The National Football Head and Neck Injury Registry has documented 1,129 injuries since 1971 that involved hospitalization for more than 72 hours, surgical intervention, fracture-dislocation, permanent paralysis, or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last two decades, there has been a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage, and injuries associated with death. Conversely, cervical spine injuries with fracture-dislocation and with permanent quadriplegia have increased. We believe that these observations are the result of the development of a protective helmet-face mask system that has effectively protected the head, and by so doing has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury. (JAMA241:1477-1479, 1979)