Epidemiology of Cervical Injuries in NCAA Football Players

Andrew S. Chung, DO; Justin L. Makovicka, MD; Jeffrey D. Hassebrock, MD; Karan A. Patel, MD; Sailesh V. Tummala, BS; David G. Deckey, BS; Thomas C. Hydrick, BS; Nicolas C. Rubel, BS; Anikar Chhabra, MD


Spine. 2019;44(12):848-854. 

In This Article

Abstract and Introduction


Study Design: Descriptive epidemiology study.

Objective: The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players.

Summary of Background Data: The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years.

Methods: The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition.

Results: An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52–0.90) and 0.39 (95% CI 0.16–0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days.

Conclusion: Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value.

Level of Evidence: 4


Approximately 70,000 student-athletes participate in National Collegiate Athletic Association (NCAA) football across three divisions.[1] While the overall risk of injury is arguably less in the collegiate football setting than at the professional level, the high-impact nature of the sport still predisposes athletes to injury.[2] In particular, young athletes who participate in contact sports are at highest risk for cervical spine injuries, as sports account for 15% of all cervical spine injuries.[3,4] The clinical severity of these injuries is highly variable, ranging from transient neuropraxias to life-threatening spinal cord injuries.

Unfortunately, while less common, severe cervical spine injuries have a higher propensity to be both clinically and personally devastating when compared with other sports-related injuries.[5,6] In a study evaluating severe injuries in all NCAA sports, head and neck injuries accounted for 11.2% of all injuries which resulted in extended time lost from play.[7] For NCAA athletes with aspirations of pursuing a professional career, a cervical spine injury can be career ending.[8]

Despite the substantial clinical and career-related implications of cervical spine injuries in the collegiate athlete, no recent characterization of these injuries exists. The purpose of this study was to utilize a large NCAA database to update the current understanding regarding the epidemiology of cervical spine injuries in NCAA football athletes.