A spinal cord injury (SCI) is damage to the bundle of nerves that transmits signals between the brain and the body. While not common in sports, SCIs are one of the most severe outcomes in high-impact athletics like American football. These injuries can permanently alter a person’s physical abilities and sensation.
Mechanisms of Injury in Football
The primary cause of severe cervical spine injuries in football is axial loading. This occurs when a significant force is applied to the top of a player’s head while the neck is slightly flexed, which straightens the cervical spine’s natural curve. The force is then transmitted directly down the vertebrae, which can buckle under the load and lead to fracture or dislocation. This is most often seen in “spearing,” an illegal tackle where a player initiates contact with the crown of their helmet.
During axial loading, the impact’s energy overwhelms the intervertebral discs. Once the discs are compressed to their limit, the spine is forced to buckle. This buckling can cause the vertebrae to fracture or dislocate, which can compress or sever the spinal cord tissue within the vertebral column.
Other mechanisms that can lead to spinal cord injury are hyperextension and hyperflexion. Hyperextension happens when the head and neck are forced backward, while hyperflexion occurs when they are forced forward. In these instances, the movement of one vertebra over another can narrow the spinal canal, creating a “pincer mechanism” that pinches the spinal cord.
Immediate On-Field Recognition and Response
When a player is down and not moving, medical staff immediately suspect a spinal injury and assume one until it is ruled out. Responders check for lack of movement and ask conscious athletes about symptoms like neck pain, numbness, tingling, or difficulty breathing. Any of these signs trigger a pre-established emergency action plan.
The main principle of on-field response is immobilizing the head and neck to prevent further damage. Medical personnel maintain the head and neck in a neutral alignment, preventing twisting or bending. If a player is face down, a trained team performs a coordinated “log-roll” maneuver to move the athlete onto a spine board for transport.
For athletes in protective gear, specific protocols are followed for equipment removal. The helmet and shoulder pads are often left in place during transport unless they interfere with airway management. Removing the helmet without the shoulder pads could cause dangerous neck movement, so the process is handled carefully to prevent secondary injury.
Medical Intervention and Rehabilitation
At a medical facility, the first step is diagnosing the injury’s extent through imaging tests. X-rays show the vertebrae, CT scans provide a detailed look at bones and fractures, and MRI scans visualize the spinal cord to identify swelling, bleeding, or direct damage. These images guide all subsequent treatment decisions.
If the spinal cord is compressed by bone or a herniated disc, or if the spine is unstable, emergency surgery may be required. The goals are to decompress the spinal cord by removing the pressure source and to stabilize the spine with implants like screws and rods. Early surgical intervention is often associated with better recovery potential, and medication may be used to reduce swelling.
Rehabilitation is a long-term process that begins once the patient is stable. A distinction is made between a complete injury, with no sensory or motor function below the injury level, and an incomplete injury, where some function remains. A multidisciplinary team of physical therapists, occupational therapists, and psychologists works with the patient.
Physical therapy focuses on maximizing mobility and strength, while occupational therapy helps patients relearn daily living skills. The goal is to adapt tasks to their new physical abilities and encourage the formation of new neural pathways. Most functional recovery occurs within the first six to twelve months, but the process is often lifelong.
Injury Prevention and Rule Changes
Preventing spinal cord injuries in football has centered on changing game rules. Recognizing that axial loading from head-down tackling was a primary cause of severe injuries, governing bodies have implemented strict changes. In 1976, the NCAA and high school federations banned “spearing”—the act of striking an opponent with the crown of the helmet. This rule change is credited with a significant decrease in cervical spine injuries.
More recent rules in the NFL and other leagues penalize any player who lowers their head to initiate contact with the helmet. These “use of the helmet” rules are designed to remove the axial-loading mechanism from the game. The focus is on penalizing the action itself, regardless of intent, to discourage the technique.
Alongside rule changes, there is an emphasis on coaching proper technique. Programs like USA Football’s “Heads Up Football” teach a standard for tackling that involves keeping the head up and making contact with the shoulder. While modern helmets prevent injuries like skull fractures, proper heads-up technique is the most important factor in preventing spinal cord injuries.