Sports Injuries of the Head and Neck

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Top Contributors - Giulia Neculaes and Kim Jackson  

Introduction

Regular structured exercise is widely acknowledged for its numerous advantages. It boosts cardiovascular fitness, enhances muscular strength, and promotes increased flexibility, all of which significantly improve one's overall quality of life. Nevertheless, it is important to note that engaging in exercise also comes with a slight downside, namely an elevated vulnerability to sports-related injuries.

Despite the increasing rates of sport and exercise participation, injury rates are also increasing. According to the US Consumer Product Safety Commission, the number of injuries is on the rise: “between 1991 and 1998, golf and swimming injuries increased 110 percent; ice hockey and weightlifting injuries, 75 percent; soccer injuries, 55 percent; bicycling, 45 percent; volleyball, 44 percent; and football 43 percent”

A research study revealed that a 20% probability indicates that one out of every five athletes were prone to experiencing an injury.

What is a sports injury?

Physical injury refers to any form of stress or strain on the body that hinders its proper functioning and necessitates a reparative process. On the other hand, a sport injury encompasses any type of injury, pain, or physical harm that arises from engaging in sports, exercise, or athletic activities. However, more severe injuries like head, neck, and spinal cord trauma are typically distinguished from common sports injuries such as sprains, fractures, and contusions.

Sports injuries predominantly affect the musculoskeletal system, which comprises the muscles, bones, joints, and related tissues like ligaments and tendons. Here is a concise explanation of the constituents that constitute the musculoskeletal system.

The head

The skull is composed of a total of 14 bones, with 8 of them being large and flat. These 8 bones are arranged in two pairs and 4 single bones, forming a container-like structure that encases the brain. The specific bones that make up the skull are the frontal, parietal, temporal, occipital, sphenoid, and ethmoid bones. In addition to these, the head also contains facial bones, teeth, eyes, ears, and the nose.

The neck

The neck comprises of seven vertebrae, commencing at the base of the skull (C1) and gradually angling downwards as they extend towards the chest area, where they connect with the thoracic vertebrae.

Head concussion, contusion, haemorrhage, fracture

The most common catastrophic sports injury is the one that affects the head and neck, and it is also the leading cause of death in athletics. While the brain can be damaged by direct compressive forces, it is more vulnerable to injury from shearing stresses, which are often caused by rotational forces applied to the head. The most common athletic head injury is concussion, which may vary widely in severity. Intracranial haemorrhage is the leading cause of head injury death in sports, making rapid initial assessment and appropriate follow-up mandatory after a head injury. Diffuse cerebral swelling is another serious condition that may be found in the child or adolescent athlete, and the second impact syndrome is a major concern in adult athletes.  

If the force applied is strong enough, it can cause fractures in the bones of the skull, potentially leading to the impingement of brain tissue. This can result in bleeding or haemorrhage within the skull. In the event of a blood vessel rupture between the skull and the brain, a clot or haematoma may form, exerting pressure on the underlying brain tissue. An epidural haematoma refers to a clot forming between the skull and the brain's protective covering, known as the dura mater, while a clot between the dura mater is referred to as a subdural haematoma. Haemorrhage in deeper layers can cause contusions or bruising to the brain tissue.

• Causes

The causes of head injuries include collisions with other athletes during contact sports, severe falls with impact to the head, and trauma from blows in boxing.

• Signs and symptoms

Head injuries can lead to various signs and symptoms, such as loss of consciousness, confusion, memory loss, and shock.

• Treatment

In the event of a head injury, it is important to immobilize the patient and elevate their head and shoulders in a calm environment. If necessary, stop any bleeding and seek immediate medical attention. Head injuries require prompt medical care as failure to do so can result in permanent brain damage or even death.

• Rehabilitation

The rehabilitation process for head injuries varies greatly depending on the nature and severity of the injury. Even mild concussions can lead to post-concussion syndrome, which may persist for six months to a year. More severe injuries can cause a wide range of permanent symptoms. Treatment approaches depend on the clinician’s ability to differentiate among the various conditions associated with PCS. Early education, cognitive behavioural therapy, and aerobic exercise therapy have shown efficacy in certain patients but have limitations of study design. An algorithm is presented to aid clinicians in the evaluation and treatment of concussion and PCS and in the return-to-activity decision.

Neck strain, fracture, contusion

Injuries to the neck can have severe consequences, especially when it comes to fractured or broken vertebrae. On the other hand, neck strains are more prevalent and less severe, typically causing damage to the muscles or tendons in the neck. Contusions, which are bruises on the skin and underlying tissues of the neck, often occur as a direct result of a blow.

The incidence of traumatic central nervous system (CNS) injury is estimated to be 150 to 430 cases per 100,000 for brain injury and 150 to 500 cases per 100,000 for spinal injury. The percentage of these injuries related to sporting activities is believed to be 3% to 25%.24 Although it might be expected that nervous system injuries are limited solely to contact and collision sports, in actuality they can occur in most youth sports. The injuries that are most visible in the public eye tend to cause brain injuries.

• Causes

The primary causes of most neck injuries include abrupt rotation of the neck, severe falls, direct impact to the neck, and instances of concussion.

• Signs and symptoms

The symptoms include pain in the head, neck, and shoulders, a sensation of crackling in the neck, as well as a decrease in neck strength and mobility.

• Treatment

To safeguard the spinal cord, immobilization is employed, while analgesics are administered to alleviate pain. It is crucial to promptly seek medical assistance for neck injuries as they can have severe consequences such as long-term paralysis, impaired movement and coordination, as well as the development of calcification and osteoporosis. Fractures, in particular, can result in paraplegia and, in some cases, prove fatal.

• Rehabilitation

A brace may be advised for several weeks to immobilize neck strains. In instances of fractures, surgical pinning of the broken vertebrae with screws and the use of a neck cast may be necessary. After the healing process, physical therapy will focus on restoring range of motion, flexibility, and strength. To prevent certain neck injuries, wearing helmets or other athletic headgear and practising proper technique are recommended.

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