Spine injuries in athletes, though rare, can have tragic and lasting consequences. Understanding spine injuries in athletes is critical for prevention and prompt treatment when they do occur. This guide will overview the most common athletic spinal cord and vertebral column injuries, outline higher risk sports, and provide athletes, coaches and medical professionals strategies to lower injury risks.
Types of Spine Injuries in Athletes
Spinal Cord Injuries
The spinal cord is the main pathway of information flow between the brain and body. It runs through the spinal canal from the base of the skull down to the lower back, protected by the vertebral bones. Trauma or disease can damage the spinal cord, disrupting critical communication channels.
Signs and symptoms of a spinal cord injury depend on the location and severity of damage but may include:
- Loss of movement or sensation in areas of the body below the injury site
- Loss of bowel/bladder control
- Difficulty breathing, coughing or clearing secretions
- Sharp, shooting or burning pain at the injury location
Spinal cord injuries are classified as complete or incomplete. Recovery potential varies greatly but with aggressive rehabilitation some function may be restored over time. However, these injuries often result in permanent disability.
Spinal Fractures and Dislocations
While the spinal cord is the pathway for nerve signals, the spinal column surrounding it provides structural support and protects from external impacts. Excess axial compressive forces and rotational mechanisms can fracture vertebrae or displace them from their proper alignment.
Spinal fractures frequently involve the cervical spine and occur most often at C5-C6. They may be stable or unstable depending on the damage to supporting ligaments and location of bone fragments. Spinal dislocations happen when vertebrae are knocked completely out of position, severely stretching or tearing connective tissues.
These acute spinal traumas can cause blood vessel rupture, pinched nerves, organ damage and spinal instability. Seeking prompt medical treatment is imperative to realign the vertebral column, decompress neural elements, and stabilize the spine to prevent further injury.
High Risk Sports
Some athletic activities have higher incidences of spine trauma due to contact-related collisions, axial loading mechanisms, or complex skill maneuvers.
Football
As America’s most popular sport, football tops the charts for quantity of catastrophic cervical spine events each year. Tackling and blocking with improper form is the primary culprit. Leading with the crown of the helmet transmits dangerous compressive energy through the neck that can exceed the cervical spine’s load tolerance threshold.
Fortunately, recognition of spearing and helmet-to-helmet contact as the catalyst for permanent quadriplegic outcomes provoked massive declines when penalties and coaching changes aimed to eradicate it from the game in the late 1900s. While football’s risk profile improved, it still claims more spine casualties across youth, high school and collegiate levels combined than any other sport.
Another common football neck injury is called cervical cord neuropraxia. This means the spinal cord in the neck gets squeezed temporarily, causing paralysis-like symptoms. The paralysis is terrifying when it happens but actually goes away fully within minutes to hours. Athletes born with narrower spinal canals in their neck may be more prone to these stingers. Even though complete recovery is expected, getting multiple stingers is still concerning. The nervous system can only handle so much, even with rest between. So doctors remain very cautious about clearing players to return after repeat neuropraxia, despite recovery from the recent event. We have to consider the risk of cumulative harm adding up over time.
Ice Hockey
The speed and physicality ingrained in hockey contribute to it posting the highest rate of catastrophic spinal injuries per capita, though still relatively low in absolute terms. Checking from behind into the boards accounts for many of the cervical spine fractures and dislocations documented in the sport.
The good news is that rules penalizing dangerous hits from behind, along with required neck guards, seem to be reducing these injuries. Officials closely enforcing these rules, along with ongoing coaching and training on safer techniques, remains critical to bring the injury risk down further. We’ve made great progress but can’t let up now. Continuing education and vigilant rule enforcement is key to better protect players.
Wrestling
Wrestling’s intense, physical nature leads to frequent neck injuries, usually during takedowns. Getting forcefully thrown down while stuck in a bent or twisted position can severely damage the spinal cord.
Coaches play a huge role in prevention by constantly teaching proper and safe technique. Getting young athletes to make smart habits second nature gives them the tools to react well despite wrestling’s chaotic situations. Officials also protect wrestlers by quickly stopping the match if they end up in peril and penalizing illegal moves.
And all coaches must train wrestlers on safer stances, throws, and how to fall. Learning to fluidly move with and redirect an opponent’s force protects the spine when aggressive takedowns happen. Because with such a gritty, hard-fought sport, those intense battles are inevitable. But we can better prepare athletes so they emerge unscathed.
Diving
While diving has moderately high spinal injury rates, most traumatic events happen with recreational activities rather than competitive diving under proper supervision. Racing dives into shallow water produce the vast majority seen in the sport.
Collegiate and Olympic platforms have converted to water depth or adjusted board height rules to allow sufficient space for divers to straighten before entry. Facilities catering to public diving should mimic these updated standards. More importantly, lifeguards must proactively enforce “feet first” jumping requirements in shallow areas.
Skiing and Snowboarding
Once considered low risk for spinal fractures, newer data found snow sports neck and back injury trends climbing over the past decades. Likely factors include faster ski speeds, evolving equipment profiles, snowboarding’s influx, and extreme park features enabling radical aerial attempts.
Beginners face higher risks until technique matures, so gradual skill progression under guidance is key. Avoiding fatigue and sizable crowds on slopes may also be protective. Lastly, those flying high cross fingers no hidden rock, tree or ground-hugging backflip awaits their landing.
Rugby
Rugby’s legendary intensity exacts a toll on players’ long-term health. The sport sees more than its fair share of serious neck and spine injuries every year. The scrum in particular poses problems, as the front line players absorb dangerous blows to the head and neck.
Some rule changes show promise in lowering risk though. Having the two packs come together more slowly, in a controlled sequence, may help drop scrum-related injuries. More careful return-to-play decisions for athletes recovering from spinal issues could also help. Being overeager to put players back on the pitch before they fully heal often backfires. Some careers get cut short as recurring injuries accumulate. Taking a smart, patient approach allows proper strength and stability restoration and helps athletes avoid preventable reinjury.
Cheerleading
Once viewed mostly as peppy sideline entertainment, competitive cheerleading now consists of elite tumbling, intricate basket tosses and precarious multi-layer pyramids. The visual appeal does not align with elevated catastrophic injury risks though, especially for younger participants.
Restricting difficult skill elements by age and mandating spotters helps mitigate exposure. Coach and athlete education on concussion risks with falls onto hard surfaces is also beneficial. Separating performance cheer from school-affiliated participation could allow differentiated rules tailored to environment.
Baseball
Baseball has an interesting mix of generally low incidence of injury compared to high proportion of them being severe when they do happen. Numerous catastrophic spine incidents involved base runners upending over catchers, fueling recent debate over head first sliding restrictions returning at higher levels.
Coaches should train players on proper sliding form and catchers how to brace for contact. Umpires can also help by consistently enforcing collision rules meant to protect vulnerable fielders. And baseball commissions reexamining head first sliding merits more research weighing risks against theorized speed advantages.
Prevention Strategies
Implementing sound prevention strategies reduces spine injury vulnerability so athletes can keep fulfilling their championship dreams.
Protective Equipment
Sports engineering continues evolving protective gear capabilities balancing injury prevention and play performance. Proper protective equipment selection, fitting, maintenance and refurbishment/replacement of helmets, braces, and pads is imperative. Ensuring compliance with safety gear mandates falls not just on athletes, but coaches and referees as well.
Technique and Training
Coaches play the most vital role in ingraining proper technique fundamentals from the earliest skill development stages. They also craft strength and conditioning programs that prime athlete’s bodies to avoid exceeding tissue tolerances. Refining movement patterns and decision making under game situations right along proper skill progressions can pay huge dividends.
Rule Changes and Enforcement
Sports governing boards and referees steer the game through prudent rule adjustments targeting heightened injury risk areas. Consistent enforcement of dangerous play penalties also deters athletes from compromising safety for milliseconds of advantage. Saving neck function far outweighs any small edge dangerous maneuvers garner.
Core Muscle Strengthening
Strengthening core stabilizer and postural muscles enhances spine robustness and resiliency. Pilates, yoga and targeted strength routines bolster muscle guardians that kick in automatically during awkward impacts and abrupt load exposures. A stronger foundation fosters safer play.
Supervision and Education
Coaches and training staff directly control athlete exposures, so keeping close reins on risk escalation is vital. Educating athletes on injury mechanisms in their sport allows self-protection by avoiding potentially dangerous situations. Open communication channels between athletes, medical staff, coaches and governing bodies continue optimizing safety initiatives.
Conclusion
Spinal cord injuries are uncommon but can have devastating impacts on athletes. The good news is that increased awareness and changes in training, rules, and equipment have made most sports safer over time. Still, contact sports like football and rodeo, along with activities like cheerleading and diving, have more risk than others. Coaches and medical staff play key roles in teaching proper form and technique from the start. And governing boards balance making rules safer without changing the spirit of the game. Athletes also have to speak up about injuries, avoid dangerous moves or positions, and follow guidelines. Working together, we can help prevent spinal cord injuries, so athletes can enjoy long careers doing what they love. But these injuries may still occur despite the best efforts. So having an emergency action plan and proper medical expertise on standby remains vital as well.
Written by Dr. Tony Mork
Orthopedic Spine Surgeon
I’m Dr. Tony Mork, MD, a Minimally Invasive Orthopedic Spine Surgery Specialist in Newport Beach, California. With over 40 years of experience, I’m dedicated to providing information for all topics that involve neck and back pain.
February 12, 2024
Contact a Spine Specialist Near You!
Related Articles
Lower Back Pain | An Overview
Lower back pain is an exceedingly common affliction that affects up to 80% of adults at some point in their lives. Understanding the underlying causes of lower back pain is key to finding the appropriate treatment and relief. Anatomy of the Lower Back The lower back,...
Degenerative Disc Disease | Causes and Risk Factors
Degenerative disc disease describes age-related wear and tear to the rubbery spinal discs cushioning the vertebrae that can lead to chronic back or neck pain. While partly genetic, there are also lifestyle factors and injuries that accelerate disc degeneration over...
Upper (Thoracic) Back Pain | What is Causing My Pain?
Upper back pain is a surprisingly common affliction, affecting up to one-quarter of the adult population at some point. While not as prevalent as lower back pain, discomfort in the thoracic region still accounts for a substantial slice of musculoskeletal complaints...