The Dangers of Spear Tackling: A Case Report of a NEXUS-negative High School Football Player

Although "spear tackling" is known to be a risk factor for cervical spine injury due to axial loading of the neck, and although this technique was officially banned from American football in 1976, football-associated cervical spine injuries continue to be reported. This case highlights the importance of recognizing high-risk mechanisms for cervical spine injury, and specifically the danger of spear tackling among football players at all levels.

A 16-year-old male high school football player presented to the pediatric emergency department for a neck injury sustained after spear tackling during a football game. He had no neurologic symptoms and met the NEXUS criteria for omitting x-ray evaluation. However, the description of spear tackling as the mechanism of injury led to the ordering of cervical radiographs, which revealed a C5 fracture. The patient was ultimately taken to the operating room for internal fixation, with a final surgical diagnosis of a C5 teardrop fracture. On outpatient follow-up at 1 year, the patient has had no neurologic sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case serves as a reminder that all evaluations of trauma patients should begin with an attempt to determine, as precisely as possible, the mechanism that was in play at the time of injury. The reassurance provided by a normal physical examination may be misleading. Spear tackling is not an uncommonly encountered cause of injury in American football, despite the practice being prohibited since a rule change in 1976. Continued education and increased awareness of the association of axial load injury with spear tackling may make it possible to avoid missing a potentially devastating cervical spine injury.