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Risk Factors of Head and Spine Injuries

Head and cervical spine injuries are a result of a blow to the head or body that causes a whiplash effect at the head. Specifically with head injuries, the whiplash motion causes a coup or countercoup brain injury. With cervical spine injuries, the primary mechanism is forced hyperflexion of the neck, which causes an axial load on the spine, resulting in injury. This occurs most frequently in football when a tackler uses the crown of his head as the point of first contact, known as spearing.35 In sports, such as diving, cheerleading, and gymnastics, axial loading resulting in a possible catastrophic outcome can occur from any fall greater than an individual’s height while the neck is flexed.

Not all risks in collision sports are modifiable because collisions are inherent in these sports (American football, rugby, and ice hockey). Protective equipment, such as a helmet in American football and ice hockey, protects against traumatic injuries but not against internal brain injuries caused by blows to the head, body, or both. Also, when athletes wear protective equipment, they often feel invincible and are more likely to take risks that may contribute to the increased risk of catastrophic injury.35 In rugby, athletes wear no form of head protection, so they are at increased risk of head injury and facial trauma.52-54

The spearing and hyperflexion risk factors are modifiable. Rule changes have decreased the rates of head and spine injuries. Eliminating spearing, intentional or unintentional, in American football, has reduced the incidence of cervical spine injuries. Also, penalizing athletes for intentional blows to the head or checking from behind in ice hockey assists in teaching athletes the proper technique and reduces the risks of head and spine injuries.55

A history of head and neck injuries may be another risk factor. Precautions should be taken in athletes with a previous history of concussion or other head injury and athletes with diagnosed cervical stenosis. Evidence shows that 25% of athletes with a brain fatality had a previous history of concussion, with 16% of those suffering from second-impact syndrome after sustaining a concussion within 1 month of death.35,52 Although it has been documented that history of a concussion may predispose an athlete to a more serious head injury, additional research needs to investigate exact mechanisms.35,56 In addition, athletes with conditions such as cervical stenosis have an increased risk of cervical spine injury during sports in which they may sustain an axial load on the spine due to the narrowing of the neural foramina in the cervical vertebrae.35,57

Prevention of Head and Spine Injuries

The preparticipation examination is an important tool for determining if an athlete is predisposed to a head or spine injury. Assessing the athlete’s prior history of head and neck injuries and recovery from such injuries provides sports medicine professionals with an indication of the athlete’s predisposition for future, potentially catastrophic injuries of the head and neck. The preparticipation physical examination may disqualify an athlete from participation if there are contraindications that dramatically increase the likelihood of them suffering a catastrophic head and neck injury. Examples of disqualifications include spinal stenosis with neurological impairments, prior history of head or spine injury with incomplete neurological recovery, degenerative disease, and other conditions that may predispose athletes to head or spine injury.

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Proper education is essential in reducing the incidence of head and spine fatalities. Teaching athletes the proper technique for tackling in American football and rugby and checking in ice hockey and lacrosse should begin at the youth level and continue throughout to ensure that athletes minimize their risk of catastrophic injury. Athletes should be taught to keep their head up and use their shoulders to contact their opponents. This takes the head out of the hit in collision sports. Teaching athletes the proper technique, beginning at a young age, helps them develop the motor control necessary to play the sport safely.

In sports that do not involve tackling but have a high incidence of catastrophic head and neck injuries, such as diving, cheerleading, and gymnastics, proper technique and safety practices need to be taught at a young age (-3). Proper and attentive spotting during practice and competition reduces the risk of catastrophic outcome. Also, more advanced techniques such as pyramids and basket tosses should only be performed by experienced athletes who are capable of performing these skills safely.55 Specific to cheerleading, various organizations have limited the height in which pyramids can be performed (2 levels high at the high school level and 2.5 times the body height at the collegiate level).55

Lightning Strikes

Lightning is consistently a leading cause of weather-related death in the United States. Sport participation and recreational activity lightning deaths account for 15% and 25% to 30% of the fatalities respectively.58,59 Due to the number of sports played outside during the stormy seasons from early spring into the fall and the frequency of lightning-producing storms combined with population density in certain areas of the United States, athletes and spectators are at risk for sustaining a lightning-related injury.58,59 It is important for athletic trainers to be cognizant of the risks associated with lightning and take steps to reduce risk of lightning-related fatalities.

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