Neck and Cervical Spine Injuries in National College Athletic Association Athletes

A 5-Year Epidemiologic Study

David G. Deckey, MD; Justin L. Makovicka, MD, MBA; Andrew S. Chung, DO; Jeffrey D. Hassebrock, MD; Karan A. Patel, MD; Sailesh V. Tummala, BS; Austin Pena, BS; Walker Asprey, BS; Anikar Chhabra, MD, MS


Spine. 2020;45(1):55-64. 

In This Article

Abstract and Introduction


Study Design: Descriptive epidemiology study.

Objective: The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period.

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

Methods: The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program 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: Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs.

Conclusion: The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation.

Level of Evidence: 4


Neck and cervical spine injuries in college athletes are relatively common.[1] Athletes are at highest risk for neck and cervical spine injuries as sports account for 15% of all cervical spine injuries.[2,3] These injuries can range from minor muscle sprains to vertebral fractures with resulting long-term disability or death.

The high prevalence of neck and cervical spine injuries in sports is thought to be due to the inherent instability of the neck.[3] Common contact mechanisms leading to pathology include axial loading, hyperextension, traction or compression of the brachial plexus, repetitive axial loading, eccentric muscle contraction, or multiple repetitive traumatic episodes.[4] Risk of injury is highest in the setting of underlying muscle imbalances which can oftentimes be secondary to inadequate conditioning.[5,6] Furthermore, cadaveric studies have shown that abrupt deceleration of the head and continued forward inertia of the torso leads to excessive axial compression.[7] This mechanism of injury is commonly seen in sports such as football, rugby, hockey, diving, wrestling, and gymnastics.[7]

Rates of neck injury have been described for individual sports, but there is a paucity of literature describing national trends across sports at the collegiate level.[8–12] This investigation sought to use the NCAA Injury Surveillance Program, which collects injury data from NCAA sporting teams, to estimate sport-specific rates of neck and cervical spine injuries in 22 varsity sports nationally.