Playing sports can put one at risk to neck injuries that may be minor to life-threatening. Minor injuries would include muscle strains and life-threatening injuries can include neck fractures and cervical spinal cord injuries. While a neck fracture is a severe injury, the patient typically can make a complete recovery. Sometimes, a neck fracture can cause a complete spinal cord injury which can lead to some paralysis or death.
With safety measures, proper gear, and proper coaching the chance of receiving a severe neck injury in sports has decreased over the decades. These injuries can still occur in contact or noncontact sports. Cervical sports-related injuries can be divided into the following clinical syndromes:
- Cervical fractures and dislocations
- Nerve root or brachial plexus injuries
- Intervertebral disc lesions
- Cervical stenosis
- Acute cervical sprains/strains including whiplash injury
- Transient quadriplegia
The spine provides structural support for the body and is part of the axial skeleton. The cervical portion of the spine includes the neck and is made up of seven bones (C1-C7 vertebrae). The seven bones are separated from one another by discs. The discs act to absorb shock and allow the spine to move around during activity. The spine lets us stand, bend, twist, and move. The spinal cord is a very sensitive nervous tissue that connects the brain to the body. The spinal cord is positioned in the middle of the cervical spine and is protected by vertebral bone structures.
The cervical spine has the job of supporting the weight of the head and to allow for the movement of our head. Head movement is possible because of the C1 and C2 vertebrae as they connect to the skull. The C1 vertebrae is the first vertebrae and called the “atlas”. The C1 vertebrae allows for the nodding of the head motion by articulating along the atlanto occipital joint. The C2 vertebrae is the second vertebrae and called the “axis”. The C2 vertebrae allows for the side to side motion of the head by pivoting along the atlantoaxial joint.
Cervical Fractures and Dislocation
A break in one or multiple cervical bones/vertebrae in the neck is a cervical fracture. A cervical dislocation is an injury to a ligament of the neck that has made at least two cervical vertebrae to separate from one another abnormally.
Extreme and sudden twists or a blow to the head or neck region may lead to a neck fracture. Sports with intense contact increases risk of getting a neck fracture. These sports can include football, ice hockey, rugby, or wrestling. Gymnastics is a noncontact sport that has a high risk for broken necks or neck injuries. The cervical spine acts as an energy absorber for the collision by dissipating forces through the muscles, the intervertebral discs, and the C-spine curve bones. An unusual axial load on the support structures of the neck is created when the neck is flexed. This can lead to the tearing of a ligament or bone. Injuries to the cervical spine can be subluxations and dislocations that may or may not cause neurologic symptoms or they can be fractures that may or may not cause neurologic symptoms.
Following a neck injury, a person should not be moved unless advised by medical care. Medical attention should be immediately called. The spine must have proper stability to not cause any more damage.
SIGNS AND SYMPTOMS
- Localized neck pain
- Stiffness in the neck
- Pain reaching down neck to shoulders or arms
- Swelling
- Bruising
- Tenderness
- Decreased sensation in body
- Muscle weakness
- Paralysis in arms or legs
- Trouble breathing
INCIDENCE
The U.S. Consumer Product Safety Commission (CPSC) pays attention to product-related injuries through its National Electronic Injury Surveillance System (NEISS). There are about 23,720 neck fractures that were cared for at American hospital emergency rooms in 2018. Of the 23,720 neck fractures there were 3194 due to sports incidents in 2018. The number of neck injuries could actually be higher. From 2000 to 2015, the number of sport related cervical fractures has become 30% higher because of a 300% increase in cycling injuries. It was shown that males cases were 1.7 times greater for neck sprains and 3.6 times greater for fractures compared to females. The main cause of cervical fractures in females was from horseback riding while for males it was cycling.
Source: US Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS), 2018.
Cervical Spinal Cord Injury
A major neck injury can affect part or the spinal cord. Depending on the location of the injury on the spinal cord, symptoms can vary. The closer an injury is to the brain, there is a greater chance of affecting body movements or sense of feeling. Of all spinal cord injuries, one to the cervical spinal cord is typically the most severe. This can lead to quadriplegia or tetraplegia. Depending on the injury, the cervical spinal cord can be complete or incomplete.
COMPLETE SPINAL CORD INJURY
When a spinal cord injury (SCI) is complete, there will be a complete loss of motor and sensory functions to all levels below the injury. Half of spinal cord injuries are complete and will affect both sides of the body. The spinal cord will rarely ever be cut or completely transected.
INCOMPLETE SCI
An incomplete spinal cord injury can leave some function below the level of injury. One side of the body may be more functional than the other.
SPINAL CONCUSSIONS
There are incomplete and complete spinal concussions. The spinal cord dysfunction is usually transient and can resolve around one or two days. Football players are at high risk of spinal concussions and spinal cord contusions. Spinal concussions can cause some neurological symptoms that include numbness, tingling, shocking sensations, and burning in the extremities.
SIGNS AND SYMPTOMS
- Severe pain in neck, head, or back
- Tingling or sensation loss in hands, fingers, feet, toes
- Partial or complete loss of control of body parts
- Urinary or bowel urgency
- Trouble with balance or walking
- Unusual band-like feelings in the thorax:pain or pressure
- Difficulty breathing
- Abnormal lumps on spine or head
INCIDENCE
The National Spinal Cord Injury Statistical Center and the University of Alabama tracks statistics regarding spinal cord injuries
TOP SPORTS CONTRIBUTING TO SCI
- Diving: 1,772 males, 160 females = 1932
- Bicycling: 496 males, 68 females = 564
- All Terrain-Vehicle/All Terrain-Cycle (ATV/ATC): 218 males, 37 females = 255
- Football: 153 males = 153
- Snow Skiing: 170 males, 19 females = 189
- Horseback Riding: 76 males, 77 females = 153
- Winter Sports: 135 males, 30 females = 165
- Other Sports: 126 males, 29 females = 155
- Surfing (including body surfing): 140 males, 6 females = 146
- Wrestling: 94 males, 2 females = 96
- Trampoline: 68 males, 8 females = 76
- Gymnastics: 38 males, 21 females = 59
- Snowmobiles: 48 males, 9 females = 57
- Field Sports: 44 males, 2 female = 46
- Hang Gliding: 40 males, 2 females = 42
- Baseball: 23 males, 1 female = 24
- Basketball: 15 males = 15
- Skateboard = 8 males, 1 female = 9
- Track and field: 6 males = 6
SCI DEMOGRAPHICS
- 1% of all SCI are related to sports
- Of the 33,406 reported SCIs, a combined total of 3,367 were sports-related
- 3,003 cases occurred in males while 364 cases occurred in females
- 9% of all sports-related SCIs resulted in tetraplegia
SPORTS RELATED SCI BY AGE AT TIME OF INJURY
- Ages 0-15: 24.1%
- Ages 16-30: 14.2%
- Ages 31-45: 7.3%
- Ages 46-60: 4.5%
- Ages 61-75: 2.8%
- Ages 76-98: 0.9%
Source: The National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, NSCISC 2018. Annual Statistical Report and Facts at a Glance, January 2019.
TESTING AND DIAGNOSIS
Any injury to the neck sustained during a sporting activity should be dealt with a high concern for a severe condition. Any injury to the spinal cord or to the neck is a medical emergency. An athlete should not return to playing their sport until they have been cleared by a medical official. The patient should receive a neurological exam as quickly as possible. CT scans, MRI, or an X-ray can be used.
TREATMENT
The treatment plan will differ depending on the severity of the injury, if there is dislocation or instability, the injury to the cervical bones, and whether there is injury to the nerves or spinal cord.
Minor fractures can typically be treated with a neck collar or brace worn for six to eight weeks until the bones have healed. More severe injuries may require traction or surgery such as a spinal fusion with or without decompression.
After an injury has occured in the spinal cord, surgical decompression will be performed. The surgery will remove the tissue or bone pieces that are affecting the spinal cord. Decompression can be approached from the front or back of the body. Decompression and stabilization should be done as soon as possible following a spinal cord injury.
SPECIFIC SPORTS
Bicycling
Cycling accidents often result in head injuries but a head and neck injury can occur often too. Of 2692 sports-related neck fractures treated in United States hospital emergency rooms in 2009, 536 were from cycling. Around 80% of deathly bicycle accidents involve motor cars among children under the age of 14.
Source: US Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS), 2009.
Football
Of 2692 sports-related neck fractures treated in U.S. hospital emergency rooms in 2009, 268 were caused by football accidents. Acceleration of the head on the neck can cause whiplash. Deceleration of the head on the neck from a collision between players can result in flexion forces.
Cervical spine injuries occur most often in lineman and defensive football players. A cervical spine injury is estimated to happen to 10-15% of all football players. The main problem is tackling and blocking.
In the last 33 years there were 307 football players with incomplete neurological recovery due to a cervical spinal cord injury. The majority of the players were playing defense. Around 10% of cervical spinal injuries take place during the tackling phase.
Water sports
- 47 year old male fell off board while surfing which resulted in a compression fracture at C1 and a thoracic compression fracture at T1
- an 11 year old boy was hit while on an inner tube at a water park which resulted in a deathly neck fracture
- A 6 year old boy hit head on concrete pool floor and fractured neck at C2 and C3
- 32 year old male hit head on pool and fractured neck
Source: US Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS), 2009.
PREVENTION TIPS
Bicycling
Spinal cord injuries can be prevented by using SNELL, ANSI, or ASTM approved helmets. Buy a proper fitting helmet. Some other tips include keeping children under one year of age off of a bike, cycle a couple feet away from parked cars, obey traffic rules, nover hold onto a moving vehicle, and use hand signals.
Football
- Strengthen head and neck muscles
- Use proper hitting and blocking techniques
- Use equipment that fits well
- Prepare team to know what to so in case of an injury to the spine
- Do not spear
- Avoid helmet to helmet collisions
Skateboarding and inline skating
- Inspect for any damaged materials
- Wear helmet
- Skate on smooth grounds
Swimming and diving
- No diving in water under 12 feet depth
- Do not push or shove people into the pool
- Follow safety rules
General Sports
- Do not play sports when sick or tired
- Wear proper gear
- Be cautious
