Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Field care and evaluation of the child or adolescent athlete with acute neck injury

Jason E Decker, MD, FAAP
Albert C Hergenroeder, MD
Section Editors
Joseph Chorley, MD
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


The prehospital evaluation and initial management of the young athlete with an acute neck injury will be discussed here. The approach to the athlete with a complaint of neck pain or injury and overviews of musculoskeletal, cervical spinal cord, and cervical peripheral nerve injuries are presented separately. (See "Approach to the child or adolescent athlete with neck pain or injury" and "Overview of musculoskeletal neck injuries in the child or adolescent athlete" and "Overview of cervical spinal cord and cervical peripheral nerve injuries in the child or adolescent athlete".)


For this topic, spinal motion restriction is used in preference to spinal immobilization. Historically, the process of restricting the motion in the spine during emergency medical management was described as "spinal immobilization." More recently, trauma experts have adopted the term “spinal motion restriction” for this process because true immobilization of the spine is unattainable. (See "Pediatric cervical spine immobilization".)


The prehospital care and evaluation of young athletes with acute neck injuries include the following steps [1]:


Suspicion and recognition

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Ghiselli G, Schaadt G, McAllister DR. On-the-field evaluation of an athlete with a head or neck injury. Clin Sports Med 2003; 22:445.
  2. Warren WL Jr, Bailes JE. On the field evaluation of athletic neck injury. Clin Sports Med 1998; 17:99.
  3. Torg JS. Management guidelines for athletic injuries to the cervical spine. Clin Sports Med 1987; 6:53.
  4. Vegso JJ, Lehman RC. Field evaluation and management of head and neck injuries. Clin Sports Med 1987; 6:1.
  5. Haight RR, Shiple BJ. Sideline evaluation of neck pain: when is it time for transport? Phys Sportsmed 2001; 29:45.
  6. Kleiner DM, Almquist JL, Bailes MD, et al. Prehospital care of the spine-injured athlete: a document from the inter-association task force for the appropriate care of the spine-injured athlete. National Athletic Trainers Association, Dallas, TX 2001.
  7. Proctor MR, Cantu RC. Head and neck injuries in young athletes. Clin Sports Med 2000; 19:693.
  8. Skellett S, Tibby SM, Durward A, Murdoch IA. Lesson of the week: Immobilisation of the cervical spine in children. BMJ 2002; 324:591.
  9. Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebrae. J Trauma 1977; 17:126.
  10. Podolsky S, Baraff LJ, Simon RR, et al. Efficacy of cervical spine immobilization methods. J Trauma 1983; 23:461.
  11. Bonadio WA. Cervical spine trauma in children: Part I. General concepts, normal anatomy, radiographic evaluation. Am J Emerg Med 1993; 11:158.
  12. Garfin SR, Shackford SR, Marshall LF, Drummond JC. Care of the multiply injured patient with cervical spine injury. Clin Orthop Relat Res 1989; :19.
  13. Waninger KN, Swartz EE. Cervical spine injury management in the helmeted athlete. Curr Sports Med Rep 2011; 10:45.
  14. Spine and spinal cord trauma. In: Advanced trauma life support (ATLS) Student Course Manual, 9th, American College of Surgeons, Committee on Trauma (Eds), American College of Surgeons, Chicago 2012. p.174.
  15. Sanchez AR 2nd, Sugalski MT, LaPrade RF. Field-side and prehospital management of the spine-injured athlete. Curr Sports Med Rep 2005; 4:50.
  16. Football helmet removal. ACSM Current Comment. https://www.acsm.org/docs/current-comments/footballhelmet.pdf (Accessed on November 03, 2015).
  17. Treme G, Diduch DR, Hart J, et al. Cervical spine alignment in the youth football athlete: recommendations for emergency transportation. Am J Sports Med 2008; 36:1582.
  18. Swartz EE, Armstrong CW, Rankin JM, Rogers B. A 3-Dimensional Analysis of Face-Mask Removal Tools in Inducing Helmet Movement. J Athl Train 2002; 37:178.
  19. Almquist JL, Schuler TC. Cervical spine injured athlete transfer protocol (videotape). Northern Virginia Spine Institute, Reston, VA, 1993.
  20. Donaldson WF 3rd, Lauerman WC, Heil B, et al. Helmet and shoulder pad removal from a player with suspected cervical spine injury. A cadaveric model. Spine (Phila Pa 1976) 1998; 23:1729.
  21. Appropriate prehospital management of the spine-injured athlete updated from 1998 document. National Athletic Trainers' Association. http://www.nata.org/sites/default/files/Executive-Summary-Spine-Injury-updated.pdf (Accessed on November 03, 2015).
  22. Kumar SR, Weaver FA, Yellin AE. Cervical vascular injuries: carotid and jugular venous injuries. Surg Clin North Am 2001; 81:1331.
  23. Torg JS, Booth RE Jr, Albright JP, et al. Symposium: athletic injuries to the cervical spine and brachial plexus. Contemp Orthop 1984; 9:65.
  24. Anderson C. Neck injuries, backboard, bench, or return to play. Phys Sportsmed 1993; 21:23.
  25. Wiesenfarth J, Briner W Jr. Neck injuries: urgent decisions and actions. Phys Sportsmed 1996; 24:35.
  26. Cantu RC. Criteria for return to competition after head or cervical spine injury. In: ACSM's Guidelines for the Team Physician, Cantu RC, Micheli LJ (Eds), Lea & Febiger, Philadelphia 1991.