Female Flag Football Injury Study Explained: Balachandran et al. 2025 OJSM

Balachandran et al. (2025) in the Orthopaedic Journal of Sports Medicine analyzed NEISS emergency-department data and found strains, sprains, and fractures — not concussions — dominated female flag football injuries from 2014 to 2023, while concussion counts remained a meaningful subset as participation surged. The study extrapolated 605 sampled injuries to roughly 22,666 national visits. Adolescents 11–20 sustained the most injuries; 2023 peaked as girls flag expanded.

Flag baseline guide · helmet debate article

Study design in plain language

Researchers queried NEISS for female patients with flag football-related injuries treated in U.S. emergency departments. NEISS samples roughly 100 hospitals and extrapolates national estimates — useful for trend detection, not every backyard game.

Key numbers

• 605 sample injuries → ~22,666 national estimate (2014–2023)
• Strains/sprains: ~30.2% of injuries
• Peak year: 2023 (~3,531 national estimate)
• Low year: 2020 (pandemic disruption)
• Leading mechanism: falls, including fall on outstretched hand (~19.1%)

Concussions in context

Concussions appeared in the dataset but were not the top diagnosis. CU Anschutz coverage emphasized concussion frequency is lower than tackle while still warranting attention — especially combined with fall mechanisms baseline programs already target.

Protective equipment takeaway

Authors emphasized appropriate protective gear as the sport grows — a prevention discussion, not a rule change. Leagues should pair equipment conversations with baselines and return-to-play. See flag football hub and girls flag baselines.

Limitations of NEISS data

NEISS captures emergency-department visits — not every sideline evaluation or urgent care stop. True injury counts exceed ED data, but trends still inform policy. Under-reporting may affect concussion subset estimates; treat absolute concussion percentages as directional, not precise epidemiology.

The study focused on female patients; male flag injury patterns may differ but also rise with participation. Commissioners should not ignore boys leagues when applying fall-prevention lessons from this paper.

Translating research into league action

Practical responses: annual baselines for adolescent girls flag, dive rules in middle-school divisions, finger and wrist injury awareness in rulebooks, and incident reporting when any head impact occurs. Research discussion of protective gear belongs on the agenda — not as a rushed helmet vote without medical input.

Baseline cadence for flag football

Annual pre-season baselines before the first competition remain the standard for athletes under eighteen in organized flag programs. Adults in rec leagues can follow biennial testing when league policy and clinical context support it — always re-baseline after medical clearance from a concussion, after invalid test sessions, or after twelve or more months away from sport. Mid-season re-baseline is optional for flag compared with tackle line groups carrying heavy subconcussive load, but athletic trainers may recommend it after a cluster of head injuries on one roster.

Baselines capture symptoms, cognition, and balance under quiet conditions. They do not diagnose concussion on the sideline and do not replace licensed clearance for return-to-play. They give clinicians a personal comparison when flag-specific mechanisms — dives, falls, rusher whiplash, quarterback scrambles — produce symptoms that population averages cannot interpret fairly.

Flag football resource cluster

Start with the youth & adult flag football baseline guide, browse the flag football concussion & baseline hub, and read concussion rates and statistics for epidemiologic context. Parents: parent guide. Coaches: coach checklist. Return pathways: return-to-play and return-to-learn.