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Head and Neck Injuries in Football

Football is undeniably one of the most popular sports internationally, especially in the United States. For example, the Michigan Governor’s Council on Physical Fitness, Health and Sports that an approximately 1. 5 million individuals played football at high school and junior high level during the 1997 football season alone, with another additional 300,000 playing the game at professional, collegiate and/or organized recreation level.

The report also indicated that the proportion of the population playing football has increased slightly over the past decade, although football is most common among males, only about 740 females played football at high school level during the 1997 season (Position Statement, 2006).

It is commonly generally acknowledged that physical activities, in whatever form, carries with it the risk of injury, however, sports involving body contacts, projectiles and/or high speed are particularly associated with higher risks of head and neck injuries (McIntosh and McCrory, 2005) and this is especially the case with football (Fuller, Junge and Dvorak, 2005) which in most studies account for the highest incidence of head and neck injuries (Delaney and Al-Kashmiri, 2005).

Football is considered a high risk game because of its inherent physical, which is both a cause and outcome of the speed, strength and size of players involved in the game. Injuries resulting from the game of football can be broadly grouped into two classes: acute and chronic injuries. While acute injuries subsumes injuries that result from sudden trauma, especially during play or practice, chronic injuries, on the other hand, also known as overuse injuries results from systematic, repetitive training.

Head and neck injuries falls into the acute injury category (Position Statement, 2006) and they constitute the most devastating types of injuries in the sport (Heck et al, 1994). Heck et al (1994) contend that though head and neck injuries occur very rarely, when they do, they can be very devastating, affecting not only the athlete involved and his family, but also the entire community. As a result of the seriousness and finality of this type of injuries every party involved in organizing and planning football game should take positive steps towards the reduction of and care for head and neck injuries.

Furthermore, though the coach and athletic trainer are especially responsible for the prevention and care of head and neck injuries, their responsibility in this regard is affected by the team physician, equipment manager and the administration; the efficacy of one is greatly influenced and dependent upon the efficacy of others. This paper therefore intends to discuss head and neck injuries in football from a wide perspective; how it has been managed and reduced over the years and the treatment for the injury and after treatment, when it does occur.

History and Statistics of Head and Neck Injuries in Football American football is generally agreed to have started early in the 1800s and as Cahill (2003) reports, the game then was without rules, padding helmets or officials and as such, injuries during the game were enormous. The first university football match was reportedly between Princeton and Rutgers in November of 1869. Rules of play during those early days were different from what is obtainable today.

The early football team had 25 payers each, the goal posts were 25yards apart and the bar was raised at liberty, ball was also moved then, using methods from soccer and rugby. Rules first changed when Walter Camp joined Yale University in 1880 with teams reducing to 15 players each, the creation of the centre ‘snap’ to start the ball and different goal scores for passing the goal line. More referees were also added to the game to reduce the number of injuries resulting from breaking of rules. However, the rate of injuries during these early days was still very high (Cahill, 2003 p.

108). The injuries resulting from football game were so high that in 1902, an editorial in the Journal of the American Medical Association stated that: “The football season is now over and leaves behind it a respectable record of casualties, enough to supply a respectable Spanish-American War. The reports of casualties give plenty of evidence of this [slugging]; we had the records—’kicked in the head’, ‘stabbed in the back’— showing that the game is made absolutely murderous at times” (quoted in Cahill, 2003 p. 108), and President Roosevelt vowed to abolish the game.

Levy et al (2004) reports that from 1869 when the first inter-university football match was played, till 1905, football produced a total of 159 serious injuries and 18 deaths. To reduce the severity and incidence of injuries, several measures have been put in place over the years; officials were introduced, rules changed and modified continually to reduce contact, helmets introduced and required for play, padding in uniforms and other protective devices, despite all these, injuries still occur, although to lesser degree.

Today, the risk of head and neck injury is of major concern in the game; concussions of varying degrees and brain damage results from head injuries, while neck injuries are often associated with spinal cord injury (SCI) (Fuller, Junge and Dvorak, 2005; McIntosh and McCrory, 2005). Although there is no central organization that monitors and reports these injuries in the country, and there often exist different definitions and reporting procedures for the injuries, several authors have attempted to present a clear picture of head and neck injuries resulting from football over the years.

In this regard, McIntosh and McCrory (2005) reports from 1945 till date (2005) a total of 497 players have died as a result of football injuries, 69 percent of these died if fatal brain injuries while 16 percent from spinal cord injury. Using data compiled for the US Consumer Product Safety Commission to generate estimates, Delaney and Al-Kashmiri (2005) reports that a total of 114706 neck injuries was recorded for football in the United States from 1990-1999.

Total neck fractures and dislocations accounted for 1588, total neck contusions/ sprains/strains for 104483 and total neck lacerations for 621. Unlike most reports that present only severe cases, this study presents a complete picture of neck injuries that occurred over a nine year period, irrespective of the severity of the injury. The Michigan Governor’s Council on Physical Fitness, Health and Sports reported that in the 1997 season a total of six deaths were recorded due to brain (head) injuries, five from high school football and one as from middle school football.

During the same period 17 cases of permanent disability were recorded, 14 at high school level, two in college football and one in professional football. Preventive Measures Though the risk of injury in football is always present and high, several preventive measures can and have been adopted over the years to reduce the severity and incidence of injuries. For example, Levy et al (2004) suggests that the continual increase in football related injuries, prospective collection and analysis of injury data was initiated in 1967.

Also, the continued increase in head and neck injuries from 1965 to 1974 caused the modification of several rules of the game and the establishment of the National Operating Committee on Standards for Athletic Equipment (NOCSAE) for research into head protection and then safety standards for helmets in 1973 (Levy et al, 2004). Today, measures to reduce the severity and incidence of head and neck injuries in football can be broadly categorized into three areas.

First, is individual player risk factors that must be identified and if possible corrected, to reduce the risk of injury; second is the hazards related to the game settings and equipment that should be eliminated or minimized and three, is game practices that can be effectively managed to minimize the risks of head and neck injuries. The three preventive measures will be briefly presented below (Position Statement, 2006).

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