Head and neck sports injuries: on-field management
An on-field sporting injury to the head or neck can potentially be very serious and such injuries need to be managed effectively and safely. If a player is unconscious or cannot move, the most important aspects of treatment are spinal precautions and resuscitation. Assessment and treatment of these injuries is best performed by medical personnel.
Emergency procedures for head and neck sports injuries
- Call 000 for an ambulance immediately.
- Check that the player is not at risk of further injury and whether they are responding to stimuli (e.g. talking, responding to pain). Check the player’s breathing and pulse without moving their head or neck.
- If the player is not breathing and has no pulse, begin cardiopulmonary resuscitation (CPR). CPR involves mouth-to-mouth breathing and external heart massage through the chest.
- If the player is breathing but not moving, DO NOT MOVE the person. The player can only be moved when a spinal injury has been ruled out by medical personnel.
Concussion is a temporary loss of awareness or consciousness caused by a blow to the head.
- The symptoms of a concussive head injury may include headaches, blurred vision, dizziness, nausea and loss of consciousness.
- The player should be taken off the field and should be monitored closely.
- If the player experiences persistent vomiting or complains of an increasingly painful headache they should be transported to hospital immediately.
- If the player is unconscious for more than one minute or if they experience a seizure or fit, they should be transported to hospital immediately.
- If medical personnel are not at the field to assess the player, they should be transported to hospital for further assessment and medical attention. The player should not return to play unless they have been assessed by medical personnel.
- Return to sports and activity after a head injury should be in a graded manner and under the supervision of appropriately trained medical professionals.
- Facial swelling, bruising, deformity, difficulty in facial movement and pain are all signs of a broken nose, cheekbone or a mid-face fracture. The player should be taken off the field and an ice-pack should be applied to the injury to minimise swelling before the player is taken to hospital for further treatment.
- If the player cannot bite or completely close their mouth, they may have a fractured jaw bone. The player should be temporarily bandaged around the jaw and head to prevent movement before being transported to hospital.
- When a facial fracture has occurred and a cervical spine injury has been excluded by medical personnel, the player should be seated upright in a forward-leaning position to allow drainage of blood and fluids.
- Symptoms of eye injury include obscured or blurred vision, pain and non-matching pupil sizes.
- The player should be taken off the field and transported to hospital for further treatment.
- If the player has sensations of flashing lights, blackness or the sense of a curtain falling in front of the eye, they may be suffering retinal damage and should be transported to hospital immediately. In such cases, eye patches (if available) should be placed over both eyes.
Last Reviewed: 25/07/2012
1. Whiteside JW. Management of head and neck injuries by the sideline physician. Am Fam Physician 2006; 74: 1357-62. Available from: http://www.aafp.org/afp/2006/1015/p1357.html (accessed Aug 2012). 2. American College of Emergency Physicians. What to do in a medical emergency. Irving (TX): ACEP, 2009. Available from: http://www.emergencycareforyou.org/Search/Default.aspx?searchtext=ID=1560 (accessed Aug 2012). 3. Mayo Clinic. Retinal detachment (Nov 2010). Available from: http://www.mayoclinic.com/health/retinal-detachment/ds00254/dsection=symptoms (accessed Aug 2012).
Video: Spinal injury
What is spinal injury?
Spinal injury can occur to the bones (vertebrae) that make up the spine, or to the spinal cord, which is the bundle of nerves running down the neck and spine that carries electrical signals between the brain and body. Spinal cord injury can disrupt these signals and is therefore extremely serious, because it can result in loss of movement (paralysis) below the point of injury. Damage to the vertebrae often occurs at the same time as damage to the spinal cord, but the spinal cord can also be damaged without any damage to the vertebrae.
There are many possible causes of spinal injury. Some common causes include:
- Motor vehicle accidents;
- Any trauma to the head, neck, face, chest or back;
- Stab or bullet wounds;
- Infection, inflammation and tumours, and;
- Electric shock.
Risk factors for spinal injury include:
- Dangerous driving;
- High-impact contact sports, and;
- Risky behaviour, such as diving into shallow water.
Signs and symptoms
Signs and symptoms of spinal injury can include:
- Difficulty walking;
- Loss of movement in the arms or legs;
- Loss of control of the bladder or bowel;
- A stiff neck or neck pain;
- A numb or tingling feeling in the arms or legs, and;
Methods for diagnosis
To diagnose spinal injury, a doctor will perform a physical examination, during which they will perform a range of tests to check a person's ability to move and feel sensation. This involves the doctor touching various parts of the person's body to check they can still feel, as well as checking their muscle strength and reflexes.
After physical examination, X-rays, CT or MRI scans are done to check if there is any spinal injury and related damage, such as fractures.
Types of treatment
Immediate first aid for a spinal injury is required. If someone has experienced a spinal injury, call 000. A person with a spinal injury should not be moved unless it is absolutely necessary (such as if they are in a car that is on fire). Their head and neck are to be held in place until medical assistance arrives. Under no circumstances should their head or neck be straightened, or allowed to bend or twist.
If someone is unconscious as a result of their injury, it is also important to check their breathing and, if necessary, to perform cardiopulmonary resuscitation (CPR). If CPR has to be performed, then it is again important not to tilt the persons head back.
Surgery and medication
Steroid medications can help to slightly improve a person's condition if taken within eight hours of injury. Depending on the extent of the injury, surgery may also be required to remove bone fragments, foreign objects or herniated discs, as well as to stabilise the spine.
After the initial period of treatment, rehabilitation is generally recommended to aid a person's recovery. It requires the assistance of physiotherapists to help strengthen muscles, and occupational therapists to help the person learn new skills. Psychologists will also form part of the management team, as the difficulties experienced from having a spinal injury can be a cause of psychological distress.
Researchers are currently developing robotic exoskeletons and other technological solutions that will hopefully one day help people with total paralysis to walk again, but the technology is in the early stages of development and is not yet in wide use.
The main complication of spinal cord injury is loss of movement, which results from damage to the nerves that form the spinal cord. When people lose the use of their legs, this is termed paraplegia. When they lose the use of their body and all four limbs, it is termed quadriplegia or tetraplegia.
If the nerves are completely severed, then total paralysis occurs. If they are only partly severed, then some movement may remain.
Spinal injury can also lead to loss of bladder or bowel control. This can be very difficult to deal with; however, with appropriate treatment many people can live with these issues.
The vast majority of people with a spinal cord injury have a minor enough injury that they can remain fully independent. If the damage is moderate, there is a chance they will walk again. However, if the spinal cord injury is severe, chances of a full recovery are poor. If paralysis is still present three days after injury, there is likely to be some ongoing physical disability.
Very rarely, if the spinal injury is very high up in the neck, it can cause paralysis of the breathing muscles, leading to cessation of breathing. If first aid is not immediately given, death is a possibility.
There are a number of different ways to reduce the risk of spinal injury in different situations, including:
- Wearing a seatbelt when in a car;
- Not drinking and driving;
- Not diving into shallow pools or other bodies of water where the depth of the water cannot be seen, and;
- Avoiding high-impact contact sports, or if they are played, by only tackling someone safely and not head-first.
Video: Head injury in children
Head injuries in children are commonly caused by accidents, falls, trauma or sport. Most are classified as either minor or moderate and aren’t associated with any long-term complications. Close observation of all children with a head injury is needed, but not all need to go to hospital.
First aid in an emergency
Find out what to do if you witness an emergency or see someone who is unconscious and needs help.
Neck pain: treatment
Treatment for neck pain depends on the cause and how severe it is. Neck pain treatment, including treatment for whiplash, often involves a combination of self-care, medicines, exercises and relaxation therapies.
Video: Mild head injury - Dr Golly
Across Australia, every year, more than 15,000 children and young people – mostly boys – are admitted to hospital for a head injury from sport, accidents or falls. They’re really common, so it’s helpful to know whether a trip to your GP or Emergency Department is actually needed.