When do cervical spine (c-spine) precautions apply in sports medicine coverage?

From the Guidelines

C-spine precautions should be implemented immediately for any athlete with suspected neck or spinal cord injury, especially in high-risk sports like football, rugby, or diving, as this can help prevent secondary injury to the spinal cord during assessment and transport 1. When to apply c-spine precautions:

• There's neck pain after trauma
• The athlete reports numbness, tingling, or weakness in extremities
• There's altered level of consciousness
• Any mechanism of injury that could have affected the spine Steps to take:

1. Immobilize the head and neck in a neutral position
2. If a first aid provider suspects a spinal injury, they should have the person remain as still as possible and await the arrival of EMS providers 1
3. Secure the athlete to a backboard for transport, if available and trained to do so
4. Maintain inline stabilization during any movement It is crucial to note that the use of cervical collars is not recommended as a routine application by first aid providers, as there is evidence showing more harm than benefit 1. However, in situations where spinal injury is suspected, it is essential to prioritize immobilization and stabilization over the potential risks associated with cervical collar use. Do not remove helmet or shoulder pads on the field, as this can cause further injury, and only remove equipment in a controlled medical setting. The goal is to prevent secondary injury to the spinal cord during assessment and transport, and always err on the side of caution - it's better to take unnecessary precautions than to risk catastrophic spinal cord injury.

From the Research

Cervical Spine Precautions in Sports Medicine

Cervical spine precautions apply in various situations in sports medicine coverage, including:

• Contact and collision sports, such as American football and rugby, where cervical spine injuries are most common 2, 3
• Noncontact sports, such as baseball, gymnastics, and diving, where cervical spine injuries can also occur 2, 3
• Situations where athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma 2, 3

Return to Play Guidelines

Return to play guidelines after a cervical spine injury consider factors such as:

• Asymptomatic status from prior injury with no neurological deficits 4, 5
• Full, painless, active range of motion of the neck 4
• Injury diagnosis, symptoms and severity, history of cervical spine injuries, anatomic variants/anomalies, history of treatment/surgery, and any ongoing or persistent symptoms 4
• Clinical judgment to ensure conservative decisions are made and patient safety is maintained 4

Common Cervical Spine Injuries

Common cervical spine injuries associated with contact sports include:

• Cervical muscle strains 2, 3
• Cervical fractures with spinal cord injuries 2, 3
• Stinger/burners, strain, stenosis/cord neuropraxia, disc herniation, and fracture/instability 6