Recommendations for return to sports following cervical spine injuries.

The decision of return to play following cervical spine injuries can be one of the most challenging with a wide variation in opinion as far as management. The onus is on the physician to consider the risks of continued play for patients who have experienced a cervical spine injury and who are reluctant to give up their sport of choice. In general, the literature shows agreement for the basic necessities for return to collision sports to include: normal strength, painless range of motion, a stable vertebral column and adequate space for the neurological elements. In addition, return to play in an unsafe environment is contraindicated. Playing with defective equipment or with improper technique has been associated with catastrophic injuries and should be avoided. This particularly includes: spear tackling, diving in unknown or shallow water, diving while intoxicated, checking from behind in hockey or using a trampoline without spotting equipment. However, there is a lack of consensus on returning to play with the following: stenosis, spear tackler's spine, loss of normal lordosis or range of motion, surgically corrected instability, ligamentous instability less than that defined by White/Panjabi, transient quadriparesis, healed disc herniation and congenital fusion. More informed decisions can be made by physician and patient using a basic knowledge of: (i) previous clinical experience, including that outlined in published epidemiological studies and guidelines; (ii) biomechanical data defined in the laboratory; and (iii) the priorities of the patient.