Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine.

Athletic injuries to the cervical spine associated with quadriplegia most commonly occur as a result of axial loading. Whether it be a football player striking an opponent with the top or crown of his helmet, a poorly executed dive into a shallow body of water where the subject strikes his head on the bottom, or a hockey player pushed into the boards head first, the fragile cervical spine is compressed between the rapidly decelerated head and the continued momentum of the body. Appropriate rule changes recognizing this mechanism have resulted in a reduction of football quadriplegia by two-thirds. Presumably, educational efforts designed to inform the public of the dangers of diving would have a similar effect. The predominance of the axial loading mechanism is not as clearly defined in trampoline and minitrampoline injuries. However, both of these devices are dangerous when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics. The emergence of severe cervical spine injuries resulting from ice hockey is recognized. Methods, based on sound scientific evidence, to modify the games so as to prevent these injuries are lacking.