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It makes your arm very hot, heavy and difficult to move. Stingers don’t tend to last too long: you get pins and needles down your arm as the heaviness goes away. Sometimes it’s 10 seconds, sometimes maybe a minute.

England Rugby star Jonny Wilkinson, who required neck surgery after recurrent injuries

This chapter focuses on the assessment and management of non-catastrophic painful neck conditions in the athlete. While there is much attention on prevention and acute management of catastrophic neck injuries, these injuries occur predominantly, but not exclusively, in contact sports.1, 2 Yet, many athletes suffer from debilitating non-traumatic neck pain that can affect both their participation in sport and their quality of life. Such conditions range across a spectrum from acute muscle injury to chronic repetitive strains to cervical degenerative joint disease.3, 4, 5


It is usually not possible to make a definitive patho-anatomical diagnosis in most neck pain conditions. Lesions can be identified on imaging with injuries such as cervical fractures or dislocations, or disc disruption (linked with symptoms of a radiculopathy), as can anatomical abnormalities which may predispose the athlete to neck pain or injury.6 However, for the majority of neck pain presentations in both the athletic and the general population, radiological imaging is unable to identify the pathoanatomical pain source with any certainty. As a result, the majority of disorders are generically classified as non-specific or mechanical neck pain. Despite having one label, the presentation of neck pain conditions is highly variable. Thus, the clinical examination assumes primary importance in identifying the symptom sources and any sensory, neuromuscular and sensorimotor abnormalities associated with the individual athlete’s neck pain. The clinical examination relies on a foundation of anatomical knowledge.

The cervical spine is designed for movement, in contrast to the lumbar spine that is designed to carry load. As the most mobile region of the spine, its movements ensure a wide visual field. The functional cervical spine extends from the atlanto-occipital (C0–1) segment to the upper thoracic region (approximately T3–4 segment).

There are many key features to note when performing a clinical evaluation. Movement occurs independently and interdependently between the cranio-cervical, cervical and cervicothoracic regions. The atlanto-axial (C1–2) segment contributes about half the total rotation of the cervical region and this head movement can be performed relatively independently. Most of the remaining rotation occurs at the cervical segments (C2–7), but the head will not rotate to its full excursion unless the upper thoracic region provides the necessary 10° of this movement.7 From a postural perspective, there is interdependence of the lumbar, thoracic and cervical spinal curves.8 Evaluation must be both local and regional.

The neck muscles have many diverse roles given the broad functional requirements of the cervical region. For example, an ice hockey player needs fast movements ...

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