Are You Ready for Some Football? Get the Facts of Cervical Spine Injuries

Are you or your children susceptible to traumatic sports injuries? If you are, or if you know someone who is, consider the importance of sports injury prevention. What you do off the field contributes greatly to how you perform when the whistle blows.

Well more than half of catastrophic injuries in sports are cervical spine injuries. Cervical spine injuries have been reported in most contact sports, including football, hockey, rugby, and wrestling. Football and rugby have the highest incidence of cervical spine injuries of all sports.

Cervical spine injuries are estimated to occur in 10-15% of all football players, most commonly in linemen and defensive players. Serious injuries with neurologic consequences are less common, the majority of cervical spine injuries are considered self-limiting. However, the cervical spine is such a delicate aspect of the body is the risk worth taking (Olympia et al., 2007)?

Injuries are reported to occur in all levels of play, from the high school to the professional level. A desire to “make the team” and to perform well drives athletes to the point of injury in many cases.

How Does Injury Occur?
Injury is usually secondary to high-velocity collisions between players, causing acceleration or deceleration of the head on the neck (Rihn et al., 2009)

  • Acceleration usually causes a whiplash type of extension force on the neck
  • Deceleration usually results in flexion forces.
  • Spearing, which has been banned in American football since 1976, occurs when a player uses the helmet/head as the first point of contact with another player.

Spearing is a significant cause of cervical spine injuries and may result in quadriplegia. The force transmitted to the cervical spine in these cases is one of axial compression with the vertebrae in positions of slight flexion. These cases were much more prevalent in history, now only approximately 6 cases per year occur after changing the rules in the 1970s. This was an effective prevention plan set in place by the football authorities (Fuller et al., 2007).

With the reduction of spearing, cervical spine injuries are more commonly self-limited than they are traumatic and life threatening. Self-limiting cervical spine injuries can be divided into the following categories:

  • Nerve root or brachial plexus injuries
  • Acute cervical sprains/strains
  • Intervertebral disc injuries
  • Cervical fractures and dislocations
  • Cervical stenosis
  • Stingers

Stingers are thought to be the result of either of the following mechanisms:

  1. A distraction or stretch injury in which the head is driven to the side opposite and the painful arm and the ipsilateral shoulder is depressed. This causes a momentary stretch injury to the upper cords of the brachial plexus.
  2. The extended Cervical spine is compressed and rotated toward the painful arm. The dentate ligament attachments become taut and stretch the cervical nerve roots as they leave the spine.

Tulane University reported a 7.7% incidence of stingers in a group of college football players. Initially, the player complains of total arm weakness and a radiating burning sensation that usually resolves. Numbness in the C-6 dermatomal distribution may persist. Motor weakness of shoulder abductors, elbow flexors, external humeral rotators, and wrist and finger extensors also may persist.

The duration of symptoms is acute. Symptoms may last from 2 minutes to 24 hours depending upon the complexity of the injury and the intensity of the impact. Function gradually returns from the proximal muscle groups to the distal muscle groups.

Although the majority of cervical spine injuries is self-limiting and considered to be musculoskeletal in origin, if you or someone you know suffers for a sports-related traumatic injury they should have a neurologic examination performed to rule out cervical instability and neurologic compromise. This is considered best practices for athletes suffering injuries.

As football players of all ages are preparing for the upcoming season, or getting ready for the big game, they should take injury prevention strategies very seriously. Consider the following tips for prevention of cervical spine injuries while playing football.

 Prevention Strategies:

  • Always perform Head-Up tackles to prevent spearing.
  • Integrate mobility training exercises to improve range of motion in regular sports training.
  • Engage in postural correction treatment to ensure proper cervical spine alignment and balanced dynamic posture patterns.



Fuller CW, Brooks JH, Kemp SP. Spinal injuries in professional rugby union: a prospective cohort study. Clin J Sport Med. 2007 Jan. 17(1):10-6.

Maroon JC, Bailes JE. Athletes with cervical spine injury. Spine. 1996 Oct 1. 21(19):2294-9

Olympia RP, Dixon T, Brady J, Avner JR. Emergency planning in school-based athletics: a national survey of athletic trainers. Pediatr Emerg Care. 2007 Oct. 23(10):703-8.

Rihn et al. (2009) Cervical Spine Injuries in American Football. Sports Medicine, 39(9):697-708.


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