Injuries of the cervical spine in football

The neck is a vulnerable area in contact sports in general and in football in particular. The type of injuries encountered often vary with the age and development of the players. Five well-established mechanisms of injury have been identified. Most injuries appear to occur during the act of tackling when the well protected head sustains violent trauma which is transferred directly to the neck. The most dangerous single mechanism is that of flexion, but lateral deviation, extension and impaction also have been identified as mechanisms of injury. The pattern of injuries would suggest that several measures should be undertaken. First, coaches, officials and doctors associated with football teams need to be aware of the dangers of head-on tackling and the value of "heads-up" football to avoid flexion injuries. Deliberately butting players with the head or "spearing" is illegal but head-on tackling and blocking of the so-called "stick-blocking" type is specifically taught at the high school and college levels. In the immature neck this is a dangerous maneuver and should be discouraged. The development of strong neck musculature could reasonably be expected to prevent many neck injuries and isometric and resistance exercises to develop neck strength should be a part of all preseason conditioning. All players who have neck symptoms should be thoroughly evaluated both clinically and radiologically to rule out damage or predisposing structural weakness. This is particularly important in the atlanto-axial area in immature players. Finally, it is recommended that protective collars be worn by all players with a history of neck injury. The authors have gained the impression in surveying a large number of injuries that most serious neck injuries, particularly those involving fracture-dislocation are incurred in the act of open field tackling by defensive players making head-on tackles. Neck flexion is the usual mechanism. A light-weight sponge rubber collar is presently available. It is designed to be used to prevent extension and lateral flexion but it can be easily modified to extend anteriorly where it should aid in preventing the extreme flexion which is responsible for many serious injuries in the young players at the high school level.