Sports-related neck injuries

Neck pain is a frequent complaint addressed in general practice in non-athletic individuals. It can be a debilitating physical condition of varying degrees, from mild to moderate and severe injuries, to those involving the cervical spine.

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Injury to the neck can occur in all ranges; it could be a mild concussion, soft tissue injury, spondylolisthesis, or fracture to the cervical vertebrae. Neck pain can be related to poor posture, occupational stress, and increasing workload, and is one of the top reasons for disability in middle-aged adults, according to the global burden of diseases. 

Neck pain due to injury in athletic individuals is attributed to the frequency, intensity, and nature of the sports they participate in. Research has shown that the prevalence of neck pain in athletes is high, depicting a rise of 38% to 73% within 1 year with a ratio of 1.7. This can be due to poor form and biomechanics of neck movement during activity. The prevalence of neck injuries is higher in football compared to any other game. 

Risk factors for sports-related neck injuries

Poor neck stability

The incidence of life-threatening neck injuries in athletes is rare but not uncommon. However, it is often overlooked when it comes to training. Strength training of neck muscles should be included in the exercise protocol of athletes for quick head movements and defence from the force of collision.

Impaired range of movement

High-contact sports require quick head movements. This swift head turning, bending, and extension can lead to trauma.

Poor sports biomechanics

Spearing in sports is the most common cause of catastrophic sports injury. In spearing, the player uses his/her head to collide with another person. The collision can result in severe axial compressional trauma to neck muscles, soft tissues, vertebral fractures, and spinal cord injury.

Spearing occurs in slight head flexion, and the force is transferred to the intervertebral disks and spinal cord. The normal lordosis curvature of the cervical spine is lost.

Broad spectrum neck injuries in sports

Neck injuries in sports have a broad spectrum, including:

1. Ligament sprain
2. Traction injury
3. Whiplash injury
4. Stingers:
   • brachial plexus injury - pathological reflexes
   • cervical cord neuropraxia
   • cervical spinous stenosis
5. Incomplete or complete spinal cord injury - Brown Sequard syndrome
6. Cervical spine fracture or subluxation
7. Cervicalgia
   • axial neck pain
   • cervical neuropathy
   • cervical myelopathy
8. Concussion (primary/secondary)
9. Transient quadriplegia

Prevention of neck injuries in sports

• Penalise for dangerous behavior, e.g. spearing, pushing, hitting with helmet, clothesline hit.
• Wear protective equipment, e.g. cowboy collar. The equipment should be appropriately fitted.
• Include neck conditioning and strengthening exercises to adapt to high-demand sports activities.
• A healthcare provider and trained paramedics should be present at the frontline to provide prompt response when an injury occurs and minimise the risk for further injury.
• Fellow athletes should also be trained to respond to emergencies on the ground.
• Throw away damaged equipment.

Management

The athlete is first assessed on the ground by the frontline healthcare team to determine the type and severity of the injury. The athlete should be log rolled onto the spine board by highly trained paramedics to reduce the incidence of spinal cord injury.

The sideline healthcare provider must immobilise the whole spine of the patient; it has been observed that a cervical collar is not enough to prevent cord injuries while transferring the patient. They ensure that the airway, breathing, and circulation of the patient are stable.

A concussion is a frequent sports injury in athletes; the healthcare team should assess the severity of concussion by assessing three parameters, i.e. loss of consciousness (time duration <15 minutes or more), acquired memory (regain after a few minutes or amnesia), and postural stability. The athlete may be further investigated for vertigo, dizziness, vomiting, attention deficit, headache, tinnitus, and blurred vision. 

Sports-related neck injuries can pose severe life-threatening and life-altering complications. Neck injuries require a multifaceted approach by a multidisciplinary team. The athletes must be educated by coaches and the sideline healthcare team about potential risks and injuries during sports. By emphasising proper biomechanical form, education, and early intervention, injuries can be prevented, and athletes can recover and return to sport faster.

- Dr Humda, Physiotherapist

Learn more about this topic in the HealthCert Professional Diploma program in Musculoskeletal & Sports Medicine - fully online or with optional practical workshops.