HEAD/NECK SAFETY: Dr. Clement K. Jones
Here we are in mid-August and football season has started.
Athletes at every level — from Pop Warner and Pee-Wee leagues to high school, college and professional teams — are gearing up to play a game notorious for causing serious neck and spine injuries.
Of course, such injuries are also possible in non-contact sports such as soccer, diving, water polo, gymnastics, surfing and track-and-field high jumping. But contact sports like football tend to involve athletes who are bigger, faster and stronger, resulting in collisions that have become increasingly more violent. Simply put, larger masses at faster velocities lead to bigger and louder thumps.
The spine serves as the main channel for the central nervous system. It contains the spinal cord and nerve roots that supply the vital organs, as well as all four extremities. The spine is designed to be flexible enough to allow the head and eyes to move to the right place at the right time. The main reason the neck and spine are at risk for injury is because of the inability to pad, brace or protect these areas while maintaining their function.
Neck injuries in contact or collision sports are usually the result of a bio-mechanical failure or fracture of the bony elements of the spine. They can be caused by striking an opponent with the head and neck in a flexed position, or by landing on the head violently while the neck is flexed. Such motions can also cause significant damage to ligaments and muscles, which leads to dislocations and instability of the spine. Both fractures and ligament injuries can result in catastrophic dam- age to the spinal cord and nerve roots.
When an injury occurs on the field, immediate evaluation and specific management is essential to prevent further injury and maintain an optimal prognosis. Athletes themselves may not be aware of the severity of their injury because of their higher pain tolerance levels and stoic natures. But it is crucial to rapidly assess whether spinal cord or nerve root injury has occurred. Radiographic studies such as X-rays, MRIs and CAT scans can help determine the level and extent of an injury.
Fortunately, most injuries don’t involve spinal cord or nerve damage, but this can only be determined by a neurological examination. Football players often complain of “stinger” or “burner” injuries, which classically involve compression of the nerve root and result in burning or stinging pain down the arm from the neck. They may also experience weakness or numbness, but not always.
The NFL recently adopted several new rules for the 2013 season including the infraction and penalty for any player who uses the crown of the helmet to strike an opponent outside the tackle box. While clearly this was implemented with consid- eration of reducing concussions, it will also implicitly reduce the occurrence of neck injuries.
Coaches, trainers and parents are responsible for ensuring that athletes learn to play high-risk sports wisely and safely. Because incorrect head and neck positioning increases the likelihood of injury, the best prevention involves knowing and practicing proper strengthening and conditioning techniques.
Appropriate padding and equipment modifications can help but will not prevent injury. Strengthening, Practicing, and Technique are the “safety triad” to consider while playing football or any other contact or high-velocity collision sport.
Remember: Preventing injuries in the first place is the single most important way to avoid them.
As a rule of thumb, the most significant factor in preventing traumatic and potentially catastrophic spinal cord injuries involves “seeing what you hit” and “keeping your head up.”
Dr. Clement K. Jones is a board certified orthopedic surgeon specializing in spine surgery and treatment of spinal disorders for the Spine Care Institute of San Francisco, located within Saint Francis Memorial Hospital.