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Columna Cervical


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Journal of Athletic Training 155

Journal of Athletic Training 2005;40(3):155–161

q by the National Athletic Trainers’ Association, Inc

www.journalofathletictraining.org

Cervical Spine Functional Anatomy and the

Biomechanics of Injury Due to Compressive

Loading

Erik E. Swartz*; R. T. Floyd†; Mike Cendoma‡

*University of New Hampshire, Durham, NH; †University of West Alabama, Livingston, AL; ‡Sports Medicine

Concepts, Inc, Geneseo, NY

Erik E. Swartz, PhD, ATC; R. T. Floyd, EdD, ATC; and Mike Cendoma, MS, ATC, contributed to conception and design and

drafting, critical revision, and final approval of the article.

Address correspondence to Erik E. Swartz, PhD, ATC, Department of Kinesiology, New Hampshire Hall, 124 Main Street,

University of New Hampshire, Durham, NH 03824. Address e-mail to eswartz@cisunix.unh.edu.

Objective: To provide a foundation of knowledge concerning

the functional anatomy, kinematic response, and mechanisms

involved in axial-compression cervical spine injury as they relate

to sport injury.

Data Sources: We conducted literature searches through the

Index Medicus, SPORT Discus, and PubMed databases and

the Library of Congress from 1975–2003 using the key phrases

cervical spine injury, biomechanics of cervical spine, football

spinal injuries, kinematics of the cervical spine, and axial load.

Data Synthesis: Research on normal kinematics and minor

and major injury mechanisms to the cervical spine reveals the

complex nature of movement in this segment. The movement

into a single plane is not the product of equal and summative

movement between and among all cervical vertebrae. Instead,

individual vertebrae may experience a reversal of motion while

traveling through a single plane of movement. Furthermore, vertebral

movement in 1 plane often requires contributed movement

in 1 or 2 other planes. Injury mechanisms are even more

complex. The reaction of the cervical spine to an axial-load impact

has been investigated using cadaver specimens and demonstrates

a buckling effect. Impact location and head orientation

affect the degree and level of resultant injury.

Conclusions/Recommendations: As with any joint of the

body, our understanding of the mechanisms of cervical spine

injury will ultimately serve to reduce their occurrence and increase

the likelihood of recognition and immediate care. However,

the cervical spine is unique in its normal kinematics compared

with joints of the extremities. Injury biomechanics in the

cervical spine are complex, and much can still be learned about

mechanisms of the cervical spine injury specific to sports.

Key Words: catastrophic injury, whiplash, injury mechanisms,

spinal cord, axial load

Because of the potentially catastrophic and life-altering

nature of cervical spine injury (CSI), much concern

exists regarding the prehospital management of the cervical

spine–injured athlete. This is evidenced by a multiprofessional

task force effort initiated by the National Athletic

Trainers’ Association to establish general guidelines for the

acute care of the spine-injured athlete.1 Major CSIs, although

rare compared with sprain and strain injuries to the extremities,

are troubling because of mortality rates and the potential permanent

loss of neural function. A CSI requires an immediate

and deliberate, yet sensitive, response. The highest rate of severe

neck injuries has occurred in American football and rugby.

2–8 Other sports and activities that contribute to a high rate

of CSI are wrestling, diving, recreational diving, ice hockey,

gymnastics, and horseback riding.3,5,9

The more severe CSIs associated with athletics can be attributed

to compressive forces from axial loading.10,11 Clinically,

a major CSI results in compromised integrity of the cervical

segment due to fracture, dislocation, subluxation, or

ligamentous tearing, leaving the cervical spine unstable. White

et al12 defined clinical instability in the spine as more than a

3.5-mm horizontal displacement of one cervical segment on

another. Obviously, the athletic trainer is unable to detect the

presence of such a diminutive irregularity in the structure of

the spine and must, therefore, assume the worst-case scenario.

Motion in one plane at the cervical spine requires the contribution

of complementary motion from

...

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