Current Trends
Football-Related Spinal Cord Injuries
Among High School Players -- Louisiana, 1989
During the 1989 high school football season in Louisiana, four
high
school players sustained cervical spinal cord injuries (SCIs) while
playing football. From 1978 through 1988, only three such injuries
are
known to have occurred in this state (National Center for
Catastrophic
Sports Injury Research, unpublished data).* Louisiana law requires
reporting of all SCIs to the Office of Public Health, Louisiana
Department of Health and Hospitals.
Three of the injured players were defensive backs, and one was
an
outside linebacker/tight end. All injuries resulted in
quadriplegia;
three of the injuries were complete (i.e., motor and/or sensory
function below the zone of injury was not preserved). The injuries
occurred during evening games when the players were tackling or
blocking with the head as a point of contact but not in the typical
head-down or spearing position. The circumstances suggested that
the
mechanism of injury was an axial load on a partially-flexed neck
and
that the vertical force was transmitted down the length of the
spine.
Previous studies have shown axial loading to be the mechanism most
likely to lead to permanent quadriplegia in injured athletes (1-3).
The Louisiana Safety and Sports Medicine Advisory Committee, a
group formed to address the problem of SCIs among high school
football
players, is developing an educational program to instruct coaches
and
trainers on safer methods of tackling. This program may be
implemented
during the 1990 football season.
Reported by: GM Liggett, MPH, JB Mathison, MD, Disability
Prevention
Program, JL Nitzkin, MD, Director, Office of Public Health,
Louisiana
Dept of Health and Hospitals. ME Brunet, MD, Dept of Orthopedics,
Tulane Univ Medical Center, New Orleans, Louisiana. Disabilities
Prevention Program and Div of Injury Control, Center for
Environmental
Health and Injury Control, CDC.
Editorial Note
Editorial Note: Based on data collected by the National Football
Head
and Neck Injury Registry for 1971-1975 and compared with data for
1959-1963, the incidence of football-associated cervical SCIs
increased
from 0.7 per 100,000 participants to 1.6 per 100,000 participants,
respectively (3). More than half the injuries identified were
attributed to use of the top of the helmet as the initial point of
contact. This mechanism of first contact became more common because
the
modern helmet and face mask, developed in the 1960s and 1970s,
offers
greater protection in general (3). Because of the increased
occurrence
of these injuries, in 1976 the National Collegiate Athletic
Association
(NCAA) and the National Federation of High School Athletic
Associations
adopted rules prohibiting the deliberate use of the top of the
helmet
to strike a runner or use of the helmet to butt or ram an opponent
(3,4). The overall decrease in the incidence of quadriplegia in
high
school football players, from 2.2 per 100,000 participants in 1976
to
0.4 per 100,000 in 1984, was attributed to the successful
implementation of these rules (3).
The expected number of football-associated SCIs in Louisiana
during
1989 can be estimated in two ways. Based on the 1984 national rate
of
0.4 SCIs per 100,000 participants (3) and the 1989 population of
Louisiana high school football players, only one such injury would
be
expected during a 14.5-year period. Alternatively, based on the
experience in Louisiana from 1978 through 1988, one SCI would be
expected during a 3.7-year period. Reasons for the occurrence of
the
four SCIs during the 1989 high school football season in Louisiana
are
unknown.
At greatest risk for football-related SCIs are players who
tackle
by flexing their necks and using the tops of their helmets to
strike
opponents (1-3). Suggested strategies to prevent football-related
cervical SCIs include educating coaches and participants about
proper
tackling techniques, enforcing existing tackling rules (1-6),
educating
officials about the mechanisms of injury, strengthening the neck
with
proper conditioning exercises (1,6), requiring medical examinations
before participation in football and before resumption of
participation
after injury (1,5), and increasing awareness among school
administrators and coaches about the proper handling of any player
injured during practice or competition (1,5,6).
In 1987, the Council of State and Territorial Epidemiologists
recommended that traumatic SCIs be designated as reportable (7).
Strengthening state-based surveillance of SCIs will aid in
identifying
these catastrophic injuries and assist in the planning,
implementation,
and evaluation of prevention programs. SCI is a targeted condition
in
CDC's Disabilities Prevention Program, which supports SCI
surveillance
and prevention activities in Louisiana.
References
Cantu RC. Head and spine injuries in the young athlete. Clin
Sports
Med 1988;7:459-72.
Torg JS, Truex R Jr, Quedenfeld TC, Burstein A, Spealman A,
Nichols
C. The National Football Head and Neck Injury Registry: report and
conclusions 1978. JAMA 1979;241:1477-9.
Torg JS, Vegso JJ, Sennett B. The National Football Head and
Neck
Injury Registry: 14-year report on cervical quadriplegia
(1971-1984).
Clin Sports Med 1987;6:61-72.
Mueller FO. How to prevent athletic injuries: tackle football as
an
example. In: Vinger PF, Hoerner EF, eds. Sports injuries.
Littleton,
Massachusetts: PSG Publishing Company, Inc., 1986:406-10.
Mueller FO, Blyth CS, Cantu RC. Catastrophic spine injuries in
football. The Physician and Sportsmedicine 1989;17(10).
CDC. Acute traumatic spinal cord injury surveillance--United
States,
1987. MMWR 1988;37:285-6.
*National Center for Catastrophic Sports Injury Research,
University of
North Carolina at Chapel Hill, CB8605, 311 Woollen Gym, Chapel
Hill, NC
27599-8605.
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