by Dr. Ken


As Part II of this article noted, there are two primary causative factors that result in severe cervical spine injury on the football field. Axial Loading, or applying a vertical force in a manner that exceeds the structural integrity of the elements of the spinal cord was the first. It can't be mentioned, emphasized, or reinforced frequently enough that every player, especially those at the high school level, must make contact with their heads up. Dropping the head into what one researcher called the "Oh S--- position" as a reflexive response to suddenly take on or deliver a big hit, reduces or eliminates the protective lordotic curve in the cervical spine, making it more prone to extreme damage. Remember that it is the loss of this naturally occurring curve that makes the bones in the neck behave as single links or units in a chain, rather than a stronger, whole, full length of chain. Coaches should keep in mind that the normal curve in the neck places the cervical spine in an extended position; with just thirty degrees of flexion, the curve straightens, so it doesn't take a lot of "head down" action to create a potential problem. 

The other mechanism of injury also occurs with "head down" contact and is termed a DECELERATION INJURY. When a player is moving forward, he has momentum. The head, neck, and body are in motion. If his head drops and first contact is made with the top of the head into the ball carrier or defensive opponent, acceleration allows for his trunk or the rest of his body, to continue moving forward. The cervical spine is compressed by the force of the trunk which is still moving forward although the head and neck have stopped. In effect, the neck is crushed between the player's head and trunk. If the force is not dissipated by controlled motion of the cervical spine (possible only if the lordotic, or C-shaped curve is maintained), the result can be fracture and/or dislocation. This occurs in as little as 8.4 msec. so it is an almost "immediate" event and again, all of us who have played football know how instinctive it is to drop one's head just prior to contact. 

Helmet safety has improved one's risk of on-field injury, but most experts trace the initial and significant decreases in catastrophic injury to a change in the rules. In 1976, at the urging of Dr. Joseph Torg of the University Of Pennsylvania Medical School (he was at Temple University then) and himself a former player. All coaches and most players are familiar with the rules changes. In "my day" which had me playing high school football in the early 1960s, collegiate ball in the mid-1960s, and a stint in minor league football after two failed attempts at making an NFL team, the technique for blocking and tacking were taught similarly at all levels. The first point of contact was the forehead in a properly and effectively delivered block or tackle. "Forehead first" of course, often translated to "helmet first" or "top of head first." The usual instructions were to "stick your face into the bottom part of his numbers." The belief was, and this is exactly how I explained it to my players as a high school coach in Malverne, N.Y., that if you jammed your forehead between the opponent's numbers when blocking, even if he slid off, you could still "catch him" with your shoulder or arm. As the hands had to remain within the limits of the body and could not be extended forward and away from the body, the fists would be held tight to one's chest, forearms flexed at ninety degrees and held out from the body so that you were "as wide" as possible. The face first contact, which often in reality was head first contact, especially as one tired, was thought to be safe and orthopedically correct. Dr. Torg's groundbreaking work made it clear that catastrophic cervical spine and head injuries were not "freak occurrences" and could be accurately predicted. Dr. Torg's emphasis was on "taking the head out of blocking and tackling." His work indicated that it wasn't the "really hard hit" to the head that caused damage, but head first contact when the head and neck were in an improper position. The rules for high school and college football were changed to read:

1. No player shall intentionally strike a runner with the top or crown of the helmet.

2. Spearing is the deliberate use of he helmet in an attempt to punish and opponent.

3. No player shall deliberately use his helmet to butt or ram an opponent. 

These rules were specifically written to remove the head as a point of contact and certainly, as a point of first contact when blocking or tackling. 

After 1976, researchers and statisticians noted an immediate and significant decrease in the number of catastrophic head and cervical spine injuries. Current tackling procedures stress chest-to-chest contact or "head to the ball" when coming across the opposing ball carriers, but with the emphasis on "head up at all times."  Has the evolution of the helmet helped? Has the helmet become safer and more efficient in preventing injury? The answers will follow in the next installment.