To play or not to play? This continues to be the question for many parents with children who participate in contact sports known for a higher risk of concussions. It is not just football where this is an issue but given the popularity of the sport in the US, it remains front and center. For others the question is, can we make football safer and decrease the likelihood of head impacts without having to give up the sport all together? The HuTT Helmetless Tackling Training ® program is one approach to attempting to decrease head impacts. I wanted to learn more, so I reached out to see what I could find out. Dr. Swartz is one of the developers of the HuTT program and is one of the primary investigators for the currently ongoing HuTT808 project, a 3-year study of HuTT, funded by the GOG Foundation using Hawaii high schools.
A4IA: What was the inspiration for HuTT and how did it come together?
Erik Swartz (ES): The program is based on the theory of risk compensation. The idea that giving athletes protective equipment may encourage them to be more aggressive; in football, this means being more likely to lead with the head while tackling. The inspiration was my experience as a rugby player and the typical techniques used to tackle while minimizing head contact. I often refer to the program as, “rugby inspired, but football centric.” The training drills were designed in collaboration with the University of New Hampshire football coaching staff to ensure the drills were not only relevant but could be easily incorporated into a typical football practice.
A4IA: Can you summarize the overall goal of the HuTT program?
ES: The goal is fewer head impacts. The thought is that if we can decrease the total number of head impacts experienced by players it will not only decrease the number of concussions, but the accumulation of sub-concussive blows and ultimately the long-term neurocognitive damage. The idea is that if we can teach players behaviors in practice that helps minimize head impacts, those behaviors will ultimately translate to practice and game situations even though players are in helmet and pads.
A4IA: Are athletes completing full-speed, full-contact drills without their helmets as part of the training program?
ES: The training program consist of discrete individual drills, there are not full team, full contact drills. All drills are performed without a helmet and shoulder pads. A typical training program is completed a few times a week, taking about 10 minutes and focuses on both tackling and blocking. It is recommended that the program is integrated into the typical practice schedule. Some drills involve the use of tackling dummies, bags or sleds while others involve a partner and a padded shield. Certain drills do require that you take a tackling bag to the ground, through the tackle.
A4IA: You mention that the HuTT808 project is not the first research completed related to HuTT. What other studies have been completed?
ES: The first study, funded by the NATA Foundation, was published in 2015 in the Journal of Athletic Training This randomized control trial (RCT) was completed using 50 participants on the University of New Hampshire football team. Head impacts were tracked using helmets fitted with an impact sensor system. Results indicate a 30% decrease in impacts for those participating in the training as compared to the control group at the end of the season.
The second study, funded through a Head Health Challenge Award by the NFL, GE, and UnderArmour, was published in 2019 in the Journal of Science and Medicine in Sport. This RCT included 115 youth football players ages 14-17. Participants were again, tracked using helmets fitted with an impact sensor system with data collected over two years. The primary goal remained tracking head impacts, but additional analyses were performed based on exposure type (practice v. game) and participation level (JV v. Varsity). Results were mixed, as a decrease in head impacts was evident primarily in games during mid-season in both years, but differences disappeared towards the end of each season. Additionally, junior varsity players did not differ from control participants over the same time. A recommendation for further research on the dose-response relationship is needed. It’s thought that perhaps younger players may need to complete the program more frequently to have the desired long-term behavior change.
A4IA: What makes the HuTT808 project different from the other studies?
ES: The HuTT808 study is still a randomized control trial, but we are now comparing the impact of the training program at the team level as compared to the individual player level. High school teams in Hawaii are participating in the study over a three-year period. Some teams will be designated to the control group while others will complete the helmetless tackling and blocking intervention. The program has just completed the baseline year and will begin year one of a two-year intervention period during the 2020 season. To learn more about HuTT808 check out www.hawaiiconcussion.com/hutt808.
A4IA: Why is it so important to have scientific evidence to support the HuTT program?
ES: You can never underestimate the importance of scientific rigor when designing and implementing HuTT or any other injury prevention program. Randomized control trials (RCT) provide the highest level of scientific evidence, meaning the study outcomes can be implemented with confidence. Scientific evidence can help illuminate the impact of HuTT with different populations (youth, high school, college, pros) and define the dose-response relationship. Ultimately, RCTs are able to provide evidence that the program is safer, not just assumed safer (we’re not there yet, but we continue to work in that direction).
A4IA: If you give one piece of advice to the stakeholders for sports programs as it relates to minimizing head impacts, what would it be?
ES: It is important that stakeholders work together to empower athletic trainers to decrease head impacts, including allowing them to have a voice in how practices are designed. One of an athletic trainer's primary areas of expertise is injury prevention, but to be successful coaches and others must be open to feedback on improving drills, athlete form and overall training formats.
Interested in learning more about HuTT or implementing it with your team? Contact Erik Swartz at Erik_Swartz@uml.edu.
If you have specific questions about HuTT808 contact Nathan Murata at firstname.lastname@example.org.
BIOGRAPHY: Erik Swartz, PhD, ATC, FNATA is the Chair of the Department of Physical Therapy and Kinesiology at the University of Massachusetts – Lowell. According to his biography on the UMass Lowell website his research interest focuses on the prevention and acute care of head and neck injuries in football. He has received several research grants from the NATA Foundation, NOCSAE, NFL Charities among others in support of his work. His early research focused primarily on the management of acute cervical spine injury and over time has transitioned to a focus on the prevention of head and neck injuries. Check out this article from The Conversation summarizing key concepts of helmetless tackling and blocking by Dr. Swartz.
BIOGRAPHY: Nathan Murata, PhD is the Dean of the College of Education at the University of Hawaiʻi at Mānoa, and a professor and graduate chair of the college's Department of Kinesiology and Rehabilitation Science. Since 2007, Murata has coordinated the physical education teacher program, created Pre/K–12 teacher curriculum for majors and completed the first folio report for the National Council for Accreditation of Teacher Education. He works closely with graduate students interested in the field and was instrumental in obtaining more than $2.5 million in U.S. Department of Education training grants, and contracts worth $1.2 million from the state Department of Health in collaboration with the state Department of Education. Dr. Murata promotes teaching as a career to address the critical shortages facing Hawaiʻi schools by integrating research, and collaborative teaching across different disciplines. He is a strong advocate for social justice, diversity of programs and distance education.
ACKNOWLEDGEMENT: Thank you to Dr. Erik Swartz for taking the time to provide insight into HuTT and its status as an evidence based injury prevention program. I appreciate the many efforts that are ongoing in addressing head impacts in sport. This work is beginning to shed light on alternatives to eliminating the sport of football. Thank you to Dr. Nathan Murata from the University of Hawai’i at Manoa for his insights related to the HuTT808 project, I look forward to seeing the outcomes of this team-based investigation.
DISCLAIMER: The content contained in this blog is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, athletic trainer, or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.