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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three such injuries are known to have occurred in this state (National Center for Catastrophic Sports Injury Research, unpublished data).* Louisiana law requires reporting of all SCIs to the Office of Public Health, Louisiana Department of Health and Hospitals.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

  1. Cantu RC. Head and spine injuries in the young athlete. Clin Sports Med 1988;7:459-72.

  2. 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.

  3. 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.

  4. NCAA Football Rules Changes and/or Modifications. January 23, 1976. Rule 2, Section 24; Rule 9, Section 1, Article 2-L; Rule 9, Section 1, Article 2-N.

  5. 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.

  6. Mueller FO, Blyth CS, Cantu RC. Catastrophic spine injuries in football. The Physician and Sportsmedicine 1989;17(10).

  7. 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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