 to 47 - to a national estimate of 22,666 injuries over the 10-year span. Muscle strains and sprains were the most common injuries among the female players, a 30% rate, with adolescent players sustaining the greatest number of injuries.
While concussion frequency paled in comparison to tackle football, the 8% rate prompted researchers to recommend helmets and other protective equipment for players.
"You can't prevent all types of injuries, including concussions, but it's a little curious that the concussion rate is as high as it is," Frank said. "Other flag football studies have shown a higher rate than what we found, but our rate was not insignificant."
The research team:
The "Current State of American Flag Football Injuries Among Female Athletes" was published in the Orthopaedic Journal of Sports Medicine in August. Joining Rachel Frank, MD, of the CU Anschutz School of Medicine in the study were Uma Balachandran, Niklas Koehne, Auston Locke, Charu Jain, Katrina Nietsch and Robert Parisien of the Icahn School of Medicine at Mount Sinai; Mary Mulcahey of Loyola University Medical Center; and Lisa Cannada of the University of North Carolina Charlotte School of Medicine.
Frank has close ties to women's sports. She played collegiate soccer and is currently the head orthopaedic surgeon for the Colorado Rapids and a team physician for the U.S. Women's National Soccer Team. She is excited to see flag football's rapid growth; an estimated half million girls ages 6 to 17 played the sport in the United States last year, a 63% increase since 2019.
In the following Q&A, Frank breaks down the study and talks about flag football's surging popularity and possible measures to make the game safer and more enjoyable for players.
The interview has been edited and condensed.
