Return to Play Guidelines After Cervical Spine Injuries in American Football Athletes

A Literature-Based Review

Peter R. Swiatek, MD; Tejas S. Nandurkar, MS; Joseph C. Maroon, MD; Robert C. Cantu, MD; Henry Feuer, MD; Julian E. Bailes, MD; Wellington K. Hsu, MD


Spine. 2021;46(13):886-892. 

In This Article


Although an improved understanding of injury mechanisms as well as the evolution of rule changes have decreased its incidence, cervical spine injuries continue to occur frequently in American football. These conditions present a myriad of challenges and can result in significant consequences for players with improper management. RTP guidelines after injury need to be assessed based on a case-by-case basis, but we believe in several core principles. Consideration for RTP should be individualized based upon a player's history, physical examination, imaging characteristics, and sport/position played. Players should have full ROM of the cervical spine without associated pain, return of normal muscle strength, and an intact neurologic exam. Recommendations regarding congenital issues in the cervical spine and postsurgical criteria for RTP continue to evolve with the continued research of cervical spine injuries in NFL athletes.