Steps to Take to Decrease Cervical Spine Fractures and Dislocations in High School and College Football Players

With high school and college football practice getting underway, the National Athletic Trainers’ Association (NATA) has issued a timely position statement to enlighten coaches and players alike on the seriousness of head-down contact and spearing – dangerous techniques which can lead to catastrophic cervical spine injuries (CSIs) and paralysis. The position statement, authored by Jonathan F. Heck, MS, ATC and other noted health care professionals, can be read at its entirety at . Below are some of the highlights from the report: What is Axial Loading, Head-Down Contact and Spearing

  • Axial loading occurs when the neck is partially flexed aligning the cervical vertebrae in a straight column and a force is applied to the top of the head. When in this position, the neck is unable to handle the force causing the cervical vertebrae to compress and result in fracture or dislocation.
  • Axial loading is the primary cause for catastrophic cervical spine injuries (CSIs) resulting in paralysis. Head-down contact, defined as initiating contact with the top of a football helmet, is the only technique that results in axial loading.
  • Spearing is the intentional use of a head-down contact technique. Unintentional head-down contact is the dropping of the head just before contact. Both are dangerous and may result in axial loading.
  • Catastrophic CSIs resulting from axial loading are neither caused nor prevented by players’ standard equipment.
  • Catastrophic CSIs occur most often to defensive players, but all players are at risk.

What is the Safest Football Contact Position

  • Making contact with the shoulder or chest while keeping the head up greatly reduces the risk of serious head and neck injury.
  • Keep the head up so that the cervical spine is not in the axial loading position.

How Can Officials Help Prevent CSIs

  • Improve enforcement of all the helmet-contact penalties. If illegal helmet contact is not penalized, the message is sent that the technique is acceptable.
  • Maintain strict officiating to make coaches and players aware of the effects of head-down contact.
  • Recognize that the primary purpose of the helmet-contact penalties is to protect the athlete who leads with his head from CSIs.

What Should Coaches Do to Help Prevent CSIs

  • Enforce rules to reduce the incidence of head-down contact.
  • Teach correct contact techniques at the earliest organized level (e.g., Pop Warner, Midget and Pee Wee football leagues).
  • Offer formal team educational sessions at least twice per season; once before the season begins and once midway. Parents of high school players should be invited to first session.
  • Teach, demonstrate and practice the shoulder/chest technique throughout the season to all their position players.
  • Correct a football player’s technique anytime he is observed lowering his head at contact.
  • Point out proper head positions during weekly film reviews of previous games.
  • Show players Prevent Paralysis: Don’t Hit With Your Head (, See What You Hit ( or other educational videos that deal with catastrophic CSIs in football.

The following individuals contributed to the conception and design; acquisition and analysis and interpretation of the data; and drafting, critical revision and final approval of the position statement: Jonathan F. Heck, MS, ATC, -- Richard Stockton College, Pomona, N.J.; Kenneth S. Clarke, PhD -- SLE Worldwide, Inc., Fort Wayne, Ind. (Retired); Thomas R. Peterson, MD -- University of Michigan, Ann Arbor, Mich. (Retired); Joseph S. Torg, MD -- Temple University, Philadelphia, Pa.; and Michael P. Weis, PT, ATC – MCRC Physical Therapy, West Orange, N.J.

Share this