Sports Medicine: Just the Facts

value for determining future injury. It is not, therefore,
a recommended screening tool.
•A diagnosis of “spear tackler’s spine” constitutes an
absolute contraindication to participation in collision
sports. It is identified as follows:

1. Developmental cervical canal stenosis


2. Reversal of the normal cervical lordosis on lateral
   radiographs


3. Preexisting posttraumatic radiographic abnormali-
   ties of the cervical spine


4. Documentation of the athlete having used spear
   tackling techniques

• Advanced imaging such as a CT scan is recommended
  to investigate a clinically suspected fracture when
  plain radiographs are unrevealing or equivocal. CT
  scan with myelography is a sensitive measure of
  spinal stenosis.


• MRI is used to evaluate soft tissues for ligamentous
  disruption or herniated nucleus pulposus, and can also
  demonstrate spinal cord contusions. T2-weighted
  images may be used to determine the extent of func-
  tional reserve, the protective cushioning of cere-
  brospinal fluid around the spinal cord.

ELECTRODIAGNOSTICS

• Electromyography and nerve conduction(EMG/NCS)
  studies may be useful in evaluating an athlete after
  neurologic insult with persistent motor or sensory
  abnormalities. Such testing can help delineate
  whether the lesion is at the level of the nerve root,
  brachial plexus, or peripheral nerve.

TREATMENT

• Sideline management of any athlete with neck pain or
  tenderness and neurologic symptoms, excluding those
  with a clear diagnosis of a stinger or burner, mandates
  immobilizing the athlete on a spine-board and emer-
  gent transport to a trauma center for evaluation by a
  spine specialist. The helmet should notbe removed.
  Trainers and physicians should be trained in equip-
  ment to remove the athlete’s facemask.


• Fractures should be referred to an orthopedic spine
  specialist for definitive treatment.


• Cervical sprains or strains are generally self-limited
  injuries managed with relative rest, icing, and nons-
  teroidal anti-inflammatory medications for pain and
  inflammation, and early mobilization and strengthen-
  ing in a pain free range of motion.


• There is no benefit to using a soft cervical collar for
  cervical sprains or strains other than perhaps providing

a sense of security and local warmth. In fact, the use of

a collar can delay recovery by causing a decrease in

cervical spine range of motion.

• Stingers or burners are generally self-limited, with
  symptom resolution in minutes to hours. Once an ath-
  lete’s neurologic examination has normalized, a tai-
  lored rehabilitation program should be instituted to
  prevent recurrence.


• Unresolved neurologic symptoms should be observed
  closely for progression.

REHABILITATION

• Rehabilitation is the cornerstone of ensuring prompt
  return of an athlete to competition and for prevent-
  ing recurrent injury. Alternative methods of condi-
  tioning should be used while the athlete is kept out
  of play.


• The sports rehabilitation paradigm is as follows:
  
  
  1. Decrease pain and inflammation.
  
  
  2. Restore pain-free, full cervical spine range of motion.
  
  
  3. Optimize head and neck posture.
     4.Strengthen the cervical spine musculature
     (dynamic stabilizers), scapular stabilizers, upper
     extremities, and trunk.
  
  
  4. Maintain cardiovascular endurance according to
     the demands of the sport.
  
  
  5. Direct sport-specific training.
  
  
  6. Review and refine specific techniques such as tack-
     ling skills. Determine, if possible, the issues sur-
     rounding the initial injury.
  
  
  7. Optimize use of well-fitted protective gear, e.g.,
     pads, collars, and the like.
  
  
  
  

RETURN-TO-PLAY GUIDELINES

•Several authors have published guidelines to assist cli-

nicians in determining when an athlete should be

allowed to return to collision sports following a cervi-

cal spine injury (Cantu 2000; Torg and Ramsey-

Emrhein, 1997; Morganti et al, 2001). All of these

guidelines are based on expert opinion (Table 41-1).

• In general, return-to-play may be contemplated when
  the athlete:
  
  
  1. Demonstrates full and pain-free range of motion
  
  
  2. Displays a normal neurologic examination includ-
     ing strength, sensation, and reflexes
  
  
  3. Does not have an osseous or unstable ligamentous
     injury
  
  
  4. Controversy exists over returning an athlete to
     sport after sustaining an episode of cervical cord
     neuropraxia (transient quadriparesis).
  
  
  
  

246 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE