National Athletic Trainers' Association Position Statement ...

National Athletic Trainers' Association Position Statement ...

National Athletic Trainers Association Position Statement: Head-Down Contact and Spearing in Tackle Football J Athl Train. 2004;39(1):101-111. 1 Jonathan F. Heck*; Kenneth S. Clarke; Thomas R. Peterson; Joseph S. Torg; Michael P. Weis *Richard Stockton College, Pomona, NJ; SLE

Worldwide, Inc, Fort Wayne, IN (Retired); University of Michigan, Ann Arbor, MI (Retired); Temple University, Philadelphia, PA; MCRC Physical Therapy, West Orange, NJ J Athl Train. 2004;39(1):101-111. 2 Recommendations J Athl Train. 2004;39(1):101-111.

3 Practices and Concepts J Athl Train. 2004;39(1):101-111. 4 1. Axial loading is the primary mechanism for catastrophic CSI. Head-down contact, defined as initiating contact with the top or

crown of the helmet, is the only technique that results in axial loading. J Athl Train. 2004;39(1):101-111. 5 2. Spearing is the intentional use of a head-down contact technique. Unintentional head-down contact is the inadvertent dropping of the head just before contact. Both

head-down techniques are dangerous and may result in axial loading of the cervical spine and catastrophic injury (Figure 2). J Athl Train. 2004;39(1):101-111. 6 3. Catastrophic CSI resulting from axial loading is neither caused nor prevented by players' standard equipment.

J Athl Train. 2004;39(1):101-111. 7 4. Injuries that occur as a result of head-down contact are technique related and are preventable to the extent that head-down contact is preventable. J Athl Train. 2004;39(1):101-111.

8 5. Attempts to determine a player's intent regarding intentional or unintentional head-down contact are subjective. Therefore, coaching, officiating, and playing techniques must focus on decreasing all head-down contact, regardless of intent. J Athl Train. 2004;39(1):101-111.

9 6. Catastrophic CSI occurs most often to defensive players. However, all players are at risk. Ball carriers and blockers have also become quadriplegics by lowering their heads at contact. Expanding the concept of J Athl Train. 2004;39(1):101-111.

10 6. (continued) head-down contact beyond tackler spearing and the intentional attempt to punish an opponent will decrease the risk of serious injury to players in other positions. J Athl Train. 2004;39(1):101-111. 11

7. As emphasized in the college and high school rule books, making contact with the shoulder or chest while keeping the head up greatly reduces the risk of serious head and neck injury. With the head up, J Athl Train. 2004;39(1):101-111. 12

7. (continued) the player can see when and how impact is about to occur and can prepare the neck musculature for impact. Even if inadvertent head-first contact is made, then the force is absorbed by the neck musculature, J Athl Train. 2004;39(1):101-111. 13

7. (continued) the intervertebral discs, and the cervical facet joints. This is the safest contact technique. J Athl Train. 2004;39(1):101-111. 14 8. Each time a player initiates contact with his head down, he risks paralysis. Therefore,

increased attention to the frequency of head-down contact occurring in games and practices is needed. It is a J Athl Train. 2004;39(1):101-111. 15 8. (continued) reasonable conclusion that a reduction in the cause (head-down contact) will further reduce the

effect (catastrophic CSI). J Athl Train. 2004;39(1):101-111. 16 9. Data collection on all catastrophic CSIs is important. Attention to the number of nonparalytic cervical spine fractures and dislocations is needed, as each incident has

the potential for paralysis. These data are J Athl Train. 2004;39(1):101-111. 17 9. (continued) less reliable and harder to obtain than data for paralytic injuries. Both injury types require diligent reporting to the

J Athl Train. 2004;39(1):101-111. 18 9. (continued) National Center for Catastrophic Sports Injury Research (mailing address: CB 8700, 204 Fetzer Gymnasium, University of North Carolina, Chapel Hill, NC 27599-8700, email [email protected]). J Athl Train. 2004;39(1):101-111.

19 Rules and Officiating J Athl Train. 2004;39(1):101-111. 20 10. Officials should enforce the existing rules to further reduce the incidence of head-down contact. A

clear discrepancy exists between the incidence of head-down/headfirst contact and the level of enforcement of the helmet-contact penalties. J Athl Train. 2004;39(1):101-111. 21 10. (continued) Stricter officiating would bring more awareness to coaches and players about the effects of headdown contact.

J Athl Train. 2004;39(1):101-111. 22 11. The current annual education programs for all officials should emphasize the purpose of the helmet-contact rules and the dangers associated with headdown/head-first contact. Emphasis should be on the fact J Athl Train. 2004;39(1):101-111.

23 11. (continued) that the primary purpose of the helmet-contact penalties is to protect the athlete who leads with his head. Although the technique is dangerous to both players, it is the athlete who initiates headdown contact who risks permanent quadriplegia. J Athl Train. 2004;39(1):101-111.

24 12. Not all head-first contacts that result in serious injury are intentional. A major area of concern for officials remains application of the penalties to athletes who unintentionally initiate contact with their helmets. Athletic governing J Athl Train. 2004;39(1):101-111.

25 12. (continued) bodies should address this issue in order to improve penalty enforcement. J Athl Train. 2004;39(1):101-111. 26

13. Athletic governing bodies should coordinate a protocol to document and quantify all penalties called through their organizations. This will identify the enforcement level of the helmet-contact penalties. J Athl Train. 2004;39(1):101-111. 27 14. Athletic governing bodies

should periodically survey their football officials regarding their interpretations and perceptions of the helmet-contact rules. Existing rules and comments need to specifically include the ball carrier in the application of these penalties. J Athl Train. 2004;39(1):101-111. 28

15. Those preparing the football rule books should consider revising the wording blocking and tackling techniques with contact techniques (or similar). This revised wording would then include all position players and all types of contact. J Athl Train. 2004;39(1):101-111. 29

16. A task force of athletic trainers, coaches, team physicians, officials, and league administrators should be developed at all levels of play to monitor rule enforcement and the frequency of head-down contact by an annual, random review of game films. J Athl Train. 2004;39(1):101-111. 30

Education and Coaching J Athl Train. 2004;39(1):101-111. 31 17. The athlete should know, understand, and appreciate the risk of making head-down contact, regardless of intent. Formal team educational sessions (conducted

by the athletic trainer or team physician or both with the support of the coaching staff) should be held J Athl Train. 2004;39(1):101-111. 32 17. (continued) at least twice per season. One session should be conducted before contact begins and the

other at the midpoint of the season. Parents should be invited to the first educational session at the high school level. J Athl Train. 2004;39(1):101-111. 33 17. (continued) Recommended topics are mechanisms of head and neck injuries, related rules and

penalties, the incidence of catastrophic injury, the severity and prognosis of these injuries, and the safest contact positions. The use of videos such as J Athl Train. 2004;39(1):101-111. 34 17. (continued) Prevent Paralysis: Don't Hit With Your Head, See What You

Hit, or the prevention portion of Spine Injury Management should be mandatory (Table 1). The use of supplemental media and materials is strongly recommended. J Athl Train. 2004;39(1):101-111. 35 18. Correct contact technique should be taught at the earliest

organized level. Pop Warner, Midget, and Pee Wee football leagues should perpetually emphasize the importance of coaching and teaching heads-up football. J Athl Train. 2004;39(1):101-111. 36 19. It is crucial that educational programs extend to the television,

radio, and print media for both local and national affiliates regarding the dangers of headdown contact and the reasons for the helmet-contact rules. J Athl Train. 2004;39(1):101-111. 37 19. (continued) This will promote awareness of these issues and provide extended education to viewers, listeners,

and readers. J Athl Train. 2004;39(1):101-111. 38 20. Initiating contact with the shoulder/chest while keeping the head up is the safest way to play football. The game can be played aggressively with this technique with much less risk of serious

injury (Figure 3). However, J Athl Train. 2004;39(1):101-111. 39 20. (continued) it is a technique that must be learned. To be learned, it must be practiced extensively. Athletes who still drop their head just before contact require additional practice time. It is imperative

J Athl Train. 2004;39(1):101-111. 40 20. (continued) for coaches to teach, demonstrate, and practice this technique throughout the year for all position players. Specific emphasis should be placed on contact techniques at least 4 times

spread over the entire season. J Athl Train. 2004;39(1):101-111. 41 20. (continued) Tacklers, ball carriers, and blockers must receive practice time until it is instinctive to keep the head up. J Athl Train. 2004;39(1):101-111.

42 21. Initiating contact with the face mask is a rules violation and must not be taught. If the athlete uses poor technique by lowering his head, he places himself in the head-down position and at risk of serious injury. J Athl Train. 2004;39(1):101-111.

43 22. Every coaching staff must display and implement a clear philosophy regarding the reduction of head-down contact. The head coach should clearly convey this philosophy to the assistant coaches and the entire team and pursue an J Athl Train. 2004;39(1):101-111.

44 22. (continued) enforcement policy during practice. A player's technique must be corrected anytime he is observed lowering his head at contact. Coaches should also use weekly game film reviews to provide players with feedback about their head positions. J Athl Train. 2004;39(1):101-111.

45 23. Athletes should have a yearround supervised neckstrengthening program with appropriate equipment and techniques. Although the role of strength training is secondary to correcting contact technique in axial-loading injury prevention, J Athl Train. 2004;39(1):101-111. 46

23. (continued) it provides the strength and endurance required to maintain the neck in extension. It also provides protection against cervical nerve root neurapraxia (burners). J Athl Train. 2004;39(1):101-111. 47

24. Schools, responsible administrators, and the sports medicine team should recognize cyclic turnover in coaches and establish programs that educate new and re-educate existing coaches to appropriate teaching and practicing methods. This will provide a documented J Athl Train. 2004;39(1):101-111. 48

24. (continued) and consistent approach to the prevention of these injuries. J Athl Train. 2004;39(1):101-111. 49 Table 1. Available Videos Title

Available From Prevent Paralysis: Dont Dick Lester, Riddell Inc Hit With Your Head E-Mail: [email protected] Cost: Free See What You Hit The Spine in Sports Foundation Cost: Free

Spine Injury Management Human Kinetics Cost: $39.95 J Athl Train. 2004;39(1):101-111. 50 Table 2. Percentage of Plays Involving at Least 1 Head-Down Contact Between Tacklers and Ball Carriers During a 1990 High School Season

Play All plays % 25 Running plays 37 Kick returns

38 Pass plays 7 J Athl Train. 2004;39(1):101-111. 51 Table 3. Percentage of Plays Involving Head-Down Contact by High School and

College Tacklers or Ball Carriers Position % Tacklers, film (1999) 26 Tacklers, live (1993) 6

College tacklers, live (1993) 8 Ball carriers, film (1990) 16 Ball carriers, film (1989) 20

J Athl Train. 2004;39(1):101-111. 52 Table 4. Helmet-Contact Rules and Selected Comments from the 2002 National Federation of State High School Associations Official Football Rules Rules 1. Spearing is the intentional use of the helmet in an attempt to punish an opponent.

2. Face tackling is driving the face mask, frontal area, or top of the helmet directly into the runner. 3. Butt blocking is a technique involving a blow driven directly into an opponent with the face mask, frontal area, or top of the helmet as the primary point of contact either in close line play or in the open field. 4. Illegal personal contact occurs when a player intentionally uses his helmet to butt or ram an opponent. J Athl Train. 2004;39(1):101-111. 53

Table 4. (continued) Points of Emphasis 1. Illegal acts such as spearing, face tackling, and butt blocking should always be penalized. 2. Coaches have the responsibility to teach the proper technique of blocking and tackling. Officials have the responsibility to penalize all illegal contact. J Athl Train. 2004;39(1):101-111. 54

Table 4. (continued) Shared Responsibility and Football-Helmet Warning Statement 1. The rules against butting, ramming, or spearing the opponent with the helmeted head are there to protect the helmeted person as well as the opponent being hit. The athlete who does not comply with these rules is a candidate for catastrophic injury. 2. The teaching of the blocking/tackling techniques which keep the helmeted head from receiving the brunt of the impact is now required by rule and coaching ethics.

J Athl Train. 2004;39(1):101-111. 55 Table 5. Helmet-Contact Rules and Comments in the National Collegiate Athletic Associations 2001 Football Rules and Interpretations Rules 1. Spearing is the deliberate use of the helmet (including the face mask) in an attempt to punish an opponent. 2. No player intentionally shall strike a runner with the crown

or top of the helmet. 3. No player intentionally shall use his helmet (including the face mask) to butt or ram an opponent. J Athl Train. 2004;39(1):101-111. 56 Table 5. (continued) Points of Emphasis 1. The NCAA Rules Committee is strongly opposed to tackling and blocking techniques that are potentially

dangerous for both the tackler/blocker and the opponent. 2. Coaches are reminded to instruct their players not to initiate contact with any part of their helmets, including the face mask. J Athl Train. 2004;39(1):101-111. 57 Table 5. (continued) Coaching Ethics The following are unethical practices:

1. Using the football helmet as a weapon. The helmet is for the protection of the players. 2. Spearing. Players, coaches, and officials should emphasize the elimination of spearing. J Athl Train. 2004;39(1):101-111. 58 Table 6. Selected 2001 National Collegiate Athletic Association PenaltyEnforcement Data from Major Division I Conferences

Penalty Type No. Called Total penalties 20837 Holding 3347

Face mask 945 Spearing 17 Butting or ramming 8

J Athl Train. 2004;39(1):101-111. 59 Figure 1. Incidence of quadriplegia in high school and college athletes. Data from the National Football Head and Neck Injury Registry (19761991) and the National Center for Catastrophic Sports Injury Research (1992present).

J Athl Train. 2004;39(1):101-111. 60 J Athl Train. 2004;39(1):101-111. 61 Figure 2. Head-down contact poses significant risks of catastrophic cervical spine injury. This defensive back (dark jersey)

sustained fractures of his 4th, 5th, and 6th cervical vertebrae. The hit resulted in quadriplegia. J Athl Train. 2004;39(1):101-111. 62 J Athl Train. 2004;39(1):101-111. 63 Figure 3. Initiating contact with

the shoulder while keeping the head up reduces the risk of catastrophic injury, as demonstrated by the blocker and potential tackler. J Athl Train. 2004;39(1):101-111. 64 J Athl Train. 2004;39(1):101-111.

65 Figure 4. Incidence of cervical fractures and dislocations in high school athletes. Data from the National Football Head and Neck Injury Registry J Athl Train. 2004;39(1):101-111. 66 J Athl Train. 2004;39(1):101-111.

67 Figure 5. (A) Axial loading of the cervical spine (B) first results in compressive deformation of the intervertebral discs. As the energy input continues and maximum compressive deformation is reached, angular deformation J Athl Train. 2004;39(1):101-111.

68 Figure 5. (continued) and buckling occur (C). The spine fails in a flexion mode, with resulting fracture, dislocation, or subluxation (D and E). J Athl Train. 2004;39(1):101-111. 69

J Athl Train. 2004;39(1):101-111. 70 Figure 6. Ball-carrier head-down contact, an often overlooked danger, increases the risk of head and neck injuries. J Athl Train. 2004;39(1):101-111. 71

J Athl Train. 2004;39(1):101-111. 72

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