Head contacts are infrequently penalized in youth basketball games

By Jeffrey Kong. This article was initially published in the 9/19/24 edition of our Concussion Update newsletter; please consider subscribing.

A study published in the Clinical Journal of Sports Medicine compared the rates and mechanisms of head contact and suspected concussions in two different divisions of boys and girls youth basketball, raising significant concerns for safety in these games. Using video software, Fehr et al. reviewed and analyzed basketball games from 24 boys’ and 24 girls’ U16-U18 Canadian club basketball teams (12 games each in higher-level ‘Division 1’ and lower-level ‘Division 2’ tournaments). They looked for moments where there was head contact (HC) and suspected concussion incidents. 

One unexpected finding of this study is the lack of fouls called for head contacts during the game, despite contact to the head being illegal in basketball. This issue was worse in the Division 2 tournaments. In Division 1, defensive players were called for a foul under 20% of the time when offensive players sustained a head contact (19.7% in boys games and 19.5% in girls), while in Division 2 games, that number was closer to 10% (8.8% in boys games 12.2% in girls). These findings led researchers to conclude that implementing greater referee rule enforcement and training for contact violations may help prevent head contact and concussions in youth basketball. The authors note that “the small proportion of fouls called for moderate and severe [head] contacts is concerning,” whereas milder head contacts may be hard for a referee to spot without video replay. They also note that enforcement of these rules may not be as effective as in football or soccer “due to characteristics of match play and injury patterns.”

In their video review, it was found that in Division 1, the Head Contact rates did not differ between boys and girls (20 vs. 18 per game on average), while in Division 2, boys had somewhat higher rates of Head Contact than girls (21 vs. 16). The rates of suspected concussion did not differ to a degree that was statistically significant between boys and girls, but the researchers note a need for more research in this area, as their findings conflict those of previous studies that found greater injury rates among girls basketball games. 

While this study is a good start, further research, and studies may be needed to grow and expand on the ideas addressed in this observational study. Fehr et al. state that “...there is limited research assessing illegal activity that goes unpenalized in competition.” Some limiting factors were a lack of footage for all games and not all concussions being immediately reported.