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07-05-2012 | Surgery | Article

American football coaches must act over ‘alarming’ rise in head injuries


NCCSIR Annual Report 2011 (PDF)

MedWire News: There has been an alarming rise in American football-related catastrophic brain injuries among high school students, a report indicates.

Describing the figures as "a major problem" the report's authors say that football coaches and trainers need "to change how they teach the fundamentals of the game" and emphasize that head-to-head contact is not just dangerous but illegal.

Indeed, forms of contact such as butt-blocking, face-tackling, and spearing tackles were explicitly banned by the National Collegiate Athletic Association and the National Federation of State High School Associations in 1976, and the ban was endorsed by the American Football Coaches Association.

"All three of these illegal techniques can cause catastrophic head and neck injuries to the athlete," explain Fred Mueller (University of North Carolina, Chapel Hill, USA) and fellow authors. "Coaches should not teach these techniques and referees should do a better job of calling these penalties in a game."

National figures on these injuries are compiled each year by the National Center for Catastrophic Sports Injury Research, which is based at the University of North Carolina.

According to the latest report, in the 2011 football season there were eight cervical cord injuries resulting in incomplete neurologic recovery (ie, quadriparesis or quadriplegia). Six of the injuries occurred at the high school level, one at the semi-professional level, and one in youth football.

For comparison, there were 14 such injuries in 2008, nine in 2009, and seven in 2010.

During the 2011 season there were also 14 brain injuries with incomplete recovery. Thirteen were at the high school level and one at the youth level compared with five such injuries in 2010.

Although the overall rate of football-related catastrophic injuries is very low, at 0.19 per 100,000 participants in 2011, it is significantly higher among high school and junior high school players, at 0.40 per 100,000, note the authors.

Of the 2011 injuries, two injuries were caused by tackling, one being tackled, one by a collision, one in a drill, one crashing into the stands at the end of a run, one while blocking on a kick-off return, and one had an unknown cause.

Historically, tackling has been the cause of nearly 70% of the catastrophic injuries since 1977, say Mueller et al, and a majority of the injuries occur while playing defensive football.

The authors admit that it is impossible to accurately record every catastrophic football injury and warn that the true figure "could be double or more." Thus, "if future reports continue to show these high numbers, steps will have to be taken for reducing these injuries," they write.

Their report contains a number of recommendations for reducing these injuries in the future. These include a renewed emphasis by coaches on the 1976 rule change that eliminated the head as the initial point of contact during blocking and tackling; improved on-site medical care; improved coaching techniques in teaching the fundamentals of tackling and blocking; and increased concern and awareness of football coaches.

The authors conclude: "Football catastrophic injuries may never be totally eliminated, but continued research has resulted in rule changes, equipment standards, improved medical care both on and off the playing field, and changes in teaching the fundamental techniques of the game."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Joanna Lyford

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