Pathophysiology
These injuries are believed to occur because of repeated microtrauma to soft tissues caused by the repetitive mechanical strain of throwing [PMID:32991703].
The systematic review by Cady-McCrea et al. [PMID:38608819] highlights the biomechanical stresses in rowing, which include significant cervical spine loading from repetitive rowing motions, contributing to injury patterns like cervical spine sprains.
Regardless of the specific sport, axial loading is a common theme in cervical injuries associated with significant neurologic impairment [PMID:33741877].
Epidemiology
Winter sports such as ice hockey, freestyle skiing, and speed skating exhibit high injury rates, with joint sprains being common, which can include injuries to the cervical spine [PMID:35372194].
Baseball players have the greatest percentage of injuries requiring surgery among high school athletes, with shoulder and elbow injuries predominating due to overuse from throwing [PMID:32991703].
During the 2009-2014 academic years, the highest deltoid ligament sprain rates were observed in women's gymnastics (2.30/10,000 AEs), men's soccer (1.73/10,000 AEs), women's soccer (1.61/10,000 AEs), and men's football (1.40/10,000 AEs) [PMID:28318315].
While 54.2% of deltoid ligament sprains happened in practice, competition injury rates were notably higher (rate ratio = 3.74) [PMID:28318315].
Nearly half (49.7%) of deltoid ligament sprains were attributed to player contact [PMID:28318315].
The review emphasizes the high kinetic energy and forces involved in alpine ski racing, coupled with human-environment interaction risks, necessitating prioritized injury prevention efforts [PMID:27480763].
MLB starting pitchers with more than 5 rest days between starts (Group B) spent significantly fewer days on the injured list for musculoskeletal injuries (IRR = 0.78 [95% CI, 0.72-0.85]; P < 0.0001) compared to those with fewer rest days (Group A) [PMID:39292010].
In a cohort study of 71 high school pitchers aged 13 to 18 years, higher game-day throwing velocity (P = .001), increased intensity (as indicated by velocity changes from preseason to in-season; P < .001), and older age (P = .014) were identified as significant risk factors for injury [PMID:38700088].
Cervical spinal injuries are a rare but potentially devastating occurrence in sports, frequently seen in football, wrestling, and ice hockey, with axial loading often implicated in significant neurologic impairment [PMID:33741877].
Clinical Presentation
Despite acceptable interrater reliability, rescuers frequently underestimated motion, with 38% of trials involving more than 10° of motion still scored as low severity by rescuers [PMID:22488229].
The study found that even with a spine board, the range of motion in the cervical spine was significantly higher when players wore improperly fitted helmets compared to properly fitted ones, highlighting the importance of proper equipment in injury management [PMID:20446833].
According to Cady-McCrea et al. [PMID:38608819], athletes involved in rowing frequently report neck pain that worsens during or immediately after rowing activities, indicative of cervical spine sprains.
In a study involving university-level athletes, significant reductions in left-sided cervical anterolateral strength (p < 0.001) and increased reports of dizziness (p = 0.004) were observed post-exertion [PMID:34225057].
The nature and location of injuries in snow parks differ based on the participant's skill level and the specific terrain features they engage with [PMID:32331952].
These critical situations depend on sports medicine personnel understanding every aspect of sideline care, including vigilant observation of the sporting event to detect the possible mechanism of injury [PMID:30482362].
Symptoms may range from transient spinal cord and peripheral nerve injuries like quadriparesis or burners/stingers to more severe, persistent neurological deficits [PMID:27642819].
Rowing involves specific biomechanical stresses, particularly repetitive movements that can strain the cervical spine [PMID:27577685]. Clinicians should consider these factors in the clinical presentation of rowers with neck pain.
The study suggests that assessing trunk muscle function, specifically multifidus muscle contraction, could identify athletes who might benefit from targeted preventive measures [PMID:27317504].
Over half of the neck and spine injuries occurred due to falling from stunts or basing/spotting stunts from height, highlighting specific mechanisms that lead to these injuries [PMID:25783366].
While most acute spinal injuries in sports are minor and self-healing, severe and potentially catastrophic injuries are also possible [PMID:17329056].
Stable soft-tissue injuries of the cervical spine are the most common injuries that occur in all athletes and are responsive to symptomatic treatment and aggressive rehabilitation [PMID:16958497].
Diagnosis
Telemedicine technologies enable timely transmission of medical images, facilitating quick identification and diagnosis of injuries like cervical spine sprains, crucial for timely treatment [PMID:35372194].
The research indicates that the condition of helmet fit can influence the assessment of cervical spine stability, as improperly fitted helmets do not adequately restrict motion, potentially complicating diagnosis and management [PMID:20446833].
Following high-intensity exertion, athletes demonstrated reduced dynamic visual acuity (DVA) (p < 0.001) and reported increased dizziness, suggesting these measures could be useful in sideline screening for sport-related concussion [PMID:34225057].
The consensus process highlighted the necessity of rapid and thorough on-site evaluations to prevent delayed diagnosis and worsening of injuries [PMID:32639439].
Cervical spine trauma evaluation necessitates thorough preparation and the initiation of the appropriate action plan when a potentially catastrophic injury is suspected [PMID:30482362].
The review emphasizes the importance of imaging findings in diagnosing a wide spectrum of spinal injuries related to sports [PMID:17329056].
For conscious athletes experiencing neck pain, serious cervical injury can frequently be excluded with an accurate history and physical examination [PMID:15831320].
The complexity of assessing brain injuries and the absence of definitive objective signs and symptoms complicate the evaluation of cervical spine injuries [PMID:11877864].
Differential Diagnosis
Emerging concepts in rowing injuries highlight the importance of considering a broader differential diagnosis, including rib injuries and thoracic outlet syndrome, which can present with symptoms similar to cervical spine sprains [PMID:27577685].
Mechanisms leading to cervical spine injuries included falling from stunts (26%), basing/spotting stunts from height (26%), being thrown/falling from a high toss (10%), and falling from a pyramid (8%) [PMID:25783366].
Management
Machine learning algorithms, particularly support vector machines (SVM), show promise in enhancing the segmentation and analysis of medical images, potentially improving the diagnosis and management of cervical spine injuries [PMID:35372194].
Researchers and practitioners emphasize that managing and regulating cumulative stress on the arm through workload monitoring is essential for injury prevention and performance optimization in adolescent baseball pitchers [PMID:32991703].
Combining jogging and practical-duration foam rolling exercises led to significantly higher values for ankle dorsiflexion (ADF) and countermovement jump (CMJ) in athletes compared to baseline measures, with benefits maintained for at least 10 minutes post-intervention [PMID:31483150].
Approximately 39.5% of deltoid ligament sprains were classified as non-time-loss injuries, with participation restricted for less than 24 hours [PMID:28318315].
Only one prevention measure has been demonstrated to significantly reduce injury risk in alpine ski racing, indicating a gap in evidence-based prevention strategies [PMID:27480763].
Rescuers and simulated patients showed variability in assessing motion during cervical spine stabilization maneuvers, with subjective scores often not correlating accurately with actual motion detected by inertial measurement units [PMID:22488229].
Providing performance feedback led to changes in preference for stabilization techniques, with some participants shifting from head-squeeze to trap-squeeze maneuvers after receiving feedback [PMID:22488229].
In collegiate men's lacrosse athletes, improperly fitted helmets allowed greater head-to-thorax range of motion compared to properly fitted helmets, suggesting that helmet removal might be necessary for optimal cervical spine stabilization [PMID:20446833].
Teams with an average of more than 5 rest days between starts had pitchers who required fewer IL days for MSK injuries, suggesting a potential management strategy to mitigate injury risk [PMID:39292010].
The study suggests that current pitch count models may be inadequate, and incorporating metrics like pitching velocity and intensity into workload monitoring could better predict and prevent throwing-related injuries [PMID:38700088].
The review by Cady-McCrea et al. [PMID:38608819] suggests that effective management of cervical spine injuries in rowers involves conservative treatments alongside adjustments in rowing technique to reduce strain on the cervical spine.
The study highlights the importance of assessing cervical anterolateral strength and vestibular function, such as through DVA and dizziness reports, to guide immediate management decisions in collision and combative sports [PMID:34225057].
A cautious and conservative approach should be taken with regards to evaluation, management, and return to play for cervical spine injuries [PMID:33741877].
A consensus-driven approach involving athletic trainers, emergency responders, and sports medicine physicians resulted in key recommendations for prehospital care [PMID:32639439].
Few injured participants in snow parks contact emergency services, suggesting potential gaps in immediate medical intervention [PMID:32331952].
Findings suggest that understanding the epidemiology can guide decision-making for prevention, treatment, and rehabilitation strategies [PMID:31464974].
The study concludes that promoting safer tackling techniques, appropriate protective gear modifications, and preventive rehabilitation can help reduce cervical spine injuries [PMID:30830045].
Stakeholders such as sport clinicians, participants, coaches, parents, league administrators, officials, and the public must be engaged in a multipronged approach to decrease cervical spine injury risk [PMID:30482364].
Review of prevention strategies in collision sports indicates some success, but emphasizes the need for additional rigorous research to enhance protective measures in all sporting contexts [PMID:30482364].
Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and potentially initiation of full spine stabilization with a spine board [PMID:30482362].
Sideline management involves secondary survey for concomitant injuries following initial spine stabilization [PMID:30482362].
Complications
Severe injuries among cheerleaders included fractures (4%), muscle or tendon injuries (3%), dislocations (1%), and nerve injuries (1%) [PMID:25783366].
Prognosis & Follow-up
The experimental group showed sustained improvements in CMJ and ADF even 10 minutes post-intervention, suggesting potential long-term benefits for athletic performance and possibly recovery from cervical spine sprains [PMID:31483150].
Only 8.2% of deltoid ligament sprains were found to be recurrent [PMID:28318315].
While there was no significant difference in the number of IL assignments for MSK injuries per 1000 pitches between groups (P = 0.1715), pitchers with more rest days showed improved recovery metrics [PMID:39292010].
Cady-McCrea et al. [PMID:38608819] emphasizes that a structured rehabilitation program followed by a gradual reintegration into rowing activities is essential for optimal recovery and preventing recurrence of cervical spine sprains.
Given the potential severity, careful monitoring and conservative management are crucial, particularly during the return-to-play phase [PMID:33741877].
While the paper focuses primarily on immediate care, the consensus recommendations aim to mitigate complications and improve outcomes through standardized prehospital management practices [PMID:32639439].
The study concluded that the vast majority of these injuries were minor, and athletes typically returned to play within 24 hours post-injury [PMID:31464974].
Sixty-four point four percent of players returned to play within 24 hours, while only 2.8% were out of play for more than 21 days [PMID:30830045].
The study found a notable decrease in fastball velocity (92.2 vs 91.6 mph, P<.001) and a reduction in the percentage of fastballs thrown (60.3% vs 58.5%, P<.001) during the year of injury [PMID:29738598].
The prognosis for cervical spine injuries in rowers likely hinges on comprehensive rehabilitation adherence and a structured return-to-rowing program [PMID:27577685].
The study [PMID:23726933] highlighted that initial pain and disability levels were predictive of recovery outcomes, suggesting a need for focused early interventions for patients with high baseline symptoms.
Special Populations
An important perspective missing in current research is the monitoring and prevention of injuries among youth skiers, suggesting a need for targeted studies in this demographic [PMID:27480763].
The study by Cady-McCrea et al. [PMID:38608819] notes that novice rowers might face increased risks of cervical spine injuries due to their adaptation to the unique biomechanical demands of rowing, highlighting the need for tailored preventive measures.
Men were 1.36 times more likely to suffer a neck or cervical spine injury compared to women in sports where both genders compete [PMID:31464974].
The majority (89.2%) of injured players were forwards, with hookers specifically involved in 37.8% of the cases, indicating a higher risk among these positions [PMID:19182111].
The athlete with Down syndrome and potential cervical hypermobility requires a careful cervical and neurologic evaluation prior to clearance for participation in sports [PMID:16958497].
Physicians need to account for the heightened risk of cervical instability in athletes with Down syndrome or rheumatoid arthritis when assessing their suitability for sports or evaluating neck pain [PMID:15831320].
Key Recommendations
The review calls for additional research efforts to address deficits in understanding injury risk factors and evaluating prevention measures derived from these factors [PMID:27480763]. (Evidence: Expert opinion)
Given the identified risk factors, it is recommended that clinicians and coaches use a comprehensive workload model that includes velocity and intensity to assess and mitigate injury risks in adolescent pitchers [PMID:38700088]. (Evidence: Expert opinion)
While not explicitly detailed, the paper underscores the need for robust prevention measures in sports where cervical injuries are prevalent [PMID:33741877]. (Evidence: Expert opinion)
The systematic review and expert consensus led to pragmatic conclusions and recommendations balancing clinical evidence and expert opinion for optimal prehospital management [PMID:32639439]. (Evidence: Strong)
Both individual athlete factors and environmental controls within the sporting setting should be considered and managed to effectively mitigate risks [PMID:30482364]. (Evidence: Expert opinion)
Potentially, initiation of full spine stabilization with a spine board is required to minimize risk for further injury [PMID:30482362]. (Evidence: Moderate)
Given the findings from [PMID:23726933], there is a recommendation to concentrate efforts on developing and evaluating early pain management strategies, particularly for patients experiencing severe initial symptoms. (Evidence: Expert opinion)
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