Sports Rehab

Friday, January 22nd, 2010

Neck injuries in football can vary from the rare catastrophic event, to the much more frequent but less severe neck stinger. Specifically, brachial plexopathy, known as a stinger or burner, is a common injury in competitive football. Studies have shown lifetime injury incidences from 49% to 65% in college football. Many players will wear neck collars to prevent such injuries.

A stinger is most likely caused by damaging the upper trunk of the brachial plexus, which is made up of the C5 and C6 nerve roots. This group of nerves runs from the cervical spine through the shoulder and into the upper arm, traveling directly under the clavicle(Figure 1). Stingers usually involve excessive hyperextension or lateral flexion of the head due to an impact, either with another player or with the ground. Symptoms include numbness, pain, or a stinging or burning sensation in the shoulder and arm. Usually, these symptoms resolve within minutes. However, this simple neuropraxia can escalate into an axonotmesis (damage to the axon or myelin sheath) that lasts for days or months, or a neurotmesis (complete disruption of the nerve) that is permanent.

Severe injuries often result from axial loading injuries. When the neck is flexed 30 degrees from anatomic position, the normal cervical lordosis is straightened and the vertebrae align into a segmented column. An impact to the head will result in a crushing of the vertebrae, with the surrounding soft tissues unable to absorb the impact (Torg, 1990). Such impacts usually result in paralysis or death. During 1971 and 1975, the National Football Head and Neck Injury Registry recorded 259 cervical spine fractures, subluxations, and dislocations in high school and college football. Because of the high incidence of such serious injuries, American football instituted rule changes outlawing head-first tackling, blocking, and spearing in 1976. Since that time, the incidence of severe cervical injuries has plummeted; in 1987, 32 injuries were recorded (Torg, 1990). This injury is still one of concern, but the aforementioned rule changes combined with coach and player education have greatly reduced such injuries.

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