National Athletic Trainers' Association Position Statement: Head-Down Contact and Spearing in Tackle Football

Journal of Athletic Training

Volumn 39, Issue 1, 2004, Pages 101-111

  Heck, Jonathan F ^a,f   Clarke, Kenneth S ^b   Peterson, Thomas R ^c   Torg, Joseph S ^d   Weis, Michael P ^e  

^a RICHARD STOCKTON COLLEGE OF NEW JERSEY   (United States)

^b SLE Worldwide Inc   (United States)

^c UNIVERSITY OF MICHIGAN   (United States)

^d TEMPLE UNIVERSITY   (United States)

^e MCRC Physical Therapy   (United States)

^f National Athletic Trainers' Association   (United States)

Author keywords

Catastrophic injuries; Cervical spine; Head injuries; Injury prevention; Neck injuries; Paralysis; Quadriplegia

Indexed keywords

ACCIDENT PREVENTION; ARTICLE; CERVICAL SPINE DISLOCATION; CERVICAL SPINE FRACTURE; CERVICAL SPINE INJURY; EDUCATION PROGRAM; FOOTBALL; HELMET; HUMAN; PRACTICE GUIDELINE; SPORT INJURY;

EID: 1842731171     PISSN: 10626050     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (140)

1. Torg JS, Guille JT, Jaffe S. Injuries to the cervical spine in American football players. J Bone Joint Surg Am. 2002;84:112-122.
2. Mueller FO, Cantu RC. Annual survey of catastrophic football injuries: 1977-1992. In: Hoerner EF, ed. Head and Neck Injuries in Sports ASTM STP 1229. Philadelphia, PA: American Society for Testing and Materials; 1994:20-27.
3. Mueller FO, Cantu RC. The annual survey of catastrophic football injuries: 1977-1988. Exerc Sport Sci Rev. 1991;19:261-312.
4. Cantu RC, Mueller FO. Catastrophic football injuries: 1977-1998. Neurosurgery. 2000;47:673-675.
5. Torg JS. Prevent Paralysis: Don't Hit With Your Head [videotape]. Philadelphia, PA: Penn Sports Medicine; 1992.
6. See What You Hit [videotape]. Atlanta, GA: Kestrel Communications Inc; 2000.
7. Spine Injury Management [videotape]. Champaign, IL: Human Kinetics; 2001.
8. Clarke KS. Cornerstones for future directions in head/neck injury prevention in sports. In: Hoerner EF, ed. Head and Neck Injuries in Sports ASTM STP 1229. Philadelphia, PA: American Society for Testing and Materials; 1994:3-9.
9. Hard-shelled helmets for athletes, experts say. JAMA. 1962;180:23-24.
10. Blyth C, Arnold D. The Thirty-Ninth Annual Survey of Football Fatalities, 1931-1970. Chicago, IL: American Football Coaches Association, National Collegiate Athletic Association, and National Federation of State High School Associations; 1978.
11. American Medical Association Committee on Medical Aspects of Sports. Spearing in Football: Tips on Athletic Training. Chicago, IL: American Medical Association, National Federation of State High School Athletic Associations; 1968:6-7.
12. Mueller FO, Blyth CS. Fatalities from head and cervical spine injuries occurring in tackle football: 40 years' experience. Clin Sports Med. 1987;6:185-196.
13. Clarke KS. Calculated risk of sports fatalities. JAMA. 1966;197:894-896.
14. Hodgson V. National Operating Committee on Standards for Athletic Equipment Football Certification Program. Available at: http://www.nocsae.org/nocsae/RESEARCH/Hodgson.htm. Accessed September 23, 2002.
15. Mueller FO, Blyth CS, Cantu RC. Catastrophic spine injuries in football. Physician Sportsmed. 1989;17(10):51-53.
16. Clarke KS, Powell, JW. Football helmets and neurotrauma: an epidemiological overview of three seasons. Med Sci Sports. 1979;11:138-145.
17. Schneider RC. Serious and fatal neurosurgical football injuries. Clin Neurosurg. 1964;12:226-236.
18. Clarke KS. A survey of sport-related spinal cord injuries in schools and colleges, 1973-1975. J Safety Res. 1977;9:140-146.
19. Torg JS, Quedenfeld TC, Moyer RA, Truex R, Spealman AD, Nichols CE. Severe and catastrophic neck injuries resulting from tackle football. J Am Coll Health Assoc. 1977;25:224-226.
20. Torg JS, Truex R Jr, Quedenfeld TC, Burstein A, Spealman A, Nichols CE III. The National Football Head and Neck Injury Registry: report and conclusions, 1978. JAMA. 1979;241:1477-1479.
21. Heck JF. An analysis of football's spearing rules. Sideliner J Athl Train Soc N J. 1993;9:8,9,15.
22. Heck JF. The incidence of spearing by high school football ball carriers and their tacklers. J Athl Train. 1992;27:120-124.
23. Torg JS, Vegso JJ, Sennett B. The National Football Head And Neck Injury Registry: 14-year report on cervical quadriplegia. Clin Sports Med. 1987;6:61-72.
24. Torg JS, Sennett B, Vegso JJ. Spinal injury at the third and fourth cervical vertebrae resulting from the axial loading mechanism: an analysis and classification. Clin Sports Med. 1987;6:159-183.
25. Wilberger JE, Maroon JC. Cervical spine injuries in athletes. Physician Sportsmed. 1990;18(3):57-70.
26. Albright JP, Mcauley E, Martin RK, Crowley ET, Foster DT. Head and neck injuries in college football: an eight-year analysis. Am J Sports Med. 1985;13:147-152.
27. Anderson C. Neck injuries: backboard, bench or return to play. Physician Sportsmed. 1993;21(8):23-34.
28. Hodgson VR, Thomas LM. Play head-up football. Natl Fed News. 1985; 2:24-27.
29. Saal JA, Sontag MJ. Head injuries in contact sports: sideline decision making. Phys Med Rehabil. 1987;1:649-658.
30. Torg JS. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. Med Sci Sports Exerc. 1985;17:295-303.
31. Torg JS. Epidemiology, pathomechanics, and prevention of football-induced cervical spinal cord trauma. Exerc Sport Sci Rev. 1992;20:321-338.
32. Torg JS. Epidemiology, biomechanical and cinematographic analysis of football induced cervical spine trauma. Athl Train J Natl Athl Train Assoc. 1990;25:147-159.
33. Torg JS, Sennett B, Vegso JJ, Pavlov H. Axial loading injuries to the middle cervical spine segment: an analysis and classification of twenty-five cases. Am J Sports Med. 1991;19:6-20.
34. Diehl J. The National Federation: how rules are written. Paper presented at: National Athletic Trainers' Association 53rd Annual Meeting and Clinical Symposia; June 14-18, 2002; Dallas, TX.
35. Schneider RC. Head and Neck Injuries in Football: Mechanisms, Treatment, and Prevention. Baltimore, MD: Williams & Wilkins; 1973.
36. Dolan KD, Feldick HG, Albright JP, Moses JM. Neck injuries in football players. Am Fam Physician. 1975;12:86-91.
37. Funk FJ, Wells RE. Injuries of the cervical spine in football. Clin Orthop. 1975;109:50-58.
38. Silver JR. Injuries of the spine sustained in rugby. Br Med J (Clin Res Ed). 1984;288:37-43.
39. Melvin WJ, Dunlop HW, Hetherington RF, Kerr JW. The role of the faceguard in the production of flexion injuries to the cervical spine in football. Can Med Assoc J. 1965;93:1110-1117.
40. Ciccone R, Richman RM. The mechanism of injury and the distribution of three thousand fractures and dislocations caused by parachute jumping. J Bone Joint Surg Am. 1948;30:77-97.
41. Ellis WG, Green D, Holzaepfel NR, Sahs AL. The trampoline and serious neurologic injuries: a report of five cases. JAMA. 1960; 174:1673-1676.
42. Hage P. Trampolines: an "attractive nuisance." Physician Sportsmed. 1982;10(12):118-122.
43. Kravitz H. Problems with the trampoline, I: too many cases of permanent paralysis. Pediatr Ann. 1978;7:728-729.
44. Tator CH, Edmonds VE. National survey of spinal injuries in hockey players. Can Med Assoc J. 1984;130:875-880.
45. Tator CH, Ekong CE, Rowed DW, Schwartz ML, Edmonds VE, Cooper PW. Spinal injuries due to hockey. Can J Neurol Sci. 1984; 11:34-41.
46. Torg JS, Das M. Trampoline-related quadriplegia: review of the literature and reflections on the American Academy of Pediatrics' position statement. Pediatrics. 1984;74:804-812.
47. Carvell JE, Fuller DJ, Duthie RB, Cockin J. Rugby football injuries to the cervical spine. Br Med J (Clin Res Ed). 1983;286:49-50.
48. Gehweiler JA Jr, Clark WM, Schaaf RE, Powers B, Miller MD. Cervical spine trauma: the common combined conditions. Radiology. 1979;130: 77-86.
49. Leidholt JD. Spinal injuries in athletes: be prepared. Orthop Clin North Am. 1973;4:691-707.
50. Macnab I. Acceleration injuries of the cervical spine. J Bone Joint Surg Am. 1964;46:1797-1799.
51. McCoy GF, Piggot J, Macafee AL, Adair IV. Injuries of the cervical spine in schoolboy rugby football. J Bone Joint Surg Br. 1984;66:500-503.
52. Paley D, Gillespie R. Chronic repetitive unrecognized flexion injury of the cervical spine (high jumper's neck). Am J Sports Med. 1986;14:92-95.
53. Piggot J, Gordon DS. Rugby injuries to the cervical cord. Br Med J. 1979;1:192-193.
54. Williams JP, McKibbin B. Cervical spine injuries in rugby union football. Br Med J. 1978;2:1747.
55. Wu WQ, Lewis RC. Injuries of the cervical spine in high school wrestling. Surg Neurol. 1985;23:143-147.
56. O'Carroll PF, Sheehan JM, Gregg TM. Cervical spine injuries in rugby football. Ir Med J. 1981;74:377-379.
57. Scher AT. "Crashing" the rugby scrum: an avoidable cause of cervical spinal injury: case reports. S Afr Med J. 1982;61:919-920.
58. Burke DC. Hyperextension injuries of the spine. J Bone Joint Surg Br. 1971;53:3-12.
59. Edilken-Monroe B, Wagner LK, Harris JH Jr. Hyperextension dislocation of the cervical spine. AJR Am J Roentgenol. 1986;146:803-808.
60. Forsyth HF. Extension injuries of the cervical spine. J Bone Joint Surg Am. 1964;46:1792-1797.
61. Marar BC. Hyperextension injuries of the cervical spine: the pathogenesis of damage to the spinal cord. J Bone Joint Surg Am. 1974;56:1655-1662.
62. Alexander E Jr, Davis CH Jr, Field CH. Hyperextension injuries of the cervical spine. AMA Arch Neurol Psychiatry. 1958;19:146-150.
63. Torg JS, Quedenfeld TC, Burstein A, Spealman AD, Nichols CE III. National Football Head and Neck Injury Registry: report on cervical quadriplegia, 1971 to 1975. Am J Sports Med. 1979;7:127-32.
64. Torg JS, Vegso JJ, O'Neill MJ, Sennett B. The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma. Am J Sports Med. 1990;18:50-7.
65. Torg JS. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. Med Sci Sports Exerc. 1985;17:295-303.
66. Yoganandan N, Sances A Jr, Maiman DJ, Myklebust JB, Pech P, Larson SJ. Experimental spinal injuries with vertical impact. Spine. 1986; 11: 855-60.
67. Mertz HJ, Hodgson VR, Thomas LM, Nyquist GW. An assessment of compressive neck loads under injury-producing conditions. Physician Sportsmed. 1978;6(11):95-106.
68. Hodgson VR, Thomas LM. Mechanism of cervical spine injury during impact to the protected head. In: Proceedings of the Twenty-Fourth Staap Car Crash Conference. Warrendale, PA: Society of Automotive Engineers; 1980: 17-42.
69. Sances A Jr, Myklebust JB, Maiman DJ, Larson SJ, Cusick JF, Jodat RW. The biomechanics of spinal injuries. Crit Rev Biomed Eng. 1984; 11:1-76.
70. Gosch HH, Gooding E, Schneider RC. An experimental study of cervical spine and cord injuries. J Trauma. 1972;12:570-576.
71. Maiman DJ, Sances A Jr, Myklebust JB, et al. Compression injuries of the cervical spine: a biomechanical analysis. Neurosurgery. 1983;13: 254-260.
72. Roaf R. A study of the mechanics of the spinal injuries. J Bone Joint Surg Br. 1960;42:810-823.
73. White AA III, Punjabi MM. Clinical Biomechanics of the Spine. Philadelphia, PA: Lippincott; 1978.
74. Bauze RJ, Ardran GM. Experimental production of forward dislocation in the human cervical spine. J Bone Joint Surg Br. 1978;60:239-245.
75. Nightingale RW, McElhaney JH, Richardson WJ, Best TM, Myers BS. Experimental impact injury to the cervical spine: relating motion of the head and the mechanism of injury. J Bone Joint Surg Am. 1996;78:412-421.
76. Kazarian L. Injuries to the human spinal column: biomechanics and injury classification. Exerc Sport Sci Rev. 1981;9:297-352.
77. Kewalramani LS, Orth MS, Taylor RG. Injuries to the cervical spine from diving accidents. J Trauma. 1975;15:130-142.
78. Albrand OW, Corkill G. Broken necks from diving accidents: a summer epidemic in young men. Am J Sports Med. 1976;4:107-110.
79. Albrand OW, Walter J. Underwater deceleration curves in relation to injuries from diving. Surg Neurol. 1975;4:461-465.
80. Maroon JC, Steele PB, Berlin R. Football head and neck injuries: an update. Clin Neurosurg. 1980;27:414-429.
81. Mennen U. Survey of spinal injuries from diving: a study of patients in Pretoria and Cape Town. S Afr Med J. 1981;59:788-790.
82. Rogers WA. Fractures and dislocations of the cervical spine: an end-result study. J Bone Joint Surg Am. 1957;39:341-376.
83. Scher AT. Diving injuries to the cervical spinal cord. S Afr Med J. 1981; 59:603-605.
84. Scher AT. Injuries to the cervical spine sustained while carrying loads on the head. Paraplegia. 1978;16:94-101.
85. Scher AT. "Tear-drop" fractures of the cervical spine: radiological features. S Afr Med J. 1982;61:355-356.
86. Scher AT. The high rugby tackle: an avoidable cause of cervical spinal injury? S Afr Med J. 1978;53:1015-1018.
87. Scher AT. Vertex impact and cervical dislocation in rugby players. S Afr Med J. 1981;59:227-228.
88. Bishop PJ. Impact postures and neck loading in head first collisions: a review. In: Hoerner EF, ed. Head and Neck Injuries in Sports ASTM STP 1229. Philadelphia, PA: American Society for Testing and Materials; 1994:127-141.
89. Burstein AH, Otis JC. The response of the cervical spine to axial loading: feasibility for intervention. In: Hoerner EF, ed. Head and Neck Injuries in Sports ASTM STP 1229. Philadelphia, PA: American Society for Testing and Materials; 1994:142-153.
90. Pintar FA, Yoganandan N, Sances A JF, Cusick JF. Experimental production of head-neck injuries under dynamic forces. In: Hoerner EF, ed. Head and Neck Injuries in Sports ASTM STP 1229. Philadelphia, PA: American Society for Testing and Materials; 1994:203-211.
91. Yoganandan N, Pintar FA, Sances A Jr, Reinartz J, Larson SJ. Strength and kinematic response of dynamic cervical spine injuries. Spine. 1991; 16(10 suppl):S511-S517.
92. Yoganandan N, Sances A Jr, Maiman DJ, Myklebust JB, Pech P, Larson SJ. Experiemental spinal injuries with vertical impact. Spine. 1986;11: 855-859.
93. Burstein AH, Otis JC, Torg JS. Mechanisms and pathomechanics of athletic injuries to the cervical spine. In: Torg JS, ed. Athletic Injuries to the Head, Neck, and Face. Philadelphia, PA: Lea & Febiger; 1982: 139-154.
94. Torg JS, Truex RC Jr, Marshall J, et al. Spinal injury at the level of the third and fourth cervical vertebrae from football. J Bone Joint Surg Am. 1977;59:1015-1019.
95. Allen BL Jr, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine. 1982;7:1-27.
96. Jackson DW, Lohr FT. Cervical spine injuries. Clin Sports Med. 1986; 5:373-386.
97. Watkins RG. Neck injuries in football players. Clin Sports Med. 1986; 5:215-246.
98. Carter DR, Frankel VH. Biomechanics of hyperextension injuries to the cervical spine in football. Am J Sports Med. 1980;8:302-309.
99. Virgin H. Cineradiographic study of football helmets and the cervical spine. Am J Sports Med. 1980;8:310-317.
100. Cantu RC. Head and spine injuries in the young athlete. Clin Sports Med. 1988;7:459-472.
101. Drake GA. Research provides more suggestions to reduce serious football injuries. Natl Fed News. November/December 1994;18-21.
102. Drake GA. Catastrophic football injuries and tackling techniques. In: Hoemer EF, ed. Safety in American Football, ASTM STP 1305. Philadelphia, PA: American Society for Testing and Materials; 1996:42-49.
103. Heck JF. The incidence of spearing during a high school's 1975 and 1990 football seasons. J Athl Train. 1996;31:31-37.
104. Heck JF. Preventing catastrophic head and neck injuries in football. From Gym Jury. 1998;10(1):7.
105. Heck JF. Re-examining spearing: the incidence of cervical spine injury hides the risks. Am Football Coach. 1999;5(8):52-54.
106. Football-related spinal cord injuries among high school players: Louisiana, 1989. MMWR Morb Mortal Wkly Rep. 1990;39:586-587.
107. Buckley WE. Concussions in college football: a multivariate analysis. Am J Sports Med. 1998;16:51-56.
108. Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Physician Sportsmed. 1986;14(10):75-83.
109. Heck JF. The state of spearing in football: incidence of cervical spine injuries doesn't indicate the risks. Sports Med Update. 1998;13(2):4-7.
110. National Federation of State High School Associations. Official Football Rules. Indianapolis, IN: National Federation of State High School Associations; 2002.
111. National Collegiate Athletic Association. 2001 Football Rules and Interpretations. Indianapolis, IN: National Collegiate Athletic Association; 2001.
112. National Federation of State High School Associations. Official Football Rules. Elgin, IL: National Federation of State High School Associations; 1976.
113. National Collegiate Athletic Association. Football Rules Changes and/or Modifications. Kansas City, MO: National Collegiate Athletic Association; January 23, 1976.
114. National Collegiate Athletic Association. 2001 Consolidated NCAA Foul Report. Indianapolis, IN: National Collegiate Athletic Association; 2002.
115. Peterson TR. Roundtable: head and neck injuries in football. Paper presented at: American Society for Testing and Materials' International Symposium on Head and Neck Injuries in Sports; May 1993; Atlanta, GA.
116. Heck JF. A survey of New Jersey high school football officials regarding spearing rules. J Athl Train. 1995;30:63-68.
117. Lutz R. Good judgment critical in making call. Available at: http://www.mcoa.org/articles/fb_003.html. Accessed July 9, 2002.
118. National Federation of State High School Associations. Official Football Rules. Indianapolis, IN: National Federation of State High School Associations; 1988.
119. Lawrence DS, Stewart GW, Christy DM, Gibbs, LI, Ouellette M. High school football-related cervical spinal cord injuries in Louisiana: the athlete's perspective. Available at: http://www.injuryprevention.org/states/la/football/football.htm. Accessed July 15, 2002.
120. National Federation of State High School Associations. Official Football Rules. Indianapolis, IN: National Federation of State High School Associations; 1994.
121. Bishop PJ. Factors related to quadriplegia in football and the implications for intervention strategies. Am J Sports Med. 1996;24:235-239.
122. Heck JF. The football official's role in the prevention of catastrophic neck injuries. Presented at: Southern New Jersey Football Officiating Association Meeting; September 1994; Audubon, NJ.
123. Kleiner DM, Almquist JL, Bailes J, et al. Prehospital Care of the Spine-Injured Athlete. Dallas, TX: Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete; 2001.
124. Albright JP, Moses JM, Feldick HD, Dolan KD, Burmeister LF. Nonfatal cervical spine injuries in interscholastic football. JAMA. 1976;236:1243-1245.
125. Graves JE, Pollock ML, Leggett SH, et al. Effect of reduced training frequency on muscular strength. Int J Sports Med. 1988;9:316-319.
126. Patterson D. Legal aspects of athletic injuries to the head and cervical spine. In: Torg JS, ed. Athletic Injuries to the Head, Neck, and Face. 2nd ed. St. Louis, MO: Mosey Year Book; 1991:198-209.
127. Patterson D. Legal aspects of athletic injuries to the head and cervical spine. Clin Sports Med. 1987;6:197-210.
128. Boulet v Brunswick Corporation, 126 Mich App 240 (1982).
129. Dibortolo v Metropolitan School District, 440 NE2d 506 Ind Ct App (1982).
130. Gerrity v Beatty, 71 III 2d 47 (1978).
131. Green v Orleans Parish School Board, 365 So2d 834, 836 La Ct App (1978).
132. Jackson v Board of Education 109, III App 3d 716, 441 NE2d 120 (1982).
133. Landers v School District #203, 66 III App 3d 78, 383 NE2d 645 (1978).
134. Low v Texas Tech University, 540 SW2d 297 Tex Supreme Ct (1976).
135. Peterson v Multnomah County School District, 669 P2d 387, 393 (1983).
136. Stehn v Bernarr Macfadden Foundations, Inc, 434 F2d811 6th Cir (1970).
137. Vendrell v School District No 26C, 233 Ore 1 (1962).
138. Wissel v Ohio High School Athletic Association, 78 Ohio App 3d 529 (1992).
139. Black J. Legal implications for the secondary school athlete. Paper presented at: National Athletic Trainers' Association 53rd Annual Meeting and Clinical Symposia; June 14-18, 2002: Dallas, TX.
140. Heck JF, Weis MP, Gartland JM, Weis CR. Minimizing liability risks of head and neck injuries in football. J Athl Train. 1994;29:128-139.