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Epidemiology-American Football

Roughly 1.8 million athletes per year participate at various levels in the collision sport of football. Approximately 1.5 million participate at the junior/senior high school level. Additionally, approximately 75,000 play in college, and approximately 2,000 are in professional football.

Although spinal cord injury is uncommon in this sport, a significant burden of cervical trauma exists. Despite the fact that football has a lower rate of catastrophic cervical spine injuries (per 100,000 players) compared with ice hockey or gymnastics, the large number of participants has resulted in football being associated with the largest overall number of catastrophic cervical spine injuries in the United States.

In football, specific patterns of injury to the cervical spine have evolved over time. From 1959 to 1963, Schneider  documented 56 cases (1.36 per 100,000 participants) of cervical fracture/dislocation, of which 30 cases (0.73 per 100,000) were associated with permanent quadriplegia.

From 1971 to 1975, the National Football Head and Neck Injury Registry compiled 259 cases (4.14 per 100,000) cervical fracture/dislocations and 99 cases (1.58 per 100,000) of quadriplegia. This disturbingly high rate of cervical spine injury was thought to be influenced by the introduction of modern football helmets.

Techniques that incorporated the helmet top as the initial point of contact during tackling had been implemented, and it became apparent that using this initial point of contact for blocking or tackling placed the cervical spine at increased risk of injury.

This important realization helped to shape major rule modifications in American football. Head-first contact was banned by the National Collegiate Athletic Association (NCAA) Football Rules Committee and high school football governing bodies early in 1976.

Penalties for “spearing” behavior were adapted by the National Federation of High Schools. These important rule changes forced players and coaches to adhere to techniques in tackling that helped to decrease the incidence of spinal cord injury in football for close to a decade. From 1976 to 1987, the rate of cervical injuries decreased by 70%, from 7.72 per 100,000 to 2.31 per 100,000, at the high school level .

Additionally, traumatic quadriplegia decreased by approximately 82% over the same time period, from an annual rate of 2.24 per 100,000 to 0.38 per 100,000 in high school football and from 10.66 per 100,000 to 0 per 100,000 in college football.

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