Ryan Shazier's Spinal Contusion Isn't a Rare NFL Injury, Say Doctors

Minutes into a horrifically violent matchup between the Pittsburgh Steelers and the Cincinnati Bengals on Monday night, the Steelers’ inside linebacker, Ryan Shazier, was carted off the field and rushed to a nearby hospital. Shazier had suffered a back injury that many are calling a spinal contusion — a bruise to the spine that could impair his ability to feel and move in his lower extremities, perhaps even permanently.

For an injury so serious, it’s also fairly common among football players. According to the Cleveland Clinic, seven out of every 10,000 football players will get a spinal contusion; for context, about 1.8 million people play football in the United States. Most recently in the NFL, in 2013, Dallas Cowboys linebacker DeVonte Holloman had one, as did the Green Bay Packers’ tight end Jermichael Finley; New York Giants linebacker Jameel McClain had one in 2012. All three of these players eventually regained motion but have since retired from football.

When a person has a spinal contusion, swelling at the site of injury creates a lot of pressure inside the spinal canal, aggravating and sometimes killing the nerves housed within. These nerves, which stem from the brain, are responsible for controlling motor function throughout the body. If there’s too much pressure in the spinal canal, these nerves start to malfunction, leading to the symptoms including “numbness, tingling, electric shock-like sensations and burning in the extremities,” according to the American Association of Neurological Surgeons, which says football players are “especially susceptible” to this injury. If the nerves are damaged beyond repair, the injury could result in paralysis.

The reason spinal cord concussions are so common in football players is because they can be caused by the “spearing motion” players use when tackling each other, in which the helmet is the tip of the spear. This threatens the spine because the skull and neck, which are connected to the spine, aren’t equipped to handle huge amounts of pressure. Unlike an actual spear, the spinal column isn’t rigid, so it can crumple if enough force is applied to it. That’s likely what happened to Shazier: in videos of his tackle, he appears to lead directly with his head.

Spearing was actually banned by the NCAA and National Federation of State High School Associations in 1976 because so many students suffered spinal cord injures that led to paralysis.

According to Dr. Robert Flannery, a physician with the Cleveland Browns, proper positioning of the head and neck during a tackle is crucial to preventing injury. “Everyone has a little bit of curve in their neck to absorb such a blow, typically,” said Flannery on Wednesday in an interview on Tuesday with the Pittsburgh Post-Gazette. “But if you straighten your neck out, you lose that absorption.”

Fortunately, it is possible to gradually regain motion if the pressure is managed properly.

Various NFL teams have been experimenting with different tackling techniques that are meant to be safer than those currently in play. The controversial NFL-supported “Heads Up” technique that’s being taught to kids is supposed to reduce the risk of concussions, and a rugby-inspired technique used by the Seattle Seahawks avoids impacts to the head.

“The head must come out of football,” said Dr. Stanley Herring, a Seattle Seahawks doctor who is a member of the NFL’s Head Neck and Spine Committee in an interview with ESPN in 2014. “You have to be tough to play football, but no one has a tough brain. And so the right thing to do is take the head out of the game.”

Not everyone is convinced that these efforts are enough, though. As concerns about spinal injuries and brain damage caused by professional football grow more and more dire, it’s seeming increasingly possible that the NFL’s worst nightmare — that there is simply no way to play American football safely — might come true.