Return to Play
Criteria for the patient's return to unrestricted competition include the following [26, 27] :
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Minimal or no tenderness
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Full AROM
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Neck strength versus resistance without pain is within normal limits (WNL)
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Posture is WNL
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Neurologic examination is WNL
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Absence of neurologic symptoms
The likelihood of a recurring injury is extremely high if the player returns to action before pain, tenderness, and ROM have returned to normal.
Prevention
For participants in football or wrestling, strengthening of the muscle groups supporting the cervical spine is imperative. [1, 2, 3] To guarantee adequate development of strength, power, and endurance, strengthening routines need to include a variety of isometric and isotonic exercises. Emphasis must be placed on strengthening not only the large cervical flexors and extensors, but also the smaller paravertebral muscle groups because they offer the final resistance to forces that may cause dislocation of the vertebrae. Sport-specific drills with emphasis on cervicothoracic spine stability should be included in the athlete’s exercise regimen.
Athletes are advised to add a minimum of 1 cm to their neck circumference. Warm-up of the neck and the cervical spine should be emphasized, especially in contact sports. By performing several repetitions of cervical flexion, cervical extension, lateral bending, and rotation, the athlete can sufficiently warm up the neck. After workouts, while the muscles are warm, stretching to maintain or increase the AROM should be completed. In all AROM, the cervical muscles should be stretched to their limits and held in the stretched position for 30-60 seconds.
In football, a proper shoulder pad should encompass many of the characteristics of a proper cervicothoracic orthosis. Important characteristics of a proper shoulder pad include a modified A-frame shape that fits the athlete's chest and prevents the shoulder pad from rolling during contact. [1, 2] Firm, circumferential fixation to the chest is important. Proper fit to the chest is important in evenly distributing the shock to the shoulders over the pad and to the thorax. Better plastics in the outer shell of the pad and improved resistive padding absorb the shock and allow the use of the shoulder in proper blocking and tackling techniques. Improved shoulder protection should allow the player to de-emphasize the use of the head as a blocking and tackling instrument.
After fixing the chest, fix the neck to the chest by the fit of the shoulder pad at the base of the neck. Thick, stiff, comfortable pads at the base of the neck are the key considerations. This lateral support at the base of the neck offers fixation to the cervical spine.
Education
Proper head and neck positioning should be emphasized in all sports. Football players must be taught proper blocking and tackling techniques to avoid the head-first block or tackle, such as spearing, and the use of the head as an offensive weapon, which can increase the potential of severe cervical injury. [1, 2] Wrestlers should be instructed to avoid the maneuver of bulling the neck into a hyperextended position while attempting or blocking a takedown because this appears to be associated with the greatest number of neck injuries in wrestling. [3]
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Bony framework of head and neck.
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Cervical vertebrae, the atlas and the axis.
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Cervical vertebrae.
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External craniocervical ligaments.
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Internal craniocervical ligaments.
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Atlantooccipital junction.
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Lateral view of the muscles of the neck.
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Anterior view of the muscles of the neck.
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Infrahyoid and suprahyoid muscles.
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Scalene and prevertebral muscles.
