Managing Transient Cervical Neurapraxia in the Athlete
Transient cervical neurapraxia is an injury to a nerve that interrupts conduction, causing temporary paralysis but not degeneration, and that is followed by a complete and rapid recovery
Most cases of transient cervical neurapraxia on the football field occur following a severe collision in which the athlete’s neck is forcefully extended or compressed from a blow to the crown of the head. The problem most commonly affects positions such as the free safety, which involve high-speed collisions and open-field tackling.
Also called cervical cord neurapraxia, transient neurapraxia in the athlete warrants extremely careful on-field management and workup. First described in 1986 by Joseph S. Torg, M.D., founder of the National Football Head and Neck Injury Registry (established in 1975), neurapraxia is characterized by numbness, tingling and/or weakness in the arms, legs or both. Episodes typically last a few seconds and resolve completely.
Due to Dr. Torg’s findings, "spearing," or lowering the head and hitting an opponent with the crown of the helmet, has been outlawed by the National Football League (NFL) and throughout other levels of football. Lowering the head even slightly reverses the normal curvature of the cervical spine, resulting in a straightened cervical spine that cannot properly absorb the force applied in a collision. Vertebral body fracture with spinal cord injury can result.
When a player is down on the field with an episode of neurapraxia, the team physician or trainer must immobilize the head and neck, perform a careful neurologic examination, then ensure safe transport off the field and to the hospital for evaluation. If the transient episode affects only the arms, and the player walks off the field, a careful history and physical exam must be performed by the physician. Following an episode of neurapraxia, the player should be seen on an urgent basis by an orthopaedic surgeon or a spinal surgeon for evaluation.
Dr. Torg believes that neurapraxia does not lead to permanent paralysis, since no player with neurapraxia from the National Football Head and Neck Registry has subsequently developed spinal cord injury. However, athletes should know that after one episode of transient cervical neurapraxia, they face an approximately 50 percent chance of a repeat episode if they choose to continue playing. Should any structural abnormalities be identified, Cleveland Clinic physicians generally recommend that the athlete not return to a collision sport. If no abnormalities are found, deciding whether to continue playing can be difficult. At the recreational or high school levels, players and their parents know it is not worth the risk. However, at collegiate and professional levels, with scholarships, careers and financial futures at stake, players face a difficult decision. About 60 percent return to contact play, according to a 1997 follow-up study by Dr. Torg. Higher-level players may explore surgical options in order to continue playing, with a reduced risk of neurapraxia or permanent cord injury.
When observing or evaluating players involved in collision sports such as football, coaches should take the opportunity to reinforce the importance of proper tackling technique (keeping the head up during tackling). On the sidelines, team physicians should bring any instances of spearing to the coach’s attention.