Recommendations for participation in contact sports in certain cervical spine conditions, part B

Condition	Contraindication to play
Condition	Absolute	Relative^*	None^*
Ligamentous injuries
Mild ligamentous sprain with no laxity			X
Ligamentous sprain with mild laxity (<3.5 mm anteroposterior displacement and 11 degrees rotation)		X
Ligamentous laxity (>3.5 mm anteroposterior displacement or 11 degrees rotation)	X
Fractures
Acute cervical fracture	X
Vertebral body fracture with a sagittal component	X
Vertebral body fracture with associated posterior arch fractures and/or ligamentous laxity	X
Vertebral body fracture with displacement into the spinal canal	X
Healed fractures with associated neurologic findings or symptoms, pain, or limitation of cervical range of motion	X
Healed, stable, mildly displaced vertebral body fracture without a sagittal component or neural ring involvement		X
Healed, stable, end-plate fracture			X
Healed stable compression fracture of vertebral body			X
Healed "clay-shoveler's" fracture			X
Healed, nondisplaced Jefferson fracture		X
Healed, stable neural ring fractures		X
Spinal fusion
Stable, one-level anterior or posterior surgical fusion			X
Stable, two-level anterior or posterior surgical fusion		X
Anterior or posterior fusion of three or more levels	X
Cervical disk conditions
Healed intervertebral disk bulge			X
Healed intervertebral disk herniation		X
Intervertebral disk herniation with neurologic signs or symptoms, pain, or limitation of cervical range of motion	X

This table provides guidance on restriction from contact or collision sports based upon specific cervical spine conditions. Some sports medicine experts would also restrict patients with these conditions from limited contact sports as well, and, if the parents/ primary caregivers were not in agreement, then make a neurosurgery or spine surgery consultation a condition of participation. This more conservative approach recognizes that, in spite of guidelines regarding return to play for various cervical spine conditions or injuries, there is limited consensus among treating physicians. This table should be used with other UpToDate content, refer to topics on musculoskeletal neck injuries in the child or adolescent athlete.

* Provided individual is asymptomatic and neurologically normal and has full range of pain-free cervical motion.

Adapted from: Torg JS, Ramsey-Emrhein JA. Cervical spine and brachial plexus injuries: Return-to-play recommendations. Phys Sportsmed 1997; 25:61.

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Recommendations for participation in contact sports in certain cervical spine conditions, part B