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Return to Play After Cervical Spine Injury in Sports

Cantu, Robert C. MD, FACS, FACSM1; Li, Yan Michael MD, PhD2; Abdulhamid, Mohamed MD2; Chin, Lawrence S. MD, FACS2

doi: 10.1249/JSR.0b013e31827dc1fb
Head, Neck, and Spine: Section Articles

Spinal cord injuries (SCIs) resulting from sports now represent 8.9% of the total causes of SCI. Regardless of cause, there are bound to be return-to-play decisions to be made for athletes. Since catastrophic cervical spine injuries are among the most devastating injuries in all of sports, returning from a cervical spine injury is one of the most difficult decisions in sports medicine. Axial loading is the primary mechanism for catastrophic cervical spine injuries. Axial loading occurs as a result of intentional or unintentional head-down contact and spearing. Most would agree that the athlete returning to a contact or collision sport after a cervical spine injury must be asymptomatic, have full strength, and have full active range of motion; however, each situation is unique. The following review discusses the pathophysiology of these conditions and suggests guidelines for return to contact sports after traumatic cervical SCI.

1Departments of Neurosurgery and Sports Medicine, Emerson Hospital, Concord, MA; and 2Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY

Address for correspondence: Robert C. Cantu, MD, FACS, FACSM, Departments of Neurosurgery and Sports Medicine, Emerson Hospital, 131 Old Road to Nine Acre Corner, John Cumming Building, Suite 820, Concord, MA 01742; E-mail:

© 2013 American College of Sports Medicine