Approximately 50 percent of the overall population will experience neck
pain at some point in their lifetimes, with sports-related injuries accounting
for about 10% of all neck injuries and symptoms. The cervical spine is a region
which requires more concentrated attention that it usually receives. – Dr. Alex
Jimenez, Chiropractor El Paso
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The predominance of neck injuries in sports is believed to be rising,
mostly due to the increased improvements in injury recording and observation. However,
the growth of physical, extreme sports has led to higher risks of injury among unprepared
athletes.
For instance, athletes who participate in sports such as skeleton, where
individuals sprint on ice and hurtle head first down an icy, often bumpy track
at elevated speeds, must learn to understand the importance of properly
training their neck to avoid complications to its surrounding structures. Neck
injuries are common in skeleton but these can be prevented. Neck training doesn’t
simply involve avoiding the risk of suffering a neck complication, in competitive
sports, such as skeleton, strengthening the neck can ultimately improve an
athlete’s overall physical performance, helping them achieve their goals of triumph.
In order to decrease the chance of injury, the neck needs to be
strategically and individually prepared to ensure it has a greater tolerance to
the increased loads it’s exposed to. But, before an athlete begins implementing
this program, it’s essential for them to receive an accurate evaluation of
their cervical spine in a comprehensive assessment and screening process.
How Neck Injuries Occur
Neck
injuries occur most frequently in motorsports and high impact, collision sports
like rugby. It’s been previously described that acute force exposure through
compression and distraction, axial loading and/or direct blows along with
sudden acceleration and deceleration of the structures of the body, are the
most common reasons for injury in these types of sports.
Compression,
or axial loading, is the primary means of neck injuries in sports and often
results when load is applied and the neck’s natural lordosis, or curvature, is
lost, generally due to an excess flexion which leads to an improper
distribution of the energy placed against the body.
With acute
exposure, the increased pressure can cause severe damage or injury to the
cervical spine while chronic exposure can create an accumulative effect. Collapsed
scrums in rugby, falls from heights and unexpectedly, timed maneuvers in combat
sports can create situations where neck injuries may occur. Another type of
neck injury which can develop from axial forces include brachial plexopathy
irritation or injury. These can be either compressive or distractive in nature,
most frequently reported among athletes who participate in tackling sports or
as a result of a fall from a height where the neck is laterally flexed and the
shoulder girdle is decompressed.
Brachial plexopathy
injuries occur when a downward traction pressure is applied on the shoulder
girdle as the neck is contra-laterally flexed or may occur due to compressive
forces being placed against the vertebra of the spine. Symptoms can include
temporary, altered sensations and weakness as a result of irritation to the
nerve roots found along the cervical region of the spine. Following any
compression or distraction injuries, healthcare professionals should suspect
the presence of spinal cord injury. This severe complication may need to be
cleared by a healthcare professional following a thorough on-field assessment
before the athlete is moved.
Whiplash Associated Disorders
Whiplash is a commonly diagnosed type of neck
injury, most frequently caused by the sheer force of an automobile accident
against the complex structures of the cervical spine, however, it can also
commonly occur in sports which also involve sudden acceleration and
deceleration of the body or after an athlete has suffered a direct flow to the
trunk or head. A combination of neck pain, headaches, temporal mandibular
dysfunction and referred pain as well as neurological symptoms may result when
applied pressure is transferred to the neck, causing sudden, uncontrolled
movements which may lead to damage or injury to the anterior and posterior
structure of the cervical spine.
The cervical spine, or neck, isn’t only at
risk of experiencing acute injuries, chronic exposure to pressure from external
and internal forces from maintained static positions, such as in sports like
archery, or constant exposure to gravitational or vibration forces can
frequently develop neck injuries and symptoms due to overuse. The symptoms of
chronic G-force exposure include neck pain as well as dizziness, disorientation,
altered vision, reduced co-ordination. These symptoms can ultimately reduce an
athlete’s performance, impairing their ability to properly participate in their
specific sport and may place both athletes and opponents at risk of serious
complications, especially when travelling at increased speeds. These symptoms
are believed to appear due to a combination of reduced blood flow to the head,
visual disturbances and high amounts of load being placed on the musculature of
the neck.
G force should be immensely considered in
contact sports where collisions between players can expose athletes to forces
equivalent to those experienced during a car crash. Long term exposure to G-forces
has been determined to leave athletes with an increased risk of developing
vertebral disc degeneration complications. Furthermore, exposure should be
observed closely.
Evaluating Neck Injuries
Before participating in any type of sport, the
basic range of mobility and strength of the neck should be properly evaluated
to provide baselines to a healthcare provider in order to help them determine
the most appropriate sport planning treatments, similar to any other peripheral
joint injury.
The structure and function of the cervical
spine is complex, where the vertebra primarily contribute to the varying
degrees of overall neck motion. The change of orientation of every cervical vertebra,
from the mid to lower cervical spine, allows for rotation, flexion and
extension of the neck, however, this also isolates lateral flexion to the upper
portion of the cervical spine. When a healthcare professional determines the
baseline range of movement of the neck, it is also essential to understand that
this can commonly decrease with age, therefore, a normal range can vary between
athletes and is likely to change over an athlete’s career.
Neck Range of Motion Stretches
The most reliable standard for measuring the range of movement of the
cervical spine is radiological examination but due to expense, this technique is
not considered convenient among sporting environments. Many healthcare
professionals can easily determine if there’s an issue with the individual’s neck
range of motion and there are several reliable and inexpensive tools which can
be effectively used. These include the full-circle goniometer, or simply a tape
measure to record the distance between anchor points, which can be easily
replicated.
The primary stabilizers of the neck are collectively known as the deep
neck flexors, consisting of the longus capitus, the longus colli, the rectus
capitis anterior and the rectus capitis lateralis. Without using EMG resources,
these can be difficult to isolate but are most active through the commonly
prescribed craniocervical flexions, or chin tuck. The most common evaluation
utilized to measure the activation and endurance of the deep neck flexors is
the craniocervical flexion test and are assessed using a biofeedback device. This
assessment serves as a useful baseline test and can be used to acknowledge
weakness and movement control dysfunctions. To perform a craniocervical flexion
test, the patient lays supine while maintaining the neck in a neutral position.
Then, an uninflated pressure sensor is placed behind the neck so that it
borders the occiput. The cuff is inflated to 20mm Hg. The movement is described
as a slow, head nodding action. The patient must attempt to sequentially target
five 2mm Hg progressive pressure increases with 10 second holds.
Previous studies have concluded that the activity of the stabilizers is
considerably decreased and delayed in anyone with neck pain and it can be
considered a great starting point for all neck rehabilitation treatments to
regain stability in the structures of the cervical spine. Postural evaluations
are also a key component of neck assessments. The main function of the neck is
to optimize head position. Equal displacement of the weight of the head is
essential when it comes to minimizing overload to the stabilizing muscles of
the neck. Several tests have been developed to aid the assessment of cervical
movement control dysfunctions including neck function in four-point kneeling and
with upper extremity movement.
Prime Movers
Cervical prime mover strength can be evaluated in several ways including
the utilization of isokinetic and isometric dynamometers which can be linked
with muscle activity measurements using EMG studies. Generally, cervical
extensions are stronger than flexions among popular research while lateral side
flexions are commonly grouped with extensions involving a bias towards the
individual’s dominant angle. Among athletes who depend on a dominant side bias,
such as racquet and other throwing sport athletes, for performance advantage,
this asymmetry should be understood but not necessarily be seen as detrimental.
In the case an athlete doesn’t have access to isokinetic and EMG
equipment, baseline strength can be determined using a handheld dynamometer. A
healthcare professional should decide on which ranges should be tested to
remain consistent while accommodating any sport specific positions if necessary.
To ensure all information is regulated, a healthcare professional should make
sure the individual’s torso is stabilized while minimizing lower limb
involvement, such as having the athlete’s feet on a wobble cushion, and
appropriate ranges should be set to measure the individual’s strength through
standardized warm-up and testing protocols.
The neck doesn’t function in isolation. A relationship between neck pain
and shoulder dysfunction has been previously recorded through research,
therefore, the entire kinetic chain should be considered when evaluating the
function of the neck. Particularly among swimmers, shoulder dysfunctions can
frequently lead to hypertonicity of the muscles surrounding the neck which can
cause muscle imbalances, dysfunction and pain, all which could eventually lead
to further neck injury in the athlete if left without a proper assessment.
Neck Injuries and Concussions
When treating acute neck injuries, healthcare professionals should
suspect the presence of concussions in athletes due to the increased forces
that are transferred between the regions of the cervical spine. After providing
the above neck evaluations, a proper assessment on athletes should be carried
out to determine if there was any head trauma, or concussion, following a neck
injury. Research has concluded that concussions may be associated with the
strength of the neck. In fact, studies showed that neck strength is a
significant predictor of concussion amongst a large percentage of high school
athletes and, although further research is needed, these showed positive
outcomes in reducing the risk of concussion when individuals adopt these neck strengthening
programs.
In conclusion, cervical injuries can occur in a variety of
sporting environments from the result of acute trauma through axial loading,
prolonged position exposure, whiplash and external forces, such as vibrations
and G forces. All cervical evaluations for neck injuries should rule out severe
spinal injury and concussion as well as include range of movement measurements
and prime mover strength assessments.
By Dr. Alex Jimenez, Chiropractor El Paso