With the recent head/neck injuries that were sustained this weekend by Washington Redskins players, Dashaun Phillips and Kyshoen Jarrett (a fellow Hokie!), after helmet-to-helmet hits with the Dallas Cowboys running back Darren McFadden, I’ve decided to elaborate on what a “cervical stinger” is, who is at risk, what can be done and how it can potentially be prevented.
What is a “Cervical Stinger?”
A “burner” or “stinger” occurs after an acute traumatic event, typically involving significant contact to the head and/or shoulder. This event results in either a tensile (stretching) injury or a compressive injury to the brachial plexus, or the nerve roots that form the brachial plexus. The brachial plexus is the nerve network responsible for the innervations of the upper extremity and shoulder.
Given that the nerves are either stretched or compressed, irritation occurs, producing symptoms that are described as burning/shooting/electrical pain or paresthesia (an abnormal sensation, “pins and needles”) in one upper extremity. These symptoms can be accompanied with varying degrees of numbness and weakness that may extend down the arm to the hand. Neck pain may be present as well. This injury usually lasts only for a short period of time, resolving spontaneously, and is impermanent. However, some cases may experience prolonged symptoms, reoccurrences or permanent neurological deficit. Recurrent episodes are more likely in those athletes who have cervical stenosis (narrowing of the spinal canal in the neck) or disc herniations (DynaMed).
Who is at Risk?
Cited as being one of the most common upper extremity nerve injuries seen in competitive athletes, football players are most affected. Other athletes that may incur such injury include wrestlers, hockey players and gymnasts. It is estimated that 50-65% of collegiate football players will experience a stinger during their career (DynaMed). For example, you all may remember David Wilson (another fellow Hokie!) who left Virginia Tech for the NFL and had to retire from football at the age of 23. If not here is an excerpt from the New York Post:
“In January of 2014 “He had a disc removed and a fusion” then “Following a prolonged rehab from the vertebrae fusion surgery, Wilson reported to training camp July 21 and was cleared for full contact. After looking quick and strong in the first week of camp, the trouble began anew for Wilson last Tuesday, when he was forced out of practice with a neck burner after running into the back of guard Eric Herman….In light of last week’s episode of symptoms, sensory and motor, Frank and I both told David he should not play football anymore. We let David know that by playing, he would be putting himself at risk for more episodes like last week or perhaps something more serious.” (Schwartz)
Wilson is a good example in the sense that he supports the research, not only in terms of incidence in collegiate players, but also in terms of likely risk factors. A history of previous episodes and high rates of structural abnormalities in the cervical spine are reported as likely risk factors. Based on a cohort study:
“55 collegiate and professional athletes (mean age 22 years) with history of recurrent burners evaluated with cervical spine radiographs and magnetic resonance imaging (MRI) showed cervical stenosis was present in 53%. According to MRI results 93% of these injured athletes had either cervical disc disease or cervical stenosis….. Although burners may be the result of a brachial plexus stretch injury in high school and collegiate football players seen with acute symptoms, nerve root compression in the intervertebral foramina secondary to disk disease is a more common cause in collegiate and professional players who have recurrent or chronic burner syndromes. There is a high incidence of cervical canal stenosis in football players with recurrent burner syndrome. The combination of disk disease and cervical spinal canal stenosis may lead to an alteration in normal cervical spine mechanics that may make these athletes more prone to chronic burner syndromes.” (Levitz)
According to reports Wilson had cervical stenosis, disc removal and spinal fusion all of which the American Journal of Sports Medicine can contribute to chronic burner syndromes. However, if this is seen so often in football players of all levels I am sure you are wondering what can be done to treat and or prevent such injuries?
What can be done?
For those who have already sustained the injury, while symptoms may disappear spontaneously it is important to ensure that symptoms are completely gone. Not only in general, but also while performing the sport-specific skill. Furthermore, ensure that full range of cervical and shoulder ranges of motion (ROM) are still intact. If not rehabilitation may be necessary to improve ROM and strength. Postural exercises, manipulation to the thoracic spine and soft tissue work primarily to the scalene muscles may be incorporated to reduce tension on the affected nerves (DynaMed), sounds like a visit to the local chiropractor may be necessary!
In attempts to prevent such injuries many steps can be taken, resorting back to the Redskins vs. Cowboys game, avoiding helmet-to-helmet contact can definitely prevent such injuries. While this weekend’s game doesn’t fit the exact definition of spearing it leads me to the topic. In recent years, the NFL has attempted to prevent this sort of injury and increase player safety by making tackles in which the contact occurs at the crown of the helmet illegal. In attempts to prevent injury it is important that players do not lead with their head! Theoretically, in attempts to tackle in a more upright position, one should be able to maintain continued eye contact with the opposition while tackling (DynaMed).
Furthermore, it is advised that athletes avoid dropping their shoulder while tackling or wrestling. Proper fitting/modification of football shoulder pads should be ensured and improved with lifters as necessary. Lastly, identification of postural or positional faults in sport-specific techniques needs to be addressed and corrected to prevent injury (DynaMed).
DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 905473, Burners and stingers; [updated 2014 Aug 13, cited January 4, 16]; [about 7 screens]. Available from http://search.ebscohost.com.proxy.palmer.edu/login.aspx?direct=true&db=dnh&AN=905473&site=dynamed-live&scope=site. Registration and login required.
Levitz, C., Reilly, P., & Torg, J. (1997). The Pathomechanics of Chronic, Recurrent Cervical Nerve Root Neurapraxia: The Chronic Burner Syndrome. The American Journal of Sports Medicine, 25(1), 73-76. Retrieved January 5, 2016, from PubMed.
Schwartz, P. (2014, August 4). David Wilson’s career over due to neck injury. Retrieved January 5, 2016, from http://nypost.com/2014/08/04/david-wilson-shut-down-for-2014-likely-ending-his-career/