Summary of the National Athletic Trainers' Association Position Statement on the Acute Management of the Cervical Spine-Injured Athlete

Abstract

The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment. The objective of the National Athletic Trainers' Association (NATA) position statement on the acute care of the cervical spine-injured athlete is to provide the certified athletic trainer, team physician, emergency responder, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in an athlete. Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport such as football, hockey, or lacrosse; and imaging considerations in the emergency department.

Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes

“…20 Contraindications for mobilizing the spine into a neutral position include: increased pain, worsening neurological symptoms, worsening muscle spasms, airway compromise, inability to physically reposition the spine, and patient-expressed trepidation. 21 Distraction in this setting should be avoided to prevent further ligamentous injury and vertebral subluxation. 22 In sports using helmets and shoulder pads, the new standard of care is that the equipment should remain on the athlete during evaluation, as the equipment contributes to preservation of spinal alignment of the athlete.…”

“…In patients with a suspicion for ACT, the cervical spine should be placed in a neutral position and immobilized in a rigid cervical collar to prevent any possibility of further injury to the spinal cord 20. Contraindications for mobilizing the spine into a neutral position include: increased pain, worsening neurological symptoms, worsening muscle spasms, airway compromise, inability to physically reposition the spine, and patient-expressed trepidation 21. Distraction in this setting should be avoided to prevent further ligamentous injury and vertebral subluxation 22…”

Implementation Science: Lessons Learned From Evaluating Practice Recommendations for the Care of Patients With Spine Injuries

“…Our approach was designed to better understand the comfort, ease of implementation, success, influential factors, and barriers of ATs who did or did not implement practice recommendations for athletes with suspected acute spine injuries. To do so, we invited practicing ATs from across the country to complete a comprehensive survey about practice recommendations for the acute care of patients with suspected spine injuries [18][19][20] that were based on long-standing and emerging practices [15][16][17] (Table). Responses from 2304 ATs were analyzed for the entire survey, and of those, a total of 1755 (76.2%) ATs responded to the portion of the survey that related directly to the implementation of practice recommendations.…”

“…Over the years, the acute care of patients with suspected spine injuries has been a focus of athletic health care and has gained considerable attention from the athletic training community, given the significant role that ATs play in the emergency management of patients with these serious injuries. [15][16][17] Although guidelines for the acute management of patients with spine injuries have been available for years, limited information is available regarding how well these practice recommendations have been implemented in clinical practice. Further, as research evidence about the care of these patients expands, updates to spine care practice recommendations are expected.…”

The knowledge and attitude concerning sport-related concussion among coaches: A survey study

“…According to a study by the Centers for Disease Control and Prevention, approximately 8.6 million sports- and recreation-related injuries occur in the United States annually (Sheu, Chen & Hedegaard 2016 ). The severity of these injuries can range from minor bruises and sprains to more severe injuries such as cervical injuries (Swartz et al 2009 ) and sports-related concussions (SRC) (McCrory et al 2017 ).…”