The National Athletics Trainers' Assn. warns that there is still too much head-to-head contact in football games (including high school, college and professional football), despite there being rules against head-first hits. The association states that the "enforcement of these rules regrettably is uneven and infrequent." Head-first hits, termed "spearing," can cause great damage to a player's head, neck and/or spine and can result in blunt-trauma and even concussions. Athletic trainers said that coaches must discourage their players from head-to-head contact, and officials must call and penalize the players more often.

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