SOURCE: NewsWire One

November 01, 2005 15:10 ET

Preventing Severe Head and Neck Injuries in High School and Collegiate Athletes

Orthopaedic Research Reveals Benefits of Enhanced Protective Gear, Preventive Strategies, Rule Revis

ROSEMONT, IL -- (MARKET WIRE) -- November 1, 2005 -- Research shows collegiate athletes are more susceptible to catastrophic (or severe) injury than athletes at the high school level, particularly when it comes to certain sports like football and cheerleading. However, the physical, mental and social benefits of team sports significantly outweigh the risks involved: only one out of every 100,000 athletes suffers from a direct catastrophic injury. Trend data on such injuries are the catalyst for sport-specific recommendations to help reduce deaths and serious injuries in school-sponsored sports. According to research published in the November 2005 issue of the Journal of the American Academy of Orthopaedic Surgeons, the dramatic decrease in brain injury-related fatalities and quadriplegic events in football over recent decades may be attributed to identifying how injuries occur, enhanced injury prevention instruction, improved equipment and protective gear, and revision of sport regulations. The key is to strike a balance between proliferating athletes' safety without drastically altering the dynamics of the sport.

Catastrophic sports injuries that may result in death or permanent neurologic disability are rare -- but tragic -- events that cause physical and emotional devastation to injured athletes and their families. Direct catastrophic injury -- mostly severe head and spinal cord injuries -- results from trauma while participating in the skills of a sport. An example is a collision in football, the sport associated with the greatest number of direct catastrophic injuries for all major team sports in the U.S., according to the National Catastrophic Center for Sports Injury Research (NCCSIR). As outlined in "Direct Catastrophic Injury in Sports" -- a review by Barry P. Boden, MD, orthopaedic surgeon in Rockville, MD, and member of the American Academy of Orthopaedic Surgeons (AAOS) -- brain injury fatalities and quadriplegic (spinal cord injury at the neck level resulting in no or limited motor function in all four extremities) injuries in football have declined drastically, thanks to data that support rule and equipment changes to promote safety in the collision sport.

Head injuries are the most common direct cause of death among football players: athletes who use their head to make contact dramatically increase their risk of sustaining serious injury. However, there has been a dramatic decrease in brain injury-related fatalities since the late 1960s; and research concluded the improved helmet design and establishment of safety standards by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) are largely responsible for this decline.

"While the frequency of brain injury-related fatalities fell after implementation of the improved football helmet, the more protective helmets gave athletes a false sense of invincibility," cautioned Dr. Boden. "This resulted in a rise in quadriplegia, most commonly caused by the mechanisms of spearing, a tackling method that uses the head (crown of the helmet) to make the initial impact." Identification of this dangerous tackling technique led to a ban on spearing (or spear tackling) which has resulted in a significant decline in quadriplegic events in football: from 34 such injuries before the ban in 1976, to 3 in 1992.

Concussions or nonfatal head injuries are extremely common in football and currently receive significant scrutiny and evaluation. Videotape analysis of football-related concussions revealed that the player being tackled sustains the majority of injuries. Because the concussed player is often hit on the side of the face by an opposing player, new football helmets with better padding around the ear and jaw are currently being tested. While the reduction in brain injury fatalities and quadriplegia in football has been significant, further research of the epidemiology and mechanisms of injury is critical to preventing other types of catastrophic head and neck injuries according to the author.

Cheerleading -- with approximately two direct catastrophic injuries per year -- is the number-one sport responsible for female direct catastrophic injuries, and accounts for more than half the catastrophic injuries in high school and collegiate female athletes. Over the last two decades, cheerleading has evolved into a physically demanding sport requiring complex gymnastic maneuvers that pose serious injury threats to participants. The most common culprits are the pyramid and the basket toss. The basket toss is a stunt in which a cheerleader is thrown into the air -- often between 6 and 20 feet -- by three or four tossers. In the pyramid drill, the cheerleader at the top is most often injured after falling and landing on a hard surface. Attune to the susceptibility of injury during pyramid formations, the National Federation of State High School Associations (NFHS) and the National Collegiate Athletic Association (NCAA) have set limits on pyramid height -- two levels in high school and 2.5 body lengths in college -- and specified positions for spotters. Safety measures have also been instituted for the basket toss: limiting the stunt to four throwers, banning flips, and positioning one of the throwers behind the top person during the toss.

The study author also recommends further cheerleading injury prevention, calling for increased spotter training, limiting the number of cheerleaders involved in pyramids, mandating the use of floor mats for complex stunts, restricting the height thrown for basket tosses, prohibiting stunts when surfaces are wet, and encouraging safety education and certification for coaches.

Catastrophic injury data has been the catalyst for rule changes to reduce injuries in other sports, as well. Yet, this research review points out that there is still room for further study and improvement. Ice hockey rules prohibit pushing or checking from behind, as these actions may result in cervical spine trauma if the athlete is pushed into the boards and makes contact with the top of the head. Because amateur hockey players wearing no facial protection are injured nearly seven times more frequently than those wearing full facial protection, full facial protection is recommended. In baseball there is concern that non-wood (aluminum) bats can be swung faster than wood bats, resulting in a higher ball exit speed and increased risk of injury. Therefore, the NCAA and NFHS now require all high school and college bats to be labeled with a permanent certification mark that the ball exit speed cannot exceed 97 mph when tested on a standardized batting device. Another baseball regulation puts limitations on bat thickness and weight. While these alterations show promise for minimizing the number of baseball-related ball-to-head impact injuries, further data collection and analysis is required to determine their true effectiveness. In soccer, the U.S. Consumer Product Safety Commission (CPSC) cited 21 deaths over a 16-year period, due to movable goalposts. The study author recommends anchoring movable goals to prevent tipping and never allowing children to play or swing on goalposts.

"It all comes down to the risk-reward ratio: determining (through data collection) how frequently a catastrophic injury occurs and whether safety measures -- such as rule changes or equipment modifications -- can be implemented without significantly affecting the nature of the sport," Dr. Boden explained. "It is likely that catastrophic sports injuries may never be completely eliminated, but with continued research and constant data analysis we can work to ensure players' safety."

An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, and nerves.

The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a publication of the 28,000-member American Academy of Orthopaedic Surgeons ( or (, a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade ( the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research, and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's 73rd Annual Meeting is being held March 22-26, 2006, at McCormick Place in Chicago.

Abstracts and full text of the monthly, peer-reviewed JAAOS are available online at

Powered by NewsWire One

Contact Information

  • Contact:
    Carlye Fallon
    Phone: (847) 384-4035
    E-Mail: Email Contact