Background: In American football, fewer fatalities and severe injuries have been seen annually since 1976, after data from 1971 through 1975 were retrospectively reviewed to better understand the mechanisms involved in catastrophic cervical spine injury and rules were enacted to prohibit certain types of aggressive tackling. The National Football Head and Neck Injury Registry was established in 1975. Purpose: To assess (1) tackling techniques that coaches were teaching at 3 levels—youth level (YL; 4th to 5th grades), middle school (MS; 6th to 8th grades), and high school (HS; 9th to 12th grades); (2) tackling techniques used during games; and (3) the successful tackle rates of these techniques. Study Design: Descriptive epidemiology study. Methods: Surveys were distributed via email to 500 coaches of YL, MS, and HS football teams in Texas. Coaches provided video recordings of football games, and all tackle attempts were graded by a single reviewer who watched game videos; 1000 consecutive tackles were observed for each group. Survey data included how coaches instructed their players to tackle, the types of tackles, the number of tackles versus missed tackles, the head position, and the initial contact. Data were analyzed with the chi-square test. A subset of 100 consecutive tackles at each level of play was reviewed by 2 blinded reviewers to assess intra- and interrater reliabilities. Results: In all groups, coaches responded that they preferred to teach the at-risk “head across the bow” tackling technique (83% YL, 81% MS, 75% HS). Coaches stated that they instructed players to “keep your head up,” as currently recommended, 89% in YL, 100% in MS, and 81% in HS. During games, players used head-up, inside-shoulder tackles more successfully across all groups (97.5% YL, 99.5% MS, 98.8% HS). While intra- and interrater reliabilities were in the good range, these scores were lower in the youth group. Conclusion: Our study supports the effectiveness of tackling with the head up and making the initial contact with the inside shoulder. Lower reliability ratings for the youth group were likely due to lower video quality and the lack of players’ tackling experience.

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Background: Head-down tackling has been associated with injuries to the brachial plexus, cervical spine, and head in high school and collegiate American football. Head-down tackling has also been associated with decreased effectiveness in successful tackles compared with head-up tackling. Purpose: To assess tackling techniques used during National Collegiate Athletic Association (NCAA) Division I football games and to evaluate the successful tackling rates according to technique. Study Design: Cross-sectional study. Methods: Three reviewers analyzed 1000 consecutive solo defensive tackling attempts made in the 2021 season (October to December) by 8 universities within the NCAA Southeastern Conference. Slow-motion replays were used to analyze the success of the tackling attempt, the tackling method, and the initial point of contact with respect to the offensive player’s waist. The chi-square or Fisher exact test was used to analyze categorical data, and the 2-tailed Student t-test or the Mann-Whitney U test was used to analyze continuous data. Results: Head-up and head-down tackling occurred in 902 (90.2%) and 98 (9.8%) tackle attempts, respectively. Head-up tackles were successful in 76.2% of the attempts compared with 55.1% for head-down tackles ( P < .001). Tackles were made at or above the offensive player’s waist in 777 (77.7%) attempts and below the waist in 223 (22.3%) attempts. Tackles at or above the waist were successful in 77.6% of the attempts compared with 61.9% of tackles below the waist ( P < .001). The inside-shoulder method was used in 592 (59.2%) tackles, the arm method in 317 (31.7%), the head-across-the-bow method in 72 (7.2%), and the helmet-to-helmet method in 19 (1.9%). Inside-shoulder tackles had the highest success rate of 93.2%, compared with 41.6% for arm ( P < .001), 59.7% for head-across-the-bow ( P < .001), and 73.7% for helmet-to-helmet ( P = .001) tackles. Inside-shoulder tackles resulted in head-up tackling in 92.9% compared with 41.7% for head-across-the-bow ( P < .001) and 57.9% for helmet-to-helmet ( P < .001) tackles. There were no recorded injuries to the tackler. Conclusion: Head-up tackles, tackles made at or above the offensive player’s waist, and inside-shoulder tackles had the highest success rates. Head-down tackling and tackling below the waist were associated with poor tackling methods, including head-across-the-bow and helmet-to-helmet tackles, which had lower success rates.