Management of Cervical Spine Injuries in Athletes

Spinal injury in sport

Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding.

Management of the helmeted athlete with suspected cervical spine injury

Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research.

On-the-field evaluation of an athlete with a head or neck injury

Head and cervical spine sports-related injuries are intimately associated. The on-field evaluation and management of the athlete with these injuries is of paramount importance to stabilize the athlete and prevent further injury. Clinicians need to be aware of the differential diagnoses and consider each possibility based on the mechanism of injury. Although recognition of head and cervical spine injuries has resulted in significant reductions of catastrophic neurological injuries, especially in the cervical spine, further advances to decrease the incidence and long-term sequelae of head and neck injuries are needed. The first step is education of the athlete and the individuals involved in the care of that athlete.

Contents for chiropractors' athletic event emergency bags

BACKGROUND

Chiropractors are providing health care at a growing number of athletic events. With this increased participation it is critical that chiropractors be adequately prepared for these events with the proper knowledge, skill, and equipment to provide emergency care.

OBJECTIVE

The objective was to recommend an inventory of items that should be included in a chiropractor's event-site emergency bag, based on the best available evidence.

DATA SOURCES

A pilot search was conducted by searching MEDLINE to retrieve articles regarding emergency supplies used at athletic events. Key terms were then taken from the pilot search and used to conduct a systematic search and review of the literature.

STUDY SELECTION

Articles were included if they were published in English and discussed athletic event-site emergency first aid and supplies. Articles published in non-peer-reviewed publications were excluded.

DATA EXTRACTION

Items recommended for event-site emergency care bags were extracted from 19 studies and reviewed by an expert panel of sports chiropractors. Expert rankings from a Likert scale were then averaged for each item.

DATA SYNTHESIS

Items are categorized as recommended, possibly recommended, or not recommended based on expert rankings and frequency counts of citations.

RESULTS

The most recommended items were latex gloves, penlights, and oral airways. An inventory of 169 items with citations and ratings is included in this review.

CONCLUSION

This is the first evidence-based article to delineate appropriate first aid and emergency equipment for sports chiropractors. This article has utility for educators who teach emergency care for athletic events and for practitioners who would like to have a clear inventory for their emergency bags.

Athletes with cervical spine injury

Athletic injuries to the cervical spine are infrequent, but can present difficulty in both diagnosis and management. We designed a simple classification system consisting of three broad types of injuries to facilitate management decisions. Also included is a discussion of variations among injuries within each type and recommendations regarding the athlete's return to competition.