What the football coach should know about catastrophic cervical cord injuries.

Though the rate of catastrophic cord injuries remains quite moderate, it can produce a paralysis and/or a permanent disability that can devastate a football team.

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During the 2005 high school football season, a total of three cervical cord injuries were recorded, leaving behind an incomplete neurological picture.

The accompanying statistics are based on the Annual Survey of the National Center for Catastrophic Sports Injury Research by Frederick O. Mueller of the U. of North Carolina at Chapel Hill, and Robert C. Cantu, Medical Director of Emerson Hospital in Concord, MA.

The survey originated as part of the effort to educate everyone on the role they can play in the prevention of these tragic injuries.

WHAT IS CONSIDERED "NORMAL?"

Each of us has seven cervical vertebrae within the neck region. When the head is in a neutral position with our eyes focused in front of us, the normal alignment of the spine is one of extension due to the natural curvature of the spine.

With the head in a neutral position or extended forward slightly, the forces of contact delivered or received in football can be partially dissipated by the athlete's well-developed musculature of the neck. Contact when tackling with the "head-up" allows the forces to be partly absorbed by the neck, and thus much less likely to occur.

WHAT CAUSES AN "INJURY?"

Severe spinal injuries can occur when a player uses improper tackling and blocking techniques, or when a running back runs with his head down into a tackler. If the head is rotated to a chin-down position, even as little as 30 degrees, the normal curve of the spine will be straightened and the forces of impact to the top of the head will be transmitted directly to the cervical vertebrae.

Potential problems arise when a player in this position collides with another player (termed spearing): The head stops, the trunk continues to move, and the cervical spine is crushed between the two. This "axial loading" has been documented as the primary cause of cervical cord injuries. Players who use the top of their helmets to make a tackle, block, or otherwise strike opponents are at greatest risk for injury. Coaches must take the extra time and effort to teach football techniques that put the players in a "head-up" position to prevent injury.

IMPORTANCE OF THE NECK MUSCLES

The neck plays a significant role in football and acts as a shock absorber to prevent injury. Weak neck muscles make a player vulnerable to injury. Strong neck muscles are needed to perform exercises to strengthen these muscles.

The simplest exercises for the neck are self-resistance using isometrics. The exercises involve applying constant pressure to the sides, front, and back of the head while holding the neck rigid for a 10-count several times a day.

Stretching the neck muscles should be a routine part of all team warm-ups before major contact drills. The neck muscles can be easily stretched by slowly rotating the head from side-to-side and from front-to-back.

TEST YOUR KNOWLEDGE

1. True or False: A player's helmet and pads will prevent catastrophic neck injury?

False -- Athletes often incorrectly think that their helmets and pads prevent severe neck injuries. Helmets protect the head and should never be used as a weapon in football. Shoulder pads prevent injury to the shoulders, not the neck.

2. True or False: Helmets, neck rolls, or cowboy collars prevent axial loading.

False -- Only by using proper tackling and blocking techniques will axial loading be prevented. As discussed earlier, axial loading occurs when a player lowers his head and strikes a player with the top of the head, transferring the forces downward to the cervical vertebrae.

3. True or False: It is legal to tackle a player by leading with the top of the helmet?

False -- It is illegal--leading with the top of the head is called spearing.

Remember, it is still a penalty, even if the hit is unintentional. Officials can play a major role in the reduction of serious injury by enforcing the spearing rule, regardless of intent, whenever a player leads with the top of the helmet when making a tackle.

WHO IS AT RISK?

Most neck injuries occur when defensive players initiate contact in the act of making a tackle, but neck injury can happen to anyone involved with head-down contact. Regardless of position, players who make contact with the top of the head increase their potential risk for injury.

TACKLING TECHNIQUES

Coaches must teach players tackling fundamentals that include making first contact with the shoulder pads/chest. See what you hit! This will reduce the chances of a head or neck injury.

Have players prepare the neck for contact before a tackle; teach them to make a "bull neck" before contact. Make certain players have stretched their neck muscles prior to contact drills and encourage strengthening exercises.

Strong neck muscles play a vital role in preventing injury during tackling or blocking drills where inadvertent headfirst contact is possible. The forces will be absorbed by the neck muscles and the likelihood of a catastrophic injury will be greatly decreased.

TOGETHER EVERYONE ACHIEVES MORE

T-E-A-M-work from everyone involved with football is needed to focus on preventing serious neck injuries.

Coaches must teach players that their helmets are not weapons; the helmet is designed for protection.

Officials must flag spearing during games when appropriate to help reinforce the importance of proper tackling techniques.

Players must follow the instructions of coaches and not only learn the proper techniques, but strengthen themselves to prevent serious injury.

Periodically review your program's plan in the event a severe injury occurs and make the plan available to the entire staff. Increased awareness to the prevention of cervical cord injuries is critical to ensure the safety and enjoyment of football for all players.

KEYS TO THE PREVENTION OF SERIOUS NECK INJURIES

1. Practice proper tackling and blocking fundamentals to minimize the risk of neck injury. Coaching point: Teach correct tackling and blocking techniques and emphasize their importance.

2. The athlete must overcome a natural tendency to tuck his head when about to collide with an opponent. Players who make tackles with their head down risk paralysis. Coaching point: Instruct players to keep the head up when making a tackle. Allow no exceptions.

3. Conditioning of neck muscles is essential. Incorporate proper exercises to stretch and strengthen the neck muscles of your players into your program. Coaching point: Make certain that the neck is included in the warm-up program before contact drills.

4. The top of the head or helmet as the point of first contact is illegal and dangerous. Officials must call spearing penalties when a player leads with the top of the helmet in an unsafe tackling method. Coaching point: Eliminate teaching headfirst contact in your football program.

5. Be prepared for any possible catastrophic neck injury. Knowing what to do may be the difference that prevents permanent disability. Coaching point: Have a written emergency plan, and make it available to all coaching staff and trainers.

For additional information concerning catastrophic cervical cord injuries, see the full report at following site: http://www.unc.edu/depts/nccsi/CataFootballlnjuries.htm

By Kenneth Hampton, Assistant Coach, Capital City Steelers Pop Warner Midget League, Raleigh, NC