Each year, approximately 12,500 new cases of spinal cord injury (SCI) are reported in the United States. Nine percent of these SCI are a result of sports and recreation. Among all US sports, the greatest number of catastrophic SCI occurs in football.
Catastrophic SCI occurs when there is structural distortion of the cervical spinal column associated with damage to the spinal cord. The SCI that carries the greatest risk of sudden death for the athlete happens when the damage is at the C4 level or above and severe enough to affect the spinal cord's ability to transmit respiratory or circulatory control from the brain.
In football, axial loading is the primary mechanism for catastrophic SCI. Axial loading occurs as a result of head-down contact and spearing. The incidence of quadriplegia in organized football has remained relatively low since rule changes by the National Collegiate Athletic Association (NCAA) and the National Federation of State High School Associations (NFHS) against helmet to helmet contact and spearing have been enforced. However, dangerous head-down contact remains a common occurrence on the football field.
An athlete risks paralysis anytime he or she initiates contact with their head down. When the head is up, the cervical spine is in a position where it has maximum flexibility to endure impact without injury. When the head is down, the natural curve of the cervical spine is reduced, the vertebrae of the neck align in a straight column, which increases the potential for an impact resulting in a serious spinal injury.
During a head-down hit, the head is stopped at contact, the trunk continues to move and the spine is crushed between the two.
Whether intentional or unintentional, head down contact results in axial loading and is the primary cause of cervical spine fractures and dislocations in football. Football equipment, such as helmet and shoulder pads, do not prevent axial loading injuries of the cervical spine.
Football hitting technique is the critical factor in preventing axial loading. When contact is made with the shoulder and chest while keeping the head up, the risk of serious head and neck injury is greatly reduced. When the head and eyes are up, the athlete can see the impact before it happens. Whether they are the ball carrier or the tackler, they can prepare their neck musculature accordingly for protection where the force of the hit can be absorbed by the neck muscles, intervertebral discs, and the cervical facet joints.
In an effort to prevent SCI many organizations promoting child safety in sports have created instructional videos on safe tackling and safe blocking, including the National Athletic Trainers' Association (NATA) and USA Football.