Suspected Spinal Injury? Evidence Based On-Field Management

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INTRODUCTION

What situation do you most dread during game day coverage? I know what my most dreaded situation is – seeing one of my guys stay down after a tackle, laying motionless on the ground. I think at that point you know, as the sports physio, it is GAME TIME!

The decisions that you make over the next few moments have the potential to impact the rest of that player’s life. Pretty heavy huh! So you would want to make sure that what you do when you get out there is evidence based wouldn’t you? I would think YES, possibly more-so than any other time.

Boissy et al (2011) studied the range of head motion that occurred when experienced professionals utilised different cervical stabilisation techniques in a range of clinical scenarios. This article discusses the implications of what they found.

CERVICAL STABILISATION TECHNIQUE

In many cases this will be the first decision that you will make. Before questioning the athlete, you will likely approach and perform a cervical stabilisation technique. Remember: assume a spinal injury until proven otherwise, and you should prevent unwanted cervical movement. The article discussed allows us to make evidence informed decisions between either head-squeeze stabilisation or traps-squeeze stabilisation techniques.

HEAD-SQUEEZE STABILISATION TECHNIQUE

In this technique the physio lets the athletes head rest in the palm. Their hands will be on both sides of the head, and the fingers are placed so that the 4th and 5th fingers grab the mastoid process. The 2nd and 3rd fingers are positioned to apply a jaw thrust (as required – see video below).

TRAPS-SQUEEZE STABILISATION TECHNIQUE

The physio will hold the athlete’s trapezius muscles on either side of the head with their hands (thumbs anterior to the trapezius muscle). The physio should then firmly squeezes the head between the forearms with the forearms placed approximately at the level of the ears

WHICH TECHNIQUE IS BEST IN DIFFERENT CLINICAL SCENARIOS?

Well, Boissy et al (2011) assessed 3 different clinical situations and found the following:

  1. Cooperative Athletes: no significant difference in movement between techniques.
  2. An Agitated Athlete who tries to Sit: the Traps-Squeeze technique provided much better stabilisation
  3. An Agitated Athlete who tries to rotate their head: the Traps-Squeeze technique provided much better stabilisation.

NB: You may note that only the head-squeeze permits a “Jaw Thrust” in the event of airway occlusion. However, it is easy to transition between the techniques in the scenario of the unconscious athlete.

TRANSFER TECHNIQUE

The study also examined the amount of head movement that occurred during both the “5 Person Log-Roll” and “6 Person Lift and Slide Techniques”. Overall, the lift and slide technique seem to produce better results. The Lift and Slide had a mean motion of less than 5 degress in all planes. This is compared to less than 15 degrees in most planes for the Log-Roll (Boissy et al., 2011).

TAKE HOME MESSAGES

  • Traps-Squeeze produces better results than Head-Squeeze Cervical Stabilisation in the agitated athlete
  • Only the Head-Squeeze permits a “Jaw Thrust” in the event of airway occlusion
  • Lift and Slide produces better results than the Log-Roll, and should be utilised where possible

What are your experiences with these techniques: I would love you to let me know in the comments or catch me on Facebook or Twitter

Remember: if you require any sports physiotherapy products be sure check out PhysioSupplies (AUS) or MedEx Supply (Worldwide)

REFERENCE

Boissy P, Shrier I, Briere S, Mellete J, Fecteau L, Matheson GO, Garza D, Meeuwisse WH, Segal E, Boulay J, Steele RJ. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 2011 21(2):80-8.