While football is frequently blamed for concussions, a new study shows that it’s also the sport in which athletes are most likely to suffer neck injuries.
A neck fracture, commonly referred to as a broken neck, is a break in one or more vertebrae in the upper part of the spine. Neck sprains involve injury to the soft tissue surrounding those bones. The neck is referred to medically as the cervical spine.
“We expected that American football was the leading cause of cervical spine injury, and it was for overall injuries (fractures and sprains),” said study author Dr. J. Mason DePasse. He’s a trauma fellow in the department of orthopaedics at Brown University’s Alpert Medical School in Providence, Rhode Island.
The increasing rate of neck injuries doesn’t surprise Matthew Axtman, DO, an orthopedic and sports medicine specialist with Spectrum Health Medical Group.
“All injury rates have increased across the spectrum of all sports,” he said. “We have become a society of individuals who have become faster, stronger, hitting harder, playing harder and are becoming more daring.”
Athletes are pushing the limits of speed and courses, and increasing the technical difficulty of maneuvers and stunts.
“Becoming more aggressive and competitive in contact sports may put you at a higher risk for injury,” Dr. Axtman said.
As a physician who treats athletes at major sporting events, Dr. Axtman said cervical spine injuries are among the top injuries he hopes don’t occur.
“These injuries can be life altering if there is injury to the spinal cord,” he said. “They are not among the most common injuries, but can be very dangerous.”
Neck fractures and sprains caused by high velocity trauma involve compression, hyperflexion or hyperextension of the neck.
Symptoms to monitor for include: midline cervical spine tenderness, numbness down both arms and legs, and loss of strength in the extremities. If there is suspicion of a cervical spine injury, ensure that the athlete does not move his or her neck until evaluated by medical personnel for spine clearance.
“Another important point is to not push yourself beyond your capabilities or attempt anything outside your comfort zone,” Dr. Axtman said.
“Most neck fractures during sports don’t involve paralysis,” DePasse added. “Certainly that can happen, but most people … can have arm weakness.”
DePasse and his colleagues combed through data collected by the U.S. National Electronic Injury Surveillance System from 2000 to 2015. More than 27,000 patients with neck injuries sustained from sports were identified, including 26,380 neck sprains and 1,166 fractures.
Compared to women, men’s injury rates were 1.7 times higher for neck sprains and 3.6 times higher for fractures.
Trailing football as the most common cause of neck sprains in men were cycling and weightlifting/aerobics. Women suffered the most neck sprains in weightlifting/aerobics, trampoline and cheerleading.
Broken necks among men resulted mostly from cycling, followed by diving/swimming and then football. In women, neck fractures were most common from horseback riding, followed by cycling and diving/swimming.
DePasse said he was struck by the dramatic jump in sports-related neck fractures over the study’s time frame. Fracture incidence grew by 35 percent and was driven by an increase in cycling-related injuries. Part of the increase might be explained by better detection of broken necks through imaging, he said.
“Most people with fractures that are invisible on X-ray are going to be fine anyway, but we’re probably catching more of them now,” DePasse added. “But there’s clearly been an increase … and this would be the time to raise awareness and call attention to this rising issue.”
Dr. K. Daniel Riew is a cervical spine surgeon at New York-Presbyterian/Daniel and Jane Och Spine Hospital in New York City. He found it surprising that horseback riding was the leading cause of broken necks in women.
“If you ask the number of women who horseback-ride, we’re probably talking about less than 1 percent of the U.S. population, so to think it’s the most common reason for a fracture? I wouldn’t have predicted that,” said Riew, who wasn’t involved with the study.
Conversely, Riew treats many patients who’ve suffered neck injuries due to bicycle accidents and football.
“Part of the reason the number of bicycle-related injuries has gone up is that more people are riding bicycles,” he said. “This research highlights the importance of being aware of the way you can injure your neck. Knowledge is the best thing.”
Since helmets can’t protect against neck injury, DePasse suggests athletes help prevent them by paying closer attention to the rules and constraints of their sport.
“For diving, it’s always someone not looking at the depth of the water,” he said. “For cycling, my guess is a lot of these injuries happen from people being hit by cars in areas they shouldn’t be in, or they go somewhere that’s clearly not meant for cycling. Make sure you’re in a place set up for your activity.”
The study is scheduled for presentation at the American Academy of Orthopaedic Surgeons’ annual meeting in New Orleans. Research presented at such meetings typically hasn’t been peer-reviewed or published, and results are considered preliminary.