Paquimé dramatically expanded during the mid 12th century when it began to acquire influences from the more advanced civilizations of Mesoamerica (historians are unsure whether this represents an invasion from the south or influence emanating from an increase in trade with southern Indian civilizations). Paquimé acquired some specifically Toltec features, such as its ballcourt.
Similar ballcourts throughout Mesoamerica are often accompanied by long platforms carved with human skulls skewered on stakes (known as Tzompantli) and reliefs depicting the decapitation of a ball player, suggesting the game may have had some religious significance. Games may have been followed by the sacrifice of one or more of the players, the skulls of the victims ending up on the Tzompantli. There is, though, no evidence to suggest human sacrifice was practiced at Paquimé.
The rules of the game varied from region to region, but probably closely resembled the ulama or pok a tok game still played throughout Central America today.