Decoding Flag Football Injuries: Lessons from a 10-Year U.S. Air Force Study

May 24, 2012; Updated Oct. 20, 2023

Flag football, a beloved sport among active-duty U.S. Air Force (USAF) personnel, may seem relatively safe compared to its full-contact counterpart. However, this assumption was challenged by a comprehensive 10-year study conducted by a team of researchers led by Bruce R. Burnham, DVM, MPH. This study aimed to unravel the mechanisms behind flag football injuries and explore effective countermeasures.

US Air Force Airmen (grey shirts) from the 447th Air Expeditionary Group play flag football against a group of US Army Soldiers, 1st Armored Division, Fort Bliss, Texas, on a muddy field at Baghdad International Airport, Iraq, during Operation IRAQI FREEDOM. The Army Soldiers eventually won the game at 24-14.

Understanding the Significance of Sports Injuries in the Military

Injuries in the military are a significant concern, often overshadowing other health conditions in terms of morbidity and mortality. Surprisingly, sports and athletics consistently rank among the top causes of nonfatal injuries among military service members. Even during deployments, such as Operation Iraqi Freedom (OIF), sports injuries continue to be a leading cause of nonfatal, non-battle injuries.

Basketball, football, soccer, and baseball consistently lead the charts in terms of sports-related injuries. Notably, the focus of this study, flag football, has received limited attention in the published literature. What makes this research even more intriguing is the scarcity of up-to-date articles on the subject.

Decoding Flag Football Injuries

The study aimed to fill this gap by examining flag football injuries suffered by active-duty USAF personnel from 1993 to 2002. It focused on injuries resulting in at least one lost workday, as recorded in safety reports within the USAF Ground Safety Automated System.

The results were eye-opening. Out of 32,812 mishap reports reviewed, 944 mishap reports met the criteria for inclusion in the study, indicating a significant number of injuries caused by flag football. The study identified eight primary mechanisms of injury, accounting for a whopping 90% of all flag-football injuries.

  1. Contact with Another Player (42%): The most prominent mechanism of injury in flag football, accounting for a staggering 42% of reported injuries. Despite the non-contact nature of the sport, player contact, whether through tackles, collisions, or other forms of physical interaction, remains a significant risk. This mechanism emphasizes the importance of enforcing rules and practices to reduce rough play and contact during the game.

  2. Slips, Trips, and Falls (14%): Slippery or uneven playing surfaces can result in players losing their footing, leading to injuries. This is a significant cause of injuries, highlighting the need for ensuring safe and well-maintained fields.

  3. Running (11%): Running is a fundamental part of flag football, but it also poses risks, especially when players change direction suddenly or make quick maneuvers. These movements can result in strains, sprains, and other injuries.

  4. Planting Feet and Cutting Moves (6%): Quick changes in direction and cutting moves are fundamental to the sport but can place significant stress on the lower extremities, leading to injuries such as twisted ankles or knee strains.

  5. Jumping for the Ball (6%): Attempting to catch or intercept the football can lead to jumping and landing awkwardly, increasing the risk of injury, particularly to the lower extremities and the spine.

  6. Grabbing the Flag (5%): The core objective in flag football is to capture the opponent’s flag. While this action is seemingly less aggressive than tackling, it can result in players reaching and stretching, which may lead to strains or sprains.

  7. Surface Conditions (4%): The quality of the playing surface plays a vital role in injury prevention. Poor field conditions, such as uneven terrain, slippery grass, or debris, can significantly increase the risk of accidents.

  8. Other Mechanisms (12%): The remaining 12% of injuries fall under various mechanisms not covered in the aforementioned categories. These could include less common scenarios or accidents unique to individual incidents.

Understanding these mechanisms is essential for developing targeted injury prevention strategies. It’s clear that even in a non-contact sport like flag football, various factors can lead to injuries. By focusing on these mechanisms, safety measures, and rule enforcement can be tailored to address the specific risks associated with each. This knowledge is not only relevant for flag football but can also inform injury prevention efforts in other sports, both in the military and civilian contexts.

The Leading Culprit: Player Contact

Perhaps the most striking finding was that contact with another player accounted for a staggering 42% of all flag-football injuries. This single mechanism stood out as the primary contributor to injuries, even in a sport designed to minimize physical contact.

Other mechanisms included slips, trips, and falls (14%), running during flag football (11%), planting feet and cutting moves, jumping for the ball, grabbing the flag, and surface conditions.

Soft shell flag football headgear from GameBreaker is made to reduce the severity of impacts related with flag football reducing the risk of head injuries from player contact, falls, slips, and trips.

The Severity of Flag Football Injuries

Beyond identifying the primary mechanisms of injury, the study shed light on a surprising aspect of flag football injuries: their severity. One might assume that in a non-contact sport like flag football, injuries would be relatively minor compared to full-contact football. However, the data presented a different story, highlighting the significant impact of these injuries on the affected personnel.

On average, each flag football injury resulted in 5.8 lost workdays. This figure is striking and challenges the perception that flag football is a safer alternative to tackle football. Many individuals might engage in flag football precisely because they perceive it as a lower-risk activity. However, the study’s findings underscore that even in a sport designed to minimize physical contact, injuries can be severe enough to cause an extended absence from work.

This loss of workdays is particularly concerning, as it emphasizes the physical and economic toll of flag football injuries on active-duty USAF personnel. Injuries can not only lead to pain and discomfort but also disrupt daily life and responsibilities, including military duties. The 5.8 missed workday average multiplied by the estimated 944 flag football related injuries in the study amounts to 15 years (5475 days) of lost workdays.

The fact that injuries in flag football result in such a significant number of lost workdays underscores the need for robust injury prevention measures. These measures must go beyond simply promoting the sport as a safer alternative and delve deeper into proactive player safety interventions such as flag football helmets, padded shoulder protection, and an enhanced understanding of the mechanisms that lead to injury as outlined in the study.


The notion that flag football injuries are less severe almost seem absurd in the context of this study. Athlete safety in this potentially injurious sporting environment should be considered with the same seriousness given to player safety in full-contact sports. This realization opens the door to targeted interventions and safety measures to ensure the well-being of military personnel on the field, whether that is here at home, or on the improvised playfields of Afghanistan.

U.S. Marines with Combat Logistics Company 28, Combat Logistics Regiment 2 play flag football during their company barbecue at Camp Dwyer in Helmand province, Afghanistan, April 3, 2013

Implications for Injury Prevention

The implications of this study go beyond the world of military flag football and the lessons can be applied to civilian flag football as well.

The results of the study were found to be consistent with findings in other sports, emphasizing the importance of enforcing rules and policies to prevent dangerous or rough play leading to injurious player contact, and supporting the need for added player protection measures such as adding soft shell headgearspider pads, or other protective equipment where appropriate for each sport.

For the U.S. Air Force, this study provides an opportunity to develop targeted prevention strategies, and to adopt equipment, that can help reduce the incidence of flag-football injuries. Furthermore, it underscores the potential of safety data to drive injury prevention efforts across various sports and occupational activities within the military.

Inexpensive solutions exist, and the science of non-contact player protection is continuously improving. Industry leaders like GameBreaker and D3O® are proud to provide military tough soft shell protection specifically tailored to the needs of flag football athletes.