Head, neck, and cervical spine injuries are common in athletes of all ages, and the incidence seems to increase with age.^1,2 Soft tissue injuries such as neck sprains and strains or facial lacerations are much more common than vertebral fractures and spinal cord injury.^1–3 Many of these injuries are self-limited and can be managed on the sideline or in the training room.³ Although catastrophic cervical spine injuries are uncommon, they are associated with significant morbidity and mortality and can have significant lifetime costs.⁴ When an athlete appears to be injured, the sideline physician must be prepared to provide a focused assessment and treatment plan.

Preparation

Before being on the sideline at a game or practice, it is important to be as prepared as possible in the event of any injury. When covering games at the high school level or higher, athletic trainers are typically present at most games and practices. Many times, they will be the first point of contact if an athlete is injured, and sideline physicians should at least make a quick introduction before the game or practice to establish a plan in the event of any athlete injury.⁵ Knowledge of the closest trauma center, available resources such as the venue’s emergency action plan, and location of an automated external defibrillator (AED) and spine board are critical. During the game or practice, the sideline physician should have a clear, unobstructed view of the field of play and quick, easy access to the field, if needed.⁶ Access to a treatment room, where more detailed evaluation and treatment can be administered, should be made available when appropriate and feasible.⁶ Awareness of supplies available in the athletic trainer bag and training room to assess injured athletes is critical. Examples of supplies include an eye kit, flashlight, and nasal packing material. A more complete list of supplies is provided by a consensus statement on sideline preparedness from several organizations including the American Academy of Family Physicians.⁷

Neck Injuries

The initial evaluation of an injured athlete with suspected head or neck trauma should include assessment of airway, breathing, circulation, disability, and exposure according to the principles of Advanced Trauma Life Support.^3,6,8 This should be followed by a spine evaluation and neurologic assessment using the Glasgow Coma Scale.⁵

Any athlete not moving, whether conscious, unconscious, or with decreased consciousness, should be considered to have a cervical spine injury^3,8 (Table 1^5,9–11). The cervical spine should be stabilized, and the athlete transferred to a spine board using the log roll or lift and slide maneuver (https://www.youtube.com/watch?v=AlwFLh36kiE). These maneuvers involve rolling the athlete to the side and transferring them onto the spine board; alternatively, the athlete should be lifted and slid onto the spine board with assistance from trained personnel such as athletic trainers.^5,8,12,13 The sideline physician is usually at the head of the athlete providing cervical spine stabilization and providing instruction to other clinicians assisting in stabilizing the athlete.^5,8,12,13 The athlete should then be transported to the emergency department by emergency medical services (Table 2^{3,5,8,10–14}). In sports such as football and hockey where the athletes are wearing helmets and pads, it is recommended to leave the equipment in place during transfer.^5,8,13 If there is altered mental status or an airway needs to be established, the face mask can be removed.^5,8 If either the helmet or pads need to be removed, both should be removed together to avoid causing any cervical hyperflexion or hyperextension, and this should be performed by a team of trained personnel comprising at least two or three additional people.^5,8 For a demonstration of helmet and pad removal, see: https://www.youtube.com/watch?v=HdyGMUJfWWw.