You will not be surprised if I say neck injury is very common in American football. In fact, because of the contact nature of tackling football, the cervical spine is at high risk of injury. Hitting the opponent with the helmet or getting hit right to it are the main causes of neck injury in football. Do we blame the fact that helmets has developed considerably to improve protection and has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury? I believe so. Anyways, neck injury has to be taken seriously otherwise it could be fatal. Among the cervical injuries, cervical radiculopathy is one of the most frequent one. Often, on the sideline, the decision of returning to play or not has to be taken quickly with specific and accurate tests provided by a physical therapist or athletic trainer.
Cervical radiculopathy, by definition, is a disorder of the cervical spinal nerve root, and most commonly is caused by a cervical disc herniation or other space occupying lesion resulting in nerve root inflammation, impingement, or both. In football, the mechanism of injury is an axial loading of the cervical spine from helmet to helmet putting pressure on the anterior part of cervical vertebral and creating disc herniation. Tackling, blocking or hitting with a flexed cervical spine put the neck into higher risk of cervical disc herniation since the axial load creates high pressure in the anterior part of the disc. This pressure pushes the disc outward which pinches the cervical nerve root to the associated segment.
The symptoms of cervical radiculopathy can be felt in the neck, shoulder, arm or hand of the involved side. The symptoms include pain, numbness and/or weakness. However, many injuries can produce those symptoms such as nerve entrapment from muscles spasm, stingers, cervical spine fractures etc. The following tests will help you ruled in or out the cervical radiculopathy with 90% accuracy.
- Upper Limb Tension Test (ULTT 1): This test assesses the median nerve, anterior interosseous nerve (C5,C6,C7). The test is done in supine lying with shoulder depression and abduction 110 degrees, elbow extension, forearm supination, wrist extension, fingers and thumb extension as well as cervical spine contralateral side bending. If pain or sensations of tingling or numbness are experienced at any stage during the positioning particularly reproduction of neck, shoulder or arm symptoms , the test is positive. Wainner et al. showed that using the single best test ULTT 1 to screen for cervical radiculopathy results in a change in probability of the condition from 23% to 3%, a 20% decrease when the test is negative.
- Involved Cervical Rotation Less than 60 degrees: Simply by assessing the player’s ROM. If the involved side rotation ROM is less than 60 degrees, the test is positive. During the test, you want to make sure the player is in good straight back position.
- Cervical Distraction Test: Either place each hand around the patient’s mastoid processes, while standing at their head, or place one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force. The force should be about 10 pounds.With distraction, the joint space is increased to relieve the pressure on the nerve roots, thus decreasing the symptoms. So, a positive test is a decreasing of symptoms.
- Spurling Test: The patient should be seated with their neck side bent/rotated towards the ipsilateral side. The examiner carefully provide a compression force straight through the head to determine if symptoms are reproduced. The test is positive if there is pain radiating into the upper extremity towards the same side that the head is laterally flexed.
Study has shown that:
- Two positives tests = 21% chance of having a cervical radiculopathy
- Three positives tests = 65% chance of having CR
- All four tests positive has 90% probability of having cervical radiculopathy.
Next time you are on the sideline and you want to know if the player has radiculopathy from the cervical spine, use those 4 tests.
References
- Robert S. Wainner et al. Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy, Spine 2003;28:52–62
American Football Staff 