General Concepts
•Catastrophic cervical spine injuries are not freak accidents. These are preventable injuries with an identified cause, head-down contact.

•Initiating contact with the shoulder while keeping the head up should be the goal of every collision. The game can be played as aggressively with this technique with much less risk of serious injury.

•This contact method decreases the risk of cervical spine fracture and concussion.

•It is not natural for a player to keep his head up at contact. It's actually instinctive for players to drop the head at contact to protect their eyes and face. Shoulder contact with the head-up must be learned. To be learned it must be practiced extensively. It requires much more than telling players to “keep their head up” and to “make contact with their shoulder.”

•Unintentional head-down contact is dropping of the head just before contact. Spearing is the intentional use of head-down contact. Both may result in paralysis.

•The primary purpose of the helmet-contact penalties is to protect the athlete making the hit from catastrophic injury.

•Catastrophic neck injuries caused by axial loading/head-down contact are neither caused nor prevented by players' standard equipment.

Specifics for Coaches
•Every coaching staff should aim at keeping head-down contact by their team to 5 or less per game. Estimates have this number at about 20 per team in a game.

•Although defensive backs tackling are at the greatest risk of catastrophic neck injuries, coaches need to teach correct technique for all types of collisions. This includes contact by ball-carriers, blockers, and special team’s players.

•Design drills that focus on shoulder contact with the head up for all positional players and types of collisions. And Run them regularly.

•Typically football programs teach correct contact to tacklers before the season begins. This must continue but include the other positional players. In addition, specific emphasis should placed on this again 3 more times spaced throughout the season.

•Use the phrase “When the shoulder goes down, the head comes up” as a repetitive teaching point.

•Do not instruct ball carriers to “lower their heads” to break tackles. Instruct them to “lower their shoulders.”

•Do not teach players to initiate contact with their face mask. This is a rule violation and against current Coaching Ethics. More importantly, this places players at risk of paralysis if they accidentally drop their head at contact.

•Do not teach defensive players to put their helmet on the ball when tackling. This is a rules violation as it is teaching athletes to initiate contact with their helmets.

•The phrase “See What You Hit” does NOT mean initiate contact with the face mask. It is intended to teach players to keep their head up as they approach contact. A more precise phrase is “See What You’re About to Hit.”

•Accept helmet-contact penalties as an officials attempt to protect your athlete from catastrophic injury.

Educating Players
•Players must know, understand and appreciate the risks of head-down and head-first contact in football, whether intentional or accidental.

•Formal classroom educational sessions should be held twice per season, directed by the medical staff. Once before contact begins and repeated at the midpoint of the season.

•It should be mandatory for all players to view the DVD “Head’s Up: Minimizing the risk of catastrophic head and neck in football,” (or similar video) as part of these educational sessionals.

Officiating/Rules
•The NFHS and the NCAA need to adapt their helmet contact rules so unintentional head-down contact will be penalized regularly. (As of 2008 adaptations to the rules are excellent)

•There is no way to distinguish between head-down hits that result in paralysis from those that don't. So all head-down contact has to be penalized.

•The current rate of enforcement of the existing helmet contact penalties needs to be drastically improved to serve as a deterrent to players and to provide coaches feedback on helmet-contact on a regular basis.

(The rationale for all of these recommendations can be found in these articles:)