NATA Updates Position on Head-First Contact in Football

The National Athletic Trainers' Association this week published its position statement "Reducing Intentional Head-first Contact Behavior in American Football Players" in the Journal of Athletic Training, NATA’s scientific publication.

The statement, released Tuesday, is an update to the 2004 position statement, “Head-Down Contact and Spearing in Tackle Football." The NATA website provides a summary comparing the 2004 and 2022 position statements.

“It’s imperative for NATA to support and fund new research in order to re-examine health care practices over the course of time and as new technology emerges,” said NATA president Kathy Dieringer, EdD, LAT, ATC, according to a release circulated by EurekAlert! “Our updated position statement provides the athletic trainer, as well as parents, athletes, coaches and other health care professionals, with the latest recommendations and tools to reduce injuries related to intentional head-first contact.”

“The original recommendations aimed to reduce behaviors that can lead to cervical spine fractures and dislocations,” said the current statement’s lead author, Erik E. Swartz, PhD, ATC, FNATA, professor and chair, Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell. “Despite new rules and education programs, head-first contact remains common in tackle football and required a renewed focus.”

NATA position statements are scientifically based on peer-reviewed research. They are compiled by teams of authors who are subject matter experts.

According to the statement, head-first contact behavior refers to players initiating contact with their heads, regardless of where that impact is initiated (top or front of helmet) or what they are doing when exhibiting the head-first contact technique (tackling, blocking or carrying the ball).

“Head impacts in American football, at all levels of play, are frequent, vary in severity and pose particular risk for acute head and neck injuries with an increasing concern that they may contribute to chronic brain injuries,” added Swartz. “In the past decade, new technologies have allowed us to track and measure head-first impacts with greater accuracy.”

The updated recommendations address: education and administration; skill development and behavior modification; rules and regulations; and technology and scientific research as they relate to decreasing head-first impacts in football. The statement authors recognize the role of the athletic trainer as part of a multidisciplinary team that can help implement these best practices to ensure the football players’ health and safety. NATA advocates the recommendations be considered a part of an overall prevention strategy to reduce the prevalence of head-first contact in football.

The recommendations are rated A, B or C in association with the Strength of Recommendation Taxonomy (SORT) developed by the American Academy of Family Physicians. They include:

Education and Administration

1. Develop and require consistent, contemporary education for players on the dangers of head-first contact in football as it pertains to the risk for head and neck injury. (SOR, C)

2. Develop and require documented education for coaches at all levels of play, including youth, on the dangers of teaching, instructing, or allowing head-first contact in football as it pertains to the risk for head and neck injury. (SOR, C)

3. Develop and require education for officials at all levels of play on the mechanisms and dangers of head-first contact in football and how they pertain to officiating, scrimmages and games. (SOR, C)

Skill Development and Behavior Modification

1. Introduce evidence-based progressive techniques for avoiding head-first contact behavior during ball carrying, tackling and blocking before the first exposure to tackle football, i.e., first-time participants, preseason. (SOR, B)

2. Teach until mastery is achieved and reinforce the maintenance of appropriate tackling and blocking skills that explicitly deter head-first contact behavior in football at all levels of play. (SOR, B)

Rules and Regulations

1. Because full-contact practice sessions (i.e., live tackling, taking the opponent to the ground) increase the opportunities for head-first behavior, regulate the time devoted to such sessions each week to ensure sufficient focus on age-appropriate instruction, maintenance and mastery of proper tackling and blocking skills. (SOR, B)

2. Adapt the practice structure by eliminating or modifying football drills that do not reinforce proper and safe tackling and blocking behaviors or techniques. (SOR, B)

3. Consistently enforce the penalties or fines (or both) for head-first contact behavior, spearing or targeting at all levels of play for all player positions. (SOR, C)

Technology and Scientific Research

1. Recognize that helmet and after-market companies that produce helmet add-on products may overstate injury-prevention benefits, leading to risk-taking behavior. (SOR, B)

2. Consider using validated head-impact monitoring systems or video capture (or both) as a complementary tool for identifying and correcting head-first contact behavior. (SOR, B)

3. Educate athletes on the influence of protective equipment and techniques related to avoiding head contact. (SOR, C)

“Putting these practices into play can help to reduce acute and chronic cervical spine and traumatic brain injuries in football at all levels of play,” Swartz said. “We hope athletic trainers and other members of the sports medicine team along with coaches, administrators, parents, players and the broader community at large will work together to ensure clear communication and education.”