Are neck injuries, and even fatalities, a simple fact of footballing life? Is enough being done to stop them happening?
De’Antre Turman was a junior cornerback at Creekside High School in Fairburn, Georgia, who suffered blunt force trauma to the neck which resulted in broken vertebrae and what appears to have been a rapid death. The accident has clearly left Tre’s teammates, family, and friends devastated and provided a stark reminder that the game can be extremely dangerous, even if such accidents are rare. Tre was an experienced football player who had already got a scholarship offer on the table, and the accident doesn’t appear to have been caused by anthing other than normal play with tragic consequences.
College Football and High School Football Risks
High school footballers are not the only ones at risk, however. Indeed, college football players have almost three times the incidence of catastrophic neurological injury in the past thirty years, with 1.5 per 100,000 players compared to 0.5 amongst high school student players. Professional athletes are also routinely injured, albeit not often with fatal consequences.
Changing the Rules of Football to Improve Safety
Malcom Floyd’s injury was the result of another player driving his head into charging linebacker DeMeco Ryans, with Floyd prone for several minutes before being carefully stretchered off the field for assessment. Physicians from both teams came to his aid and the Chargers’ coach, Mike McCoy has said that Floyd is doing fine and that “All the tests right now look good.”
So what has been done to reduce head and neck injuries in football in recent years? Is there more that can be done? Are neck injuries simply unavoidable?
Understanding why and how neck injuries occur in American football means understanding how the game is played, including how players train and what kind of contact is considered allowable and desirable. One major change was the decision in the mid-1970s to prohibit the use of the head as an initial point of contact when tackling and blocking. This resulted in a massive drop in cervical spinal injuries, and even simple neck pain, without ruining enjoyment of the game in any way.
Reducing the Risk of Neck Injuries
Other steps that have been taken to reduce neck injuries on the football field include paying special attention to strengthening of the neck muscles during training, ensuring protective headgear and padding is worn at all times, and having trained medical staff on hand to minimise risk if an injury does occur. In a paper from 2003, Cross and Serenelli also cite flexibility training as an additional approach to minimise the risk of injury and help expedite recovery after injury.
Safety First for Future Football Stars
Watkins wrote in 1986 about the importance not only of the recent changes in game strategy and technique but also of proper on-field evaluation, transportation of injured players, and consultation after injury. Players, their families, and other coaching professionals in their lives, also ought to be made aware of the risks involved in football, how to minimise the risk of neck injury, and what to do in the event of such injury.
Spinal Stenosis in the Neck
The neck is particularly vulnerable to injury in contact sports due to the more flexible structure of the vertebrae, especially at C4-C6 where the proportion of the spinal cord in the spinal canal is greater than anywhere else in the spine. As such, any trauma to this area is more likely to impact the spinal cord itself, raising the risk of severe neurological damage and death.
Causes of Neck Injuries in Football
Even in cases that are not quite so immediately catastrophic, repeated trauma to the neck can result in chronic pain and earlier onset of arthritis and severe neck pain from disc degeneration and skeletal changes. The so-called ‘stinger’ is a relatively common neck injury in football where a cervical nerve root or brachial plexus injury results in neuropraxia and intense nerve pain. Cervical cord neuropraxia also occurs and is a more severe injury after hyperextension, hyperflexion or axial loading induces damage in the neck tissues.
Symptoms of Cervical Cord Neuropraxia
Cervical cord neuropraxia is estimated to occur in 0.2 players per 100,000 at the high school level and 2 per 100,000 at the collegiate football level. Symptoms include:
- Temporary neck pain
- Paraesthesias (abnormal sensations in the arms and hands)
- Motor weakness in the fingers
In most cases, these types of ‘stingers’ resolve quickly and fully some ten minutes to 48 hours after the injury occurs. However, players with existing cervical spinal stenosis are more likely to suffer cervical cord neuropraxis and so some have suggested routine screening of players to identify those who may have a higher risk of serious injury due to congenital factors. Persistent left neck and shoulder pain or right neck and shoulder pain in a footballer who has had repeated stingers should prompt an assessment, with new tools on offer to help make decisions over future returns to play. Such tools include the mean subaxial cervical space available for the cord (MSCSAC) which can indicate risk of developing chronic stinger syndrome.
Returning to Football After Neck Injury
Catastrophic neurological injury is usually a result of hyperflexion, such as in ‘spear tackling’ and players suffering this type of injury undergo a full neurological examination before being moved from the field or sidelines. Players may be fine after rest, physical therapy, and the use of some medications or natural treatments to relieve pain and persistent inflammation. However, premature use of anti-inflammatories may result in further injury as can the use of painkillers that then allow the athlete to return too soon to physical activity that strains the neck. In some cases spinal fusion and decompression surgery is necessary.
For any player, new or with years of experience, news of the death of a fellow player is a time for reflection on the game and the risks posed by playing. Any injured player must decide whether or not to return to competition, and in most cases subsequent neck injuries are rare. However, a serious neck injury from football is always possible, even with the improvements in safety over recent decades, as illustrated by the events of this past week.
Greenberg J, Leung D, Kendall J. Predicting chronic stinger syndrome using the mean subaxial space available for the cord index. Sports Health. 2011 May;3(3):264-7.
Dec KL, Cole SL, Dec SL. Screening for catastrophic neck injuries in sports. Curr Sports Med Rep. 2007 Jan;6(1):16-9.
Rihn JA, Anderson DT, Lamb K, Deluca PF, Bata A, Marchetto PA, Neves N, Vaccaro AR. Cervical spine injuries in American football. Sports Med. 2009;39(9):697-708.
Watkins RG. Neck injuries in football players. Clin Sports Med. 1986 Apr;5(2):215-46.
Cross KM, Serenelli C. Training and equipment to prevent athletic head and neck injuries. Clin Sports Med. 2003 Jul;22(3):639-67.