Catastrophic cervical spine injuries in the collision sport athlete, part 1: epidemiology, functional anatomy, and diagnosis

Physical Therapy in Neurorehabilitation with an Emphasis on Sports: A Bibliometric Analysis and Narrative Review

The increasing interest in physical therapy in sports neurorehabilitation stems from the high incidence of neurological injuries among athletes and the crucial role of rehabilitation in facilitating their safe return to sports. This study aims to provide a comprehensive analysis of research trends in physical therapy and neurorehabilitation in athletes. This study presents a bibliometric analysis of 103 documents from the Scopus database, followed by a narrative review of the identified thematic areas. Together, these approaches offer a comprehensive overview of the international literature on the application of physical therapy in sports neurorehabilitation, highlighting key trends and contributors. The software VOSviewer and Power BI (2.136.1202.0) were used for the bibliometric analysis and the visualization of the results. Techniques such as performance analysis (documents per year, top sources and countries in documents, and top authors in citations) and science mapping (co-authorship, bibliographic coupling, co-citation, and co-occurrence) were conducted. The results revealed the journals and the authors with the greatest impact in the field and collaborations between various countries. From the co-occurrence analysis of the keywords, three key thematic clusters were identified, Clinical Approaches and Outcomes in Neurorehabilitation, Athlete-Centered Neurorehabilitation Techniques, and Specialized Interventions in Sports Medicine and Neurorehabilitation, which were used to conduct the narrative review. These findings provide a solid foundation for future research and clinical practice aimed at enhancing recovery times and overall performance in athletes with neurological injuries.

The Spine is the Tree of Life: A Systematic Review and Meta-Analysis of the Radiographic Findings Related to Spinal Injuries in Athletes

This review article explores spinal injuries in athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that contribute to spinal injuries in each sport. Electronic databases such as PubMed, Cochrane Library, Web of Science, Embase, MEDLINE Ovid, and Google Scholar were searched for articles from 2000 to 2022 on spine injuries in sports and radiological studies discussing the various injury patterns among athletes. Studies were scoured in accordance with the inclusion criteria, and relevant data such as the number of participants, sporting activities, spine injuries, and outcomes were retrieved. Fifteen articles that met the inclusion criteria were included in the study. Cervical spine injuries are common in athletes who participate in contact sports such as football. Similarly, athletes in collision sports such as football, rugby, and hockey are likely to suffer stingers due to traction and compression injuries. Players engaged in such as soccer, baseball, and swimming, are likely to suffer from spondylolysis. Soccer players are more prone to multiple lesions compared to athletes in sports such as baseball because the sport involves training exercises such as jogging and running without kicking any ball. In swimmers, spondylolysis is common in breaststroke and butterfly styles since they involve repeated flexion and hyperextension of the lumbar spine. CT is essential for diagnosing spondylolysis as it demonstrates the lesions more accurately. Ice hockey is associated with a significant incidence of cervical spine injuries, mostly due to players being constantly checked/pushed from behind. Spine injuries are common in elite athletes across several sports. About 10% of spinal injuries in the United States result from sports activities. In diagnosing spine injuries, imaging modalities such as MRI, CT, or plain radiographs are essential. From a radiologist's perspective, these tests help immensely in deciding which treatment is required for a particular athlete or how the injury can be optimally managed. Achieving recovery from a specific spine injury usually depends on the kind of injury and the rehabilitation process the athletes undergo before returning to play.

Catastrophic Sports Injuries: Causation and Prevention

➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.

Community perspectives on spinal cord injury in rugby union: facts and fears

INTRODUCTION

The sport of rugby union, henceforth rugby, is associated with a risk of spinal cord injury (SCI). Perceived risks can impact participation. Understanding community perspectives on rugby-related SCI may provide insight for addressing concerns around risk. The aim of this study was to explore community perspectives through social media discussion about SCI in rugby union.

METHODS

Posts about SCI in rugby union were identified using the advanced search function on Twitter. Data (content as original post, retweet, quote tweet and comments) were included if focused on Rugby Union and written in English. Inclusion dates (July 2018 to June 2019) were chosen to capture a period when several SCI (n = 4) occurred in community rugby in Australia. Data were analysed using a thematic approach.

RESULTS

Four themes were derived from the collected data. The 'pendulum swing' relates to the disparate views of rugby, from being overly cautious to too dangerous to play. The 'role of rugby culture' described engrained behaviours and attitudes on and off-field toward safety. 'Media influence' describes the emotive narrative used when reporting rugby-related SCI. 'After the injury' looks at expressions of sympathy and inspiration. These findings showed how individuals' views of SCI were influenced through rugby culture, trust in governing bodies and the news media.

CONCLUSION

By 'listening in' to community views, their most pertinent safety concerns can be addressed. Both facts and fears on rugby-related SCI were evident, and these extreme views can be balanced with evidence-based education and sensible risk management.

The trends in sports-related spinal cord injury in China

STUDY DESIGN

Retrospective epidemiological study.

OBJECTIVES

To determine the characteristics of sports-related spinal cord injury (SCI) in China and assess changes in the trend of these injuries that may impact policy making.

SETTING

China Rehabilitation Research Center (CRRC), Beijing.

METHODS

Of the 2448 SCI cases reviewed, 6.7% (n = 164) were caused by sport- and recreation-related accidents. They were admitted to the CRRC between January 1, 2013 and December 31, 2019. We collected data on age, sex, etiology, the neurological level of injury, the American Spinal Injury Association (ASIA) Impairment Scale (AIS) scores on admission, and the neurological recovery results at discharge.

RESULTS

Dancing (58.6%), followed by water sports (14.7%) and taekwondo (4.2%) were the leading etiologies. Of the SCIs caused by dancing, 27.1% of the individuals had incomplete injury, and of these, 57.7% showed improved neurological function. However, 72.9% had complete injury, and these individuals did not show any improvement in neurological function. Individuals with dance-related SCIs graded as A and D according to the AIS, showed no significant improvement in their motor function scores at the time of discharge. While the scores of those graded B and C increased significantly, there were no significant differences in the light touch and pin touch scores.

CONCLUSIONS

The etiology of sports-related SCI in China has changed dramatically, with dancing replacing water sports as the primary cause of SCIs. Individuals with dance-related SCIs have a poor prognosis. In China, prevention of dance-related SCIs has become a priority.

Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes

Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.

Overview of Traumatic Brain Injury in American Football Athletes

OBJECTIVE

The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football.

DATA SOURCES

A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review.

RESULTS

The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management.

CONCLUSION

Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.

Chasing the Cup: A Comprehensive Review of Spinal Cord Injuries in Hockey

Ice hockey is a high-speed sport with a high rate of associated injury, including spinal cord injury (SCI). The incidence of hockey-related SCI has increased significantly in more recent years. A comprehensive literature search was conducted with the PubMed, Medline, Google Scholar, and Web of Science databases using the phrases “hockey AND spinal cord injuries” to identify relevant studies pertaining to hockey-related SCIs, equipment use, anatomy, and biomechanics of SCI, injury recognition, and return-to-play guidelines.

Fifty-three abstracts and full texts were reviewed and included, ranging from 1983 to 2021. The proportion of catastrophic SCIs is high when compared to other sports. SCIs in hockey occur most commonly from a collision with the boards due to intentional contact resulting in axial compression, as well as flexion-related teardrop fractures that lead to spinal canal compromise and neurologic injury. Public awareness programs, improvements in equipment, and rule changes can all serve to minimize the risk of SCI.

Hockey has a relatively high rate of associated SCIs occurring most commonly due to flexion-distraction injuries from intentional contact. Further investigation into equipment and hockey arena characteristics as well as future research into injury recognition and removal from and return to play is necessary.

In vivo 3-Dimensional Kinematics Study of the Healthy Cervical Spine Based on CBCT Combined with 3D-3D Registration Technology

STUDY DESIGN

A cervical biomechanical study.

OBJECTIVE

We sought to demonstrate the three-dimensional (3D) intervertebral motion characteristics of the cervical spine in healthy volunteers using cone beam computed tomography (CBCT) combined with 3D-3D registration technology.

SUMMARY OF BACKGROUND DATA

No previous studies have used CBCT combined with 3D-3D registration technology to successfully documented in vivo 3D intervertebral six-degrees-of-freedom (6-DOF) motions of the cervical spine.

METHODS

Twenty healthy subjects underwent cervical (C1-C7) CBCT scans in seven functional positions. Segmented 3D vertebral body models were established according to the cervical CBCT images. A 3D-to-3D registration was then performed for each vertebral body in the different positions to calculate the 3D segmental motion characteristics in vivo.

RESULTS

During flexion-extension, the range-of-motion (ROM) of C1-C2 and C4-C5 was significantly greater than the other segments. The average coupled axial rotation and lateral bending of each segment were between 0.6° and 3.2°. The average coupling translations in all directions were between 0.2 and 2.1 mm. During axial rotation, the ROM of C1-C2 was 65.8 ± 5.9°, which accounted for approximately 70% of all axial rotation. The motion and displacement of C1-C2 coupled lateral bending were 11.4 ± 5.2° and 8.3 ± 1.9 mm, respectively. During lateral bending, the ROM of C3-C4 was significantly greater than C1-C2, C5-C6, and C6-C7. The coupled axial rotation of C1-C2 was 34.4 ± 8.1°, and the coupled lateral translation was 3.8 ± 0.5 mm. The coupled superoinferior and anteroposterior translation of each cervical segment were between 0.1 and 0.6 mm.

CONCLUSION

CBCT combined with 3D-3D registration was used to accurately measure and record the ROMs of lateral bending, axial rotation, and flexion-extension in cervical vertebrae under physiological-load conditions. Our findings may contribute to the diagnosis of cervical spinal disease, the development of new surgical techniques, and the restoration of normal, cervical segmental movement.Level of Evidence: 3.

Cervical Spine Injuries in the Ice Hockey Player: Current Concepts in Epidemiology, Management and Prevention

STUDY DESIGN

This review article examines the biomechanics that underly hockey-related cervical spine injuries, the preventative measures to curtail them, optimal management strategies for the injured player and return to play criteria.

OBJECTIVE

Hockey is a sport with one of the highest rates of cervical spine injury, but by understanding the underlying pathophysiology and context in which these injuries can occur, it is possible to reduce their incidence and successfully manage the injured player.

METHODS

Multiple online databases including PubMed, Google Scholar, Columbia Libraries Catalog, Cochrane Library and Ovid MEDLINE were queried for original articles concerning spinal injuries in ice hockey. All relevant papers were screened and subsequently organized for discussion in our subtopics.

RESULTS

Cervical fractures in ice hockey most often occur due to an increased axial load, with a check from behind the most common precipitating event.

CONCLUSIONS

Despite the recognized risk for cervical spine trauma in ice hockey, further research is still needed to optimize protocols for both mitigating injury risk and managing injured players.

Epidemiology of Spine Injuries in National Collegiate Athletic Association Men's Wrestling Athletes

Background:

Spine injuries are common in collegiate wrestlers and can lead to reinjury, persistent pain, and time lost from participation.

Purpose:

To describe the epidemiology of spine injuries in National Collegiate Athletic Association (NCAA) wrestlers between academic years 2009 to 2010 and 2013 to 2014.

Study Design:

Descriptive epidemiology study.

Methods:

The incidence and characteristics of spine injuries were identified utilizing the NCAA–Injury Surveillance Program database. Spine injuries were assessed for injury type, injury mechanism, time of season, event type, recurrence, participation restriction, and time lost from participation. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated for event type and time of season, and results with 95% confidence intervals that did not include 1.0 were considered statistically significant.

Results:

There were an estimated 2040 spine injuries reported in the database over the 4-year period, resulting in an injury rate of 0.71 per 1000 AEs.  Spine injuries were over twice as likely to occur in competitions as in practices (IRR, 2.02; 95% confidence interval, 1.10-3.69). More injuries occurred in both the preseason (0.94 per 1000 AEs) and the postseason (1.12 per 1000 AEs) compared with the regular season (0.55 per 1000 AEs). Contact injuries (42%) were the most common mechanism of injury, and brachial plexus injury (20%) was the most common diagnosis. Only 1.3% of injuries required surgery, and athletes most commonly returned to sport within 24 hours (33%) or within 6 days (25%).

Conclusion:

This investigation found an overall injury rate of 0.71 per 1000 AEs in wrestling athletes between academic years 2009 to 2010 and 2013 to 2014. The majority of these injuries were new, and athletes most commonly returned to sport within 24 hours. The injury rate was highest in competition, and both the preseason and the postseason showed a higher injury rate than that in season. Efforts to improve injury prevention and management should be informed by these findings.

On-Field Management of Suspected Spinal Cord Injury

Acute spinal cord injuries in athletes are rare. However, on-field management of such injuries requires a well-planned approach from a team of well-trained medical staff. Athletes wearing protective gear should be handled with care; a primary survey should be conducted to rule out life-threatening injury while concomitantly immobilizing the spine. Treatment with steroids or hypothermia have not been shown to be beneficial, ultimately time to surgery provides the athlete with the best chance of a good outcome.

Asymptomatic Spinal Cord Compression: Is Surgery Necessary to Return to Play

Advising athletes with asymptomatic cervical canal stenosis on their return to active play is a topic of considerable debate, with no definitive guidelines in place. Once cervical canal stenosis is identified, often through imaging following other injuries, it is difficult to predict the risk of future injury upon return to play in both contact and collision sports. Consequently, the decision can be a complicated one for the athlete, family, and physician alike. In this article, we identify radiographical and magnetic resonance imaging (MRI)-based criteria that may distinguish athletes "at-risk" for more severe consequences due to asymptomatic cervical canal stenosis from those who are safe to return to play. Using a Torg-Pavlov ratio <0.7 and MRI metrics, namely a minimal disc-level canal diameter <8 mm, a cord-to-canal area ratio >0.8, or space available for the cord <1.2 mm, can help when making these difficult decisions. Counseling can be a critical asset to patients with cervical stenosis who have had a previous episode of cervical cord neuropraxia, especially when they are involved in high-risk sports such as American football and rugby. We believe that while this remains an area of continued concern and controversy, improved MRI criteria will be a useful springboard for further studies, especially in the elite athlete population.

Sports-Related Cervical Spine Injuries - Background, Triage, and Prevention

ABSTRACT

Cervical spinal injuries are a rare, but potentially devastating occurrence in sports. Although many of these injuries occur in unsupervised sports, they are also seen in organized sports - most commonly in football, wrestling, and ice hockey. Additionally, although each sport is associated with its own unique injury patterns, axial loading remains a common theme seen in cervical injuries associated with significant neurologic impairment. Regardless of the mechanism, a cautious and conservative approach should be taken with regards to evaluation, management, and return to play.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

INTRODUCTION

Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.

METHODS

A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.

RESULTS

The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved.

CONCLUSIONS

These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

INTRODUCTION

Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.

METHODS

A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.

RESULTS

The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.

CONCLUSIONS

These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Intervertebral range of motion characteristics of normal cervical spinal segments (C0-T1) during in vivo neck motions

The in vivo intervertebral range of motion (ROM) is an important predictor for spinal disorders. While the subaxial cervical spine has been extensively studied, the motion characteristics of the occipito-atlantal (C0-1) and atlanto-axial (C1-2) cervical segments were less reported due to technical difficulties in accurate imaging of these two segments. In this study, we investigated the intervertebral ROMs of the entire cervical spine (C0-T1) during in vivo functional neck motions of asymptomatic human subjects, including maximal flexion-extension, left-right lateral bending, and left-right axial torsion, using previously validated dual fluoroscopic imaging and model registration techniques. During all neck motions, C0-1, similar to C7-T1, was substantially less mobile than other segments and always contributed less than 10% of the cervical rotations. During the axial rotation of the neck, C1-2 contributed 73.2 ± 17.3% of the cervical rotation, but each of other segments contributed less than 10% of the cervical rotation. During both lateral bending and axial torsion neck motions, regardless of primary or coupled motions, the axial torsion ROM of C1-2 was significantly greater than its lateral bending ROM (p < 0.001), whereas the opposite differences were consistently observed at subaxial segments. This study reveals that there are distinct motion patterns at upper and lower cervical segments during in vivo neck motions. The reported data could be useful for the development of new diagnosis methods of cervical pathologies and new surgical techniques that aim to restore normal cervical segmental motion.

Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities

BACKGROUND

Although several investigations have examined the epidemiology of cervical spine injuries in sports, few studies have analyzed the nationwide incidence and sex-specific epidemiology of cervical spine injuries.

METHOD

The National Electronic Injury Surveillance System database, which collects information on patients presenting to the emergency department at 100 hospitals across the United States, was queried for neck sprains and cervical fractures associated with sporting activities from 2000-2015.

RESULT

A total of 26,380 neck sprains and 1166 fractures were identified. Compared with females, the incidence for injuries in males was 1.7 times greater for neck sprains and 3.6 times greater for fractures (P < 0.0001). Football was the most common cause of cervical sprains in males, followed by cycling and weightlifting/aerobics. Females sustained most neck sprains in weightlifting/aerobics, trampoline, and cheerleading. From 2000 to 2015, the incidence of neck sprains from aerobics increased from 15.5 to 25.3 per million person-years (P < 0.0001). Similarly, the incidence of cervical fractures from cycling increased from 0.67 to 2.7 per million (P < 0.0001). For males, cycling was the most common cause of fracture, followed by diving/swimming and football. For females, horseback riding was most common, followed by cycling and diving/swimming.

CONCLUSIONS

Football is the leading cause of cervical sprains in the United States. The most common cause of cervical fracture in men is cycling, while in women it is horseback riding. The incidence of sport-related cervical fractures has increased by 35% from 2000 to 2015, which has been driven by an increase in cycling-related injuries.

A novel Cervical Spine Protection device for reducing neck injuries in contact sports: design concepts and preliminary in vivo testing

Head and neck injuries are common in contact sports such as American football. Different mechanisms can produce such injuries, including compressive impact forces on the crown of the helmet with the neck in a flexed chin-down position. The aim of this paper was developing and testing a novel Cervical Spine Protection Device (CSPD) designed to keep the neck within its safe physiological range. The cervical spine range of motion (ROM) of ten participants was measured under four conditions: free; wearing a football gear; wearing the CSPD; and wearing the CSPD underneath the gear. The CSPD was tested in terms of passive and active restraint of head motion, and for its capability to improve endurance time of the neck extensor muscles. Wearing the CSPD resulted in a significant 40-60% reduction in ROM across the three anatomical planes, and in increased endurance of the neck extensor muscles (FREE: 114 ± 57 s; CSPD: 214 ± 95 s; p = 0.004). In quasi-static loading conditions the CSPD was capable of keeping the neck within its physiological range, thus it may be used to decrease the risk of severe injuries due to dangerous chin-down positions.

‘In a blink of an eye your life can change’: experiences of players sustaining a rugby-related acute spinal cord injury

Background

Though rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player’s experience of such an injury and the importance of context.

Aim

The aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player.

Methods

A qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI.

Results

Four themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders.

Significance

All rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.

Common Ice Hockey Injuries and Treatment: A Current Concepts Review

Injuries are common in ice hockey, a contact sport where players skate at high speeds on a sheet of ice and shoot a vulcanized rubber puck in excess of one hundred miles per hour. This article reviews the diagnoses and treatment of concussions, injuries to the cervical spine, and lower and upper extremities as they pertain to hockey players. Soft tissue injury of the shoulder, acromioclavicular joint separation, glenohumeral joint dislocation, clavicle fractures, metacarpal fractures, and olecranon bursitis are discussed in the upper-extremity section of the article. Lower-extremity injuries reviewed in this article include adductor strain, athletic pubalgia, femoroacetabular impingement, sports hernia, medial collateral and anterior cruciate ligament tears, skate bite, and ankle sprains. This review is intended to aid the sports medicine physician in providing optimal sports-specific care to allow their athlete to return to their preinjury level of performance.

Acute management of cervical spine trauma

Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care. Diagnostic imaging and equipment considerations are reviewed, with discussion of corticosteroid administration, therapeutic hypothermia, and traction of the cervical spine. Approaches to cervical spine stabilization and return to play are also detailed, with an emphasis on patient-centered care and individualized treatment approaches to the athlete.

Cervical spine trauma evaluation

Cervical spine trauma is a relatively rare but catastrophic event in sports. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation. This involves thorough preparation, vigilant observation of the sporting event to detect the possible mechanism of injury, and initiation of the appropriate action plan when a potentially catastrophic injury is suspected. Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and, potentially, initiation of full spine stabilization with a spine board. In this chapter, our primary focus is discussion of the sideline evaluation of cervical spine trauma, and sideline practices designed to stabilize the athlete and minimize risk for further injury.

Cervical Intervertebral Disc Degeneration and Low Cervical Extension Independently Associated With a History of Stinger Syndrome

Background:

Stinger syndrome frequently occurs in athletes who compete in collision sports. Sharp pain and impairment of neck motion are major symptoms. Cervical intervertebral disc degeneration (CIDD) is also frequently observed in those who compete in collision sports.

Purpose/Hypothesis:

To investigate whether CIDD and neck functionality are related to a history of stinger syndrome. The hypothesis was that a significant relationship exists between CIDD and neck motion and a history of stinger syndrome in Japanese collegiate football players.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 49 male Japanese collegiate football players (mean age, 20.0 ± 1.1 years; mean athletic experience, 3.8 ± 2.3 years; mean height, 172.3 ± 4.8 cm; mean weight, 83.1 ± 12.2 kg) were subdivided into athletes with stinger syndrome (stinger group) and those without (control group). Stinger syndrome was confirmed based on a questionnaire and interview. CIDD was assessed by using T2-weighted magnetic resonance imaging. Range of motion (ROM) and isometric muscle strength were measured for neck function testing.

Results:

Thirty-nine percent (19/49) of athletes had at least 1 episode of stinger syndrome. The prevalence of CIDD was significantly higher in the stinger group (68%) than in the control group (30%) (P < .01). A statistically significant difference in cervical extension ROM was found between the stinger group (50.9° ± 11.1°) and the control group (60.2° ± 11.4°) (P < .01). Logistic regression analysis showed that CIDD and low cervical extension were independently associated with a history of stinger syndrome.

Conclusion:

Study results suggest that stinger syndrome is associated with CIDD and low cervical extension in collegiate football players.

Traumatic Sports-Related Cervical Spine Injuries

Cervical spine trauma in the athlete is not an insignificant occurrence with possibly catastrophic results. Football remains one of the most common and most well studied sporting activities associated with spine injuries. Transient spinal cord and peripheral nerve injuries may manifest as quadriparesis or burners/stingers with symptoms that resolve completely. More severe spinal cord injuries, typically from axial loading on the cervical spine, will cause bilateral symptoms with residual neurological deficit. Acute Trauma Life Support principles must always be applied to the player with a potential spine injury. Recent positional statements by National Athletic Trainers' Association advocate equipment removal on the field by 3 individuals with appropriate training, a shift from previous recommendations. This recommendation is still under debate, but equipment removal in the field is an option depending on staff training. The use of steroids in acute spinal cord injury remains controversial. Moderate systemic hypothermia has theoretical benefits for reducing spinal cord damage in the setting of an acute injury. Although it has been studied in the laboratory, only a few clinical trials have been performed and further research is necessary before routine implementation of hypothermia protocols.

The Influence of Friction Between Football Helmet and Jersey Materials on Force: A Consideration for Sport Safety

CONTEXT

The pocketing effect of helmet padding helps to dissipate forces experienced by the head, but if the player's helmet remains stationary in an opponent's shoulder pads, the compressive force on the cervical spine may increase.

OBJECTIVE

To (1) measure the coefficient of static friction between different football helmet finishes and football jersey fabrics and (2) calculate the potential amount of force on a player's helmet due to the amount of friction present.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Helmets with different finishes and different football jersey fabrics.

MAIN OUTCOME MEASURE(S)

The coefficient of friction was determined for 2 helmet samples (glossy and matte), 3 football jerseys (collegiate, high school, and youth), and 3 types of jersey numbers (silkscreened, sublimated, and stitched on) using the TAPPI T 815 standard method. These measurements determined which helmet-to-helmet, helmet-to-jersey number, and helmet-to-jersey material combination resulted in the least amount of static friction.

RESULTS

The glossy helmet versus glossy helmet combination produced a greater amount of static friction than the other 2 helmet combinations (P = .013). The glossy helmet versus collegiate jersey combination produced a greater amount of static friction than the other helmet-to-jersey material combinations (P < .01). The glossy helmet versus silkscreened numbers combination produced a greater amount of static friction than the other helmet-to-jersey number combinations (P < .01).

CONCLUSIONS

The force of static friction experienced during collisions can be clinically relevant. Conditions with higher coefficients of static friction result in greater forces. In this study, the highest coefficient of friction (glossy helmet versus silkscreened number) could increase the forces on the player's helmet by 3553.88 N when compared with other helmet-to-jersey combinations. Our results indicate that the makeup of helmet and uniform materials may affect sport safety.

Cervical Spine Injuries in the Athlete

Cervical spine injuries are extremely common and range from relatively minor injuries, such as cervical muscle strains, to severe, life-threatening cervical fractures with spinal cord injuries. Although cervical spine injuries are most common in athletes who participate in contact and collision sports, such as American football and rugby, they also have been reported in athletes who participate in noncontact sports, such as baseball, gymnastics, and diving. Cervical spine injuries in athletes are not necessarily the result of substantial spine trauma; some athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma. Therefore, physicians who cover athletic events must have a thorough knowledge of cervical spine injures and the most appropriate ways in which they should be managed. Although cervical spine injuries can be career-ending injuries, athletes often are able to return to play after appropriate treatment if the potential for substantial re-injury is minimized.

Treatment of Head and Neck Injuries in the Helmeted Athlete

Sport-related concussion treatment includes three major phases: initial evaluation at the time of the injury, treatment while the patient is symptomatic, and evaluation of the readiness for a gradual return to participation. Each concussion evaluation should include similar elements: assessment of symptoms, assessment of cognitive ability, assessment of coordination (of the eyes, upper extremities, and lower extremities), and assessment for additional injuries. The spine-boarding recommendations from the American College of Emergency Physicians, National Association of EMS Physicians, and National Athletic Trainers' Association have changed. These recommendations include both decreased use of spinal immobilization and removal of the helmet and shoulder pads prior to securing the athlete to the board when sufficient numbers of trained providers are present. Preseason training and pregame meetings or "medical time outs" should become standard practice for the sidelines medical team (including the athletic trainer, team physician, emergency response personnel, and possibly others).

Return-to-Play Recommendations After Cervical, Thoracic, and Lumbar Spine Injuries: A Comprehensive Review

CONTEXT

Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine.

EVIDENCE ACQUISITION

Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed.

CONCLUSION

Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.

Tackling in Youth Football

American football remains one of the most popular sports for young athletes. The injuries sustained during football, especially those to the head and neck, have been a topic of intense interest recently in both the public media and medical literature. The recognition of these injuries and the potential for long-term sequelae have led some physicians to call for a reduction in the number of contact practices, a postponement of tackling until a certain age, and even a ban on high school football. This statement reviews the literature regarding injuries in football, particularly those of the head and neck, the relationship between tackling and football-related injuries, and the potential effects of limiting or delaying tackling on injury risk.

The envelope of motion of the cervical spine and its influence on the maximum torque generating capability of the neck muscles

The posture of the head and neck is critical for predicting and assessing the risk of injury during high accelerations, such as those arising during motor accidents or in collision sports. Current knowledge suggests that the head's range-of-motion (ROM) and the torque-generating capability of neck muscles are both dependent and affected by head posture. A deeper understanding of the relationship between head posture, ROM and maximum torque-generating capability of neck muscles may help assess the risk of injury and develop means to reduce such risks. The aim of this study was to use a previously-validated device, known as Neck Flexibility Tester, to quantify the effects of head's posture on the available ROM and torque-generating capability of neck muscles. Ten young asymptomatic volunteers were enrolled in the study. The tri-axial orientation of the subjects' head was controlled via the Neck Flexibility Tester device. The head ROM was measured for each flexed, extended, axially rotated, and laterally bent head's orientation and compared to that in unconstrained neutral posture. Similarly, the torque applied about the three anatomical axes during Isometric Maximum Voluntary Contraction (IMVC) of the neck muscles was measured in six head's postures and compared to that in fully-constrained neutral posture. The further from neutral the neck posture was the larger the decrease in ROM and IMVC. Head extension and combined two-plane rotations postures, such as extension with lateral bending, produced the largest decreases in ROM and IMVC, thus suggesting that these postures pose the highest potential risk for injury.

Penetrating chest trauma secondary to a composite hockey stick injury

Hockey is enjoyed by millions of people around the world and is a sport in which aggression is encouraged and injuries are common. Although body-checking is the most common cause of injury in hockey today, hockey sticks are associated with up to 14% of injuries. We report a case of chest trauma requiring surgical intervention secondary to the penetration of a composite hockey stick into a player's thoracic cavity.

Effectiveness of a tailored neck training program on neck strength, movement, and fatigue in under-19 male rugby players: a randomized controlled pilot study

Purpose

To investigate the effect of a tailored neck muscle conditioning program on neck muscle strength, neck muscle fatigue, and range of neck movement in 16–18-year-old male rugby players.

Materials and methods

Thirty-four male rugby players were divided into forward and back playing positions and randomized within these groups. Seventeen players were randomly assigned to each group. The test group was given a tailored 6-week exercise regime based on their baseline measurements to be performed three times a week in addition to their normal training and playing. The control group trained and played as normal. The outcome measures used were cervical spine range of movement, neck strength, and neck muscle fatigability.

Results

There were no clinically relevant statistically significant differences between the two groups. Trends identified between the two groups suggest that a tailored neck exercise program increases neck strength, particularly neck extension, and increases resistance to fatigue, as well as influencing right- and left-sided neck muscle balance. A reduction in range of movement was also demonstrated in the test group. There was a great deal of variability in range of movement and strength within this age group. No previously undiagnosed neck conditions were detected, and there were no adverse events reported.

Conclusion

This study has shown that neck strength, range of movement, and susceptibility of the neck muscles to fatigue can be influenced using a focused neck training regime. It forms an important basis for a larger, multicenter study to ensure the neck is given due attention in rugby training and receives the same focus of conditioning as other parts of the body.

The influence of cervical muscle characteristics on head impact biomechanics in football

BACKGROUND

An athlete is thought to reduce head acceleration after impact by contracting the cervical musculature, which increases the effective mass of the head.

PURPOSE

To compare the odds of sustaining higher magnitude in-season head impacts between athletes with higher and lower preseason performance on cervical muscle characteristics.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Forty-nine high school and collegiate American football players completed a preseason cervical testing protocol that included measures of cervical isometric strength, muscle size, and response to cervical perturbation. Head impact biomechanics were captured for each player using the Head Impact Telemetry System. A median split was used to categorize players as either high or low performers for each of the following outcome measures: isometric strength (peak torque, rate of torque development), muscle size (cross-sectional area), and response to cervical perturbation (stiffness, angular displacement, muscle onset latency). The odds of sustaining moderate and severe head impacts were computed against the reference odds of sustaining mild head impacts across cervical characteristic categorizations.

RESULTS

Linemen with stronger lateral flexors and composite cervical strength had about 1.75 times' increased odds of sustaining moderate linear head impacts rather than mild impacts compared with weaker linemen. Players who developed extensor torque more quickly had 2 times the increased odds of sustaining severe linear head impacts (odds ratio [OR], 2.10; 95% CI, 1.08-4.05) rather than mild head impacts. However, players with greater cervical stiffness had reduced odds of sustaining both moderate (OR, 0.77; 95% CI, 0.61-0.96) and severe (OR, 0.64; 95% CI, 0.46-0.89) head impacts compared with players with less cervical stiffness.

CONCLUSION

The study findings showed that greater cervical stiffness and less angular displacement after perturbation reduced the odds of sustaining higher magnitude head impacts; however, the findings did not show that players with stronger and larger neck muscles mitigate head impact severity.

Treatment of neck injuries

Spinal cord injuries are uncommon in sports. Planning and practice for their occurrence, however, remains an essential component of Sideline Medical Team preparedness. Evaluation of cervical nerve injury, cervical cord injury, and cervical disc disease can be complex. Medical management, diagnostic imaging techniques and surgical recommendations in this setting continue to evolve. Most published guidance offers occasionally opposed expert opinion with sport participation after Cervical Cord Neuropraxia in the setting of Cervical Spinal Stenosis appearing particularly polarizing. Such conflicts can present challenges to clinicians in forming management and Return to Play decisions for the health of their athletes.

Can a rescuer or simulated patient accurately assess motion during cervical spine stabilization practice sessions?

CONTEXT

Health care providers must be prepared to manage all potential spine injuries as if they are unstable. Therefore, most sport teams devote resources to training for sideline cervical spine (C-spine) emergencies.

OBJECTIVE

To determine (1) how accurately rescuers and simulated patients can assess motion during C-spine stabilization practice and (2) whether providing performance feedback to rescuers influences their choice of stabilization technique.

DESIGN

Crossover study.

SETTING

Training studio.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers, athletic therapists, and physiotherapists experienced at managing suspected C-spine injuries.

INTERVENTION(S)

Twelve lead rescuers (at the patient's head) performed both the head-squeeze and trap-squeeze C-spine stabilization maneuvers during 4 test scenarios: lift-and-slide and log-roll placement on a spine board and confused patient trying to sit up or rotate the head.

MAIN OUTCOME MEASURE(S)

Interrater reliability between rescuer and simulated patient quality scores for subjective evaluation of C-spine stabilization during trials (O = best, 10 = worst), correlation between rescuers' quality scores and objective measures of motion with inertial measurement units, and frequency of change in preference for the head-squeeze versus trap-squeeze maneuver.

RESULTS

Although the weighted κ value for interrater reliability was acceptable (0.71-0.74), scores varied by 2 points or more between rescuers and simulated patients for approximately 10% to 15% of trials. Rescuers' scores correlated with objective measures, but variability was large: 38% of trials scored as 0 or 1 by the rescuer involved more than 10° of motion in at least 1 direction. Feedback did not affect the preference for the lift-and-slide placement. For the log-roll placement, 6 of 8 participants who preferred the head squeeze at baseline preferred the trap squeeze after feedback. For the confused patient, 5 of 5 participants initially preferred the head squeeze but preferred the trap squeeze after feedback.

CONCLUSIONS

Rescuers and simulated patients could not adequately assess performance during C-spine stabilization maneuvers without objective measures. Providing immediate feedback in this context is a promising tool for changing behavior preferences and improving training.

The incidence of rugby-related catastrophic injuries (including cardiac events) in South Africa from 2008 to 2011: a cohort study

OBJECTIVES

To establish an accurate and comprehensive injury incidence registry of all rugby union-related catastrophic events in South Africa between 2008 and 2011. An additional aim was to investigate correlates associated with these injuries.

DESIGN

Prospective.

SETTING

The South African amateur and professional rugby-playing population.

PARTICIPANTS

An estimated 529 483 Junior and 121 663 Senior rugby union ('rugby') players (population at risk).

OUTCOME MEASURES

Annual average incidences of rugby-related catastrophic injuries by type (cardiac events, traumatic brain and acute spinal cord injuries (ASCIs)) and outcome (full recoveries-fatalities). Playing level (junior and senior levels), position and event (phase of play) were also assessed.

RESULTS

The average annual incidence of ASCIs and Traumatic Brain Injuries combined was 2.00 per 100 000 players (95% CI 0.91 to 3.08) from 2008 to 2011. The incidence of ASCIs with permanent outcomes was significantly higher at the Senior level (4.52 per 100 000 players, 95% CI 0.74 to 8.30) than the Junior level (0.24 per 100 000 players, 95% CI 0 to 0.65) during this period. The hooker position was associated with 46% (n=12 of 26) of all permanent ASCI outcomes, the majority of which (83%) occurred during the scrum phase of play.

CONCLUSIONS

The incidence of rugby-related catastrophic injuries in South Africa between 2008 and 2011 is comparable to that of other countries and to most other collision sports. The higher incidence rate of permanent ASCIs at the Senior level could be related to the different law variations or characteristics (eg, less regular training) compared with the Junior level. The hooker and scrum were associated with high proportions of permanent ASCIs. The BokSmart injury prevention programme should focus efforts on these areas (Senior level, hooker and scrum) and use this study as a reference point for the evaluation of the effectiveness of the programme.

Cervical spine immobilization in sports related injuries: review of current guidelines and a case study of an injured athlete

Cervical spine immobilization is an essential component of the ATLS^® system. Inadequate training in the management of trauma calls and failure of early recognition can have disastrous consequences. Pre-hospital personnel are routinely involved more in the assessment and stabilization of patients in comparison to other health care professionals.

This case study and review highlights the importance of early recognition, assessment and correct stabilization of cervical spine injuries both in the field and during the initial assessment in hospital.

Inadequate assessment, immobilization and lack of standard guidelines on the management of suspected cervical spine trauma can result in secondary injury. Regular assessment and training of pre-hospital and medical personnel is essential to the proper management of these potentially devastating injuries.

Cervical spine alignment during on-field management of potential catastrophic spine injuries

Context:

When cervical spine injuries are suspected, the cervical spine should be immobilized in a neutral position and neck motion controlled in preparation for transport to an emergency facility. Protocols for emergency transport utilizing common devices (cervical collars) and methods (transfer techniques) during these procedures are not entirely evidence based.

Evidence Acquisition:

The medical literature search covered the time period of January 1966 to June 2008 using the following keywords, either alone or in combination: extrication collars, cervical collars, spine orthoses, spinal immobilization, spine board, spinal board, transfer techniques, and back board. Biomedical databases searched included Medline, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL [1982 to 2008]). The reference lists of all trials identified were also searched for additional trials.

Methods:

Only trials that directly compared the efficacy or safety of transfer methods and/or immobilization devices were included. Studies that measured voluntary head movement after the fitting of the cervical orthoses and those that did not evaluate motion across individual spinal segments were not included.

Results:

A lift-and-slide transfer method with a full body immobilization device creates less motion than a log-roll maneuver. Extrication-type cervical immobilization collars are limited in their ability to control neck motion in the injured cadaveric model.

Conclusion:

Allied health professionals responsible for the management of the cervical spine–injured patient should become familiar with and employ a lift-and-slide transfer technique in appropriate situations and should not rely exclusively on extrication-type collars to immobilize the neck.

The effect of laryngoscope handle size on possible endotracheal intubation success in university football, ice hockey, and soccer players

OBJECTIVE

To assess the effectiveness of a standard long-handle laryngoscope and a short-handle laryngoscope on ease of possible intubation in football, ice hockey, and soccer players.

DESIGN

Prospective crossover study.

SETTING

University Sport Medicine Clinic.

PARTICIPANTS

Sixty-two university varsity football (62 males), 45 ice hockey (26 males and 19 females), and 39 soccer players (20 males, 19 females).

INTERVENTIONS

Athletes were assessed for different airway and physical characteristics. Three different physicians then assessed the use of laryngoscopes of different handle sizes in supine athletes who were wearing protective equipment while in-line cervical spine immobilization was maintained.

MAIN OUTCOME MEASURES

The ease of passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was assessed using both a standard long-handle and a short-handle laryngoscope.

RESULTS

Use of a short-handle laryngoscope was easier for all physicians in all sports as compared with a standard-sized laryngoscope. Passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was easiest in soccer players and most difficult in football and ice hockey players for both sizes of laryngoscope. Interference from chest or shoulder pads was a common cause for difficulty in passing the laryngoscope blade into the posterior oropharynx for football and ice hockey players.

CONCLUSIONS

In the rare instances that an endotracheal intubation is to be attempted on an unconscious athlete, a short-handle laryngoscope may provide the best chance for successful intubation.

National athletic trainers' association position statement: preventing sudden death in sports

OBJECTIVE

To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports.

BACKGROUND

Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes.

RECOMMENDATIONS

These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.

Ion channel blockers and spinal cord injury

The activation of a delayed secondary cascade of unsatisfactory cellular and molecular responses after a primary mechanical insult to the spinal cord causes the progressive degeneration of this structure. Disturbance of ionic homeostasis is part of the secondary injury process and plays an integral role in the early stage of spinal cord injury (SCI). The secondary pathology of SCI is complex and involves disturbance of the homeostasis of K(+) , Na(+) , and Ca(2+) . The effect of ion channel blockers on chronic SCI has also been proved. In this Mini-Review, we provide a comprehensive summary of the effects of ion channel blockers on the natural responses after SCI. Combination therapy is based on the roles of ions and disturbance of their homeostasis in SCI. The effects of ion channel blockers suggest that they have potential in the treatment of SCI, although the complexity of their effects shows that further knowledge is needed before they can be applied clinically.

Lacrosse equipment and cervical spinal cord space during immobilization: preliminary analysis

CONTEXT

Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC).

OBJECTIVE

To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete.

DESIGN

Observational study.

SETTING

Outpatient imaging center.

PATIENTS OR OTHER PARTICIPANTS

Ten volunteer lacrosse athletes (age = 20.7 +/- 1.87 years, height = 180.3 +/- 8.3 cm, mass = 91 +/- 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI).

INTERVENTION(S)

The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition.

MAIN OUTCOME MEASURE(S)

The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3-C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 x 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA.

RESULTS

We found no equipment x level interaction effect (F(3.7,72) = 1.34, P = .279) or equipment main effect (F(2,18) = 1.20, P = .325) for the SAC (no equipment = 5.04 +/- 1.44 mm, SP = 4.69 +/- 1.36 mm, FG = 4.62 +/- 1.38 mm). The CTA was greater (ie, more extension; critical P = .0167) during the SP (32.64 degrees +/- 3.9 degrees) condition than during the no-equipment (25.34 degrees +/- 2.3 degrees ; t(9) = 7.67, P = .001) or FG (26.81 degrees +/- 5.1 degrees; t(9) = 4.80, P = .001) condition.

CONCLUSIONS

Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.

Neck back and spine injuries in amateur rugby league: a review of nine years of Accident Compensation Corporation injury entitlement claims and costs

Rugby league is a popular participation sport, but there have been concerns raised regarding the possible high number of severe neck, back and spine injuries. Therefore an epidemiological overview of rugby league neck, back and spine injuries and associated costs of these injuries was undertaken in one country over nine years. The New Zealand national Accident Compensation Corporation data for moderate to serious injury entitlement claims (MSC) over nine years were analysed for the number, type and cost of neck, back and spine rugby league injuries resulting in medical treatment. There were 206 (3%) neck, back and spine MSC claims totalling NZD$1,585,927 (4%) of the total injury entitlement costs for rugby league over the nine-year period. The rate of MSC neck, back and spine rugby league injuries was 26 per 1000 total rugby league claims. Although the rate of neck, back and spine injuries varied over the nine years from 22 to 40 per 1000 injury claims, there was a significant increase over the duration of the study in the number of neck, back and spine MSC claims (χ2=849, df=8, p<0.001), and the cost per MSC injury claim (χ2=19,054, df=8, p<0.001). The frequency, severity and first 12 months cost of neck, back and spine injuries in rugby league is an issue that needs to be addressed. Unfortunately the ACC data base does not provide information on how or why the injuries occurred. A prospective injury epidemiology study needs to be conducted that will allow collection of information surrounding the mechanisms of injury and possible causative risk factors such as tackling technique. In the meantime it is suggested that coaches should ensure tackling technique is correctly taught to all rugby league players to reduce the risk of neck, back and spine injury. Team medical personnel should be trained in dealing with neck and spine injuries as well as head related injuries, and emergency procedures in dealing with players with a suspected neck or back injury should be practiced at clubs.