Skip to main content
SpringerLink
Log in

Return-to-play decisions after cervical spine injuries

  • Published:
Current Sports Medicine Reports

Abstract

This article summarizes the current evidence and expert opinion on making return-to-play decisions after cervical spine injuries. Injuries discussed include fractures, central cord neuropraxia, stringers, disc herniations, strains, sprains, and instability. Each of these injuries may be complicated by coexistence of other conditions making return-to-play decisions more complicated. The congenital, developmental, and disease processes discussed include spear tackler’s spine, congenital and developmental stenosis, Klippel-Feil syndrome, odontoid abnormalities, rheumatoid arthritis, spina bifida, and Arnold-Chiari malformations. Postsurgical considerations are also discussed. This review represents an abundant amount of expert opinion that was overwhelmingly based on case series, case reports, and biomechanical studies to support the return-to-play guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Spinal Cord Injury Information Network. Facts and figures at a glance. Available at http://www.spinalcord.uab.edu/show.asp?durki=21446 Accessed July 22, 2006.

  2. Schneider RC: Serious and fatal neurosurgical football injuries. Clin Neurosurg 1964, 12:226–236.

    PubMed  CAS  Google Scholar 

  3. Albright J, Moses M, Harley G, et al.: Nonfatal cervical spine injuries in interscholastic football. JAMA 1976, 236:1243–1245.

    Article  PubMed  CAS  Google Scholar 

  4. Albright J, McAuley E, Martin R, et al.: Head and neck injuries in college football: an eight-year analysis. Am J Sports Med 1985, 13:147–152.

    Article  PubMed  CAS  Google Scholar 

  5. Torg JS, Pavlov H, Genuario SE, et al.: Neuraprxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am 1986, 21:1354–1370.

    Google Scholar 

  6. Pavlov H, Torg JS, Robie B, et al.: Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 1987, 164:771–775.

    PubMed  CAS  Google Scholar 

  7. Torg JS, Naranja RJ Jr, Pavlov H, et al.: The relationship of developmental narrowing of the cervical spinal canal to reversible and irreversible injury of the cervical spinal cord in football players. J Bone Joint Surg Am 1996, 78:1308–1314.

    PubMed  CAS  Google Scholar 

  8. Cantu RV, Cantu RC: Current thinking: return to play and transient quadriplegia. Curr Sports Med Rep 2005, 4:27–32.

    PubMed  Google Scholar 

  9. Cantu RC: The cervical spinal stenosis controversy. Clin Sports Med 1998, 17:121–126.

    Article  PubMed  CAS  Google Scholar 

  10. Cantu RC: Functional cervical spinal stenosis: a contraindication to participation in contact sports. Med Sci Sports Exerc 1993, 25:316–317.

    PubMed  CAS  Google Scholar 

  11. Vaccaro AR, Klein GR, Ciccoti M, et al.: Return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis. Spine J 2002, 2:351–356.

    Article  PubMed  Google Scholar 

  12. Eddy D, Congeni J, Loud K: A review of spine injuries and return to play. Clin J Sport Med 2005, 15:453–458.

    Article  PubMed  Google Scholar 

  13. Torg JS, Sennett B, Pavlov H, et al.: Spear tackler’s spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med 1993, 21:640–649.

    Article  PubMed  CAS  Google Scholar 

  14. Torg JS, Ramsey-Emrhein JA: Management guidelines for participation in collision activities with congenitlal, developmental, or post-injury lesions involving the cervical spine. Clin Sports Med 1997, 16:501–530.

    Article  PubMed  CAS  Google Scholar 

  15. Sallis RE, Jones K, Knopp W: Burners: offensive strategy for an underreported injury. Physician Sportsmed 1992, 20:47–55.

    Google Scholar 

  16. Meyer SA, Schulte KR, Callaghan JJ, et al.: Cervical spinal stenosis and stingers in collegiate football players. Am J Sports Med 1994, 22:158–166.

    Article  PubMed  CAS  Google Scholar 

  17. Levitz CL, Reilly PJ, Torg JS: The pathomechanics of chronic, recurrent cervical root neurapraxia. The chronic burner syndrome. Am J Sports Med 1997, 25:73–76.

    Article  PubMed  CAS  Google Scholar 

  18. Clancy WG Jr, Brand RL, Bergfield JA: Upper trunk brachial plexus injuries in contact sports. Am J Sports Med 1977, 5:209–216.

    Article  PubMed  Google Scholar 

  19. Vaccaro AR, Watkins B, Albert TJ, et al.: Cervical spine injuries in athletes: current return-to-play criteria. Orthopedics 2001, 24:699–703.

    PubMed  CAS  Google Scholar 

  20. Weinstein SM: Assessment and rehabilitation of the athlete with a “stinger.” Clin Sports Med 1998, 17:127–135.

    Article  PubMed  CAS  Google Scholar 

  21. Torg JS, Vegso JJ, Sennett B, et al.: Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am. 1986, 21:1354–1370.

    Google Scholar 

  22. Herzog RJ, Wiens JJ, Dillingham MF, Sontag MJ: Normal cervical spine morphometry and cervical spinal stenosis in asymptomatic professional football players: plain film radiography, multiplanar computed tomography, and magnetic resonance imaging. Spine 1991, 16(Suppl):178–186.

    Article  Google Scholar 

  23. Castro FP, Ricciardi J, Brunet ME, et al.: Stingers, the Torg ratio, and the cervical spine. AM J Sports Med 1997, 25:603–608.

    Article  PubMed  Google Scholar 

  24. Fagan K: Transient quadriplegia and return-to-play criteria. Clin Sports Med 2004, 23:409–419.

    Article  PubMed  Google Scholar 

  25. Torg JS, Ramsey-Emrhein JA: Suggested management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine. Med Sci Sports Exerc 1997, 29:S256–S272.

    PubMed  CAS  Google Scholar 

  26. Cooper L: Acute disposition of neck injuries. Curr Sports Med Rep 2005, 4:24–26.

    PubMed  Google Scholar 

  27. Kang JD, Figgie MP, Bohlman HH: Sagital measurement of the cervical spine in subaxial fractures — an analysis of two hundred and eighty-eight patients with and without neurological deficits. J Bone Joint Surg Am 1994, 76:1617–1628.

    PubMed  CAS  Google Scholar 

  28. Torg JS, Guille JT, Jaffe S: Injuries to the cervical spine in American football players. J Bone Joint Sur 2002, 84A:112–122.

    Google Scholar 

  29. American Academy of Pediatrics. Committee on Sports Medicine. Atlantoaxial instability in Down syndrome. Pediatrics 1984, 74:152–154.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. South Bend Orthopaedic Associates, PC, 53880 Carmichael Drive, South Bend, IN, 46635, USA

    Jamie E. Gottlieb MD

Authors
  1. Jessica L. Ellis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jamie E. Gottlieb MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jamie E. Gottlieb MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ellis, J.L., Gottlieb, J.E. Return-to-play decisions after cervical spine injuries. Curr Sports Med Rep 6, 56–61 (2007). https://doi.org/10.1007/s11932-007-0013-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11932-007-0013-z

Keywords

Search

Navigation