By Roger M. Lyon, M.D., Professor of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI
Don’t mess around with spine injuries in youth sports. In today’s post we’ll look at two situations: injuries that occur suddenly during play, and longer-term (“chronic”) injuries.
Spinal injuries have the potential for permanent injury to the spinal cord or nerves, and because of that they need to be very carefully managed.The child with a spine or neck injury must be removed from activities until the athlete is deemed safe for return to play by a physician.Sports associated with the highest risk of neckand spine injury are football, gymnastics, ice hockey, wrestling, skiing and snowboarding. Acute spine injuries are typically classified into catastrophic (severe) and non-catastrophic(all others). Catastrophic injuries cause the spine to be unstable and usually result in neurologicdamage. Any down playerwith neck or back pain after a sudden injury, should be assumed to have a catastrophic (severe) spine injury. They need to be handled with extreme care and urgency. Any unconscious athlete needs to be suspected of having an unstable spine injuryuntil proven otherwise. The coach should not attempt to move the downed player with significant neck or back pain. Instead, the player should be kept on the field and qualified medical personnel should be called for spine stabilization and transport. To avoid possible further injury to the spine, the coach may remove the mouthguard and facemask but the helmet and pads must be left in place.
The young athlete coming off the field with new complaints of back or neckpain should not be allowed back on the field without a thorough assessment. One of the most common and significant injuries to the neck area is a stinger. The term stinger or burner refers to a set of symptoms involving pain, burning or tingling down one arm, occasionally associated with weakness in the shoulder. These are not spinal injuries but injuries to the nerves thatleadto the arms.Symptoms involving both arms or both legs are not a simple stinger and require the athlete to be pulled from the sport immediately for a thorough evaluation. When stingers are not associated with neck pain or limitation of neck motion and all motor and sensory symptoms clear within seconds to minutes, the athlete may return to competition.
There are chronic non-acute spinal disorders in young athletes as well.Back pain is not a common condition for a young athlete. A physician should evaluate ongoing complaints of pain. Repetitive hyperextension of the lumbar spine typical in football, gymnastics and occasionally other sports can cause stress fractures of the lower spine. Typically, non-acute spinal pain does not necessitate removal from competition. If the child can compete without excessivepain or loss of function participation may continuebut medical evaluation should be completed on a timely basis.
Appropriate equipment and coaching can help to prevent, reduce and minimize spinal injuries in youth sports. Rules are in place to reduce the incidence of these injuries. Remember that coaching techniques and proper on-field injury management for youth sports should emphasize safety above winning.