Spinal Injuries: Part 1

For information purposes only. Exercise at your own risk. Always consult a doctor if you sustain an injury

Neck (Cervical Spine) Injuries

by Jon Hobbs MSc MCSP SRP

In this series of 3 articles we will be taking a look at the most common spinal injuries that can arise from both MMA training and competition. Due to the structure of the spine and the nature of spinal injuries we shall divide the spine into its three natural anatomical areas; the neck (cervical spine), the mid back (thoracic spine) and the lower back (lumbar spine).

The Neck

Function The function of the neck or cervical spine is to support the head, house and protect the spinal cord and allow a wide range of head movement (e.g., forward and backward movement bending side to side and rotation.)

Anatomy
Vertebrae and Discs
The cervical spine is made up of seven individual vertebrae stacked on top of each other to form the top section of the vertebral column. In between each one of the vertebrae is a gel-like disc (intervertebral disc) which allows movement, helps to absorb shock, distributes stress, and keeps the spine in correct alignment. As you age your discs slowly degenerate and cause the vertebrae to get closer together. The spine, like any other articulations in the body (elbow, knee, shoulder etc) also has joints and these are known as zygoapophyseal joints (or facet joints for short!). Each vertebra has two pairs of facet joints that link the vertebrae together with the one above and below. The facet joints are located at the rear (posterior) of the spinal column. It is the facet joints that help to make the spine flexible. Muscles, Tendons and Ligaments
Surrounding the bones and discs are a complex system of ligaments, tendons, and muscles which help to support and stabilize the cervical spine. Ligaments are inelastic bands of fibres that prevent excessive spinal movement that could result in serious injury. Tendons attach the muscles to the bones and the muscles control movement as well as providing stability and balance.

Central and peripheral nervous system The movement of the muscles is controlled by nerve impulses that originate in the brain and are sent via the spinal cord to the nerves of the body. The nervous system itself is split into two major regions: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord whilst the PNS consists of the nerve roots and all nerves beyond the central spinal cord. The CNS and PNS are responsible for all movement in the body. As the spinal cord is a major part of the CNS and the vertebral column houses and protects the spinal cord the spine is an area you want to avoid injuring at all costs!


Injuries
There are a number of ways to develop neck pain (or cervicalgia) but in the case of most MMA practitioners we can rule out degeneration with age as by the time this occurs your training should not be in the combative arena! If you are a more senior practitioner however and you have been suffering with long standing neck pain, degeneration of the neck joints (or spondylosis) may be the culprit and advice from your GP or Chartered Physiotherapist is essential if you wish to continue to train.
Cervicalgia as with all areas of the spine may be Acute (recent) or Chronic (longstanding). Acute injuries of the neck will tend to be soft tissue injuries (STI) which covers basically everything that isn’t bone. Fractures of the cervical spine do occur but thankfully are rarer than most people would think in MMA.

Acute Injuries
The most common ways to incur acute neck injuries in MMA will be from head strikes, landing during throws and takedowns, neck “cranks” and of course chokes. Strikes to the head are also responsible for a large number other problems such as facial fractures, lacerations, abrasions, haematomas and loss of consciousness (LOC). These other injuries are beyond the scope of this article however and will be covered at a later date when we examine head injuries in MMA. The same is true for chokes as only the effect on the neck will be discussed and the effect of LOC will be left for another time.

The most common type of acute injury occurring in the neck in the general population tends to be whiplash. In whiplash the head is literally whipped in one direction and then another, rapidly overstretching and compressing the opposing soft tissues of the neck. This traumatises the neck causing pain, swelling, stiffness and spasm in the neck muscles and possibly headaches and nausea (if you’ve ever been in a car crash you’ll know what I mean!). Similar injuries can occur with strikes to the head (especially a high Thai round kick to the side of the neck or head) or from throws (suplex onto the back of the neck). Trauma from striking can damage muscles, tendons and ligaments. Trauma to ligaments tends to cause persistent problems and will nearly always require physiotherapy intervention to recover full pain free range of movement. Trauma may also occur with a choke but this is usually from compression of one of the bones of the forearm (Radius) against the soft tissues of the neck. This not only reduces the flow of blood to the brain by compressing the Carotid artery but may also cause bruising (haematoma) of the surrounding soft tissues by rupturing smaller blood vessels. The bruising from a choke (which is technically a “strangle”, as a “choke” limits the intake of air whilst strangulation limits flow of blood) is short lived and fairly harmless but just looks bad! The major damage caused by a choke is actually internal to the brain and can neither be seen nor treated once the choke has occurred! So tapping out before unconsciousness arrives is usually a good idea!

If in the days following a neck injury you have weakness, pins and needles, numbness or burning in one or both arms you need to seek advice and assessment from a Chartered Physiotherapist ASAP. If any limb becomes paralysed or you suffer any of the above symptoms immediately following a neck injury during training or competition then get yourself to A&E ASAP and get checked out for disc or nerve damage. Any alteration in sensation or function following a neck injury suggests nerve involvement and although the spine is very strong, its internal structures are very delicate and extremely important for normal function. There’s a very good reason why a number of neck cranks and elbow strikes to the spine are outlawed in a lot of MMA promotions! Don’t be alarmed at A&E if they’re not concerned about X-raying your neck following an injury, as true dislocations or fractures of the vertebrae are very rare and usually occur in sports like motocross or show jumping (remember Christopher Reeves?). More likely to occur however is the chipping of bone or compression (or wedge) fractures of the cervical spine and possible disc protrusion but these usually take some force, like being dropped on your head from a great height….more WWE than UFC!

With the exception of bruising all neck injuries that persist beyond 24 hours should be checked out by a Chartered Physiotherapist to evaluate the injury and advise on subsequent treatment, rehabilitation and strengthening.

Chronic
Neck pain that has been around for more than a few weeks or has occurred without any injury (insidious onset) will often be biomechanical in origin. This means postural i.e. the way you sit, stand and move about. It has been estimated that 85% of neck and back pain is from postural dysfunction and only 15% of neck and back pain is from traumatic injuries. This figure may be slightly different in MMA but as most practitioners of MMA are amateur and not pros then they have to work for a living at something else during the day. 40 hours at a desk, sitting in a van or working over a bench will give you a neck problem in no time at all. An underlying neck problem like this will soon start to impact on your training if not remedied. Again any neck pain that persists, whatever the cause should be assessed and treated. You’ll pick enough injuries up training MMA without getting anymore from work!

Assessment
If you have suffered a neck injury or have neck pain or stiffness then see a Chartered Physiotherapist and get the problem assessed. When dealing with neck injuries avoid the advice of mates down the pub or even in the dojo (even if they do mean well!). The neck is as about as important as it gets when we are looking at the musculoskeletal system so get it treated properly 1st time around. Assessing the problem correctly is paramount to successful treatment. Remember that neck pain is a symptom and not actually a diagnosis!

Treatment
As with all uncomplicated STIs, PRICE(MM) is the favoured approach. The Protection, Rest, Ice are fine but Compression may not be the best idea around the neck for obvious reasons! The Elevation occurs naturally because of the location of the neck anyway. Medications and Modalities (physical treatments) should be sought from your GP or Chartered Physiotherapist if the pain persists more than a few days.
If pain from the injury persists beyond 24 hours it’s a good idea to start to increase the movement in that area gently. In a national study of people suffering from whiplash injuries, those who began gentle range of movement exercises a few days after injury made a better recovery than those that didn’t.

Most treatment plans for the neck will include manual therapy (manipulation and mobilisation), exercises (gentle bending and rotation of the neck) and modalities such as electrotherapy (ultrasound) or acupuncture (for pain and inflammation). All these treatments however are injury specific, so again assessment is very important.

Rehabilitation
As always one of the major goals of rehabilitation is to maintain your cadiovascular fitness levels, so for instance when you suffer a neck injury try avoiding the continued impact of roadwork, try aqua jogging with a flotation belt (running upright in a swimming pool without your feet touching the bottom of the pool). As a word or warning avoid swimming though, as the extended position of the cervical spine tends to aggravate neck problems. You, your coach/trainer and your physio should work together at devising alternative training programmes as soon as possible particularly if you are a competitive fighter. In addition to cardiovascular fitness, you may use the injury period as an opportunity to strengthen weaker areas whether they be physical, mental, technical or tactical. Your physical rehab plan should include exercises to restore normal strength using progressive resistance exercises and then continue to further develop strength in that area to protect it from possible future injury. In addition in the later stages rehab you should include some combat-specific drills (with an emphasis on proper technique). Both boxers and wrestlers usually have tremendous neck development. It enables boxers to take a punch and wrestlers to bridge their bodyweight without additional support from the arms to avoid being pinned. Performing a wrestler’s bridge can be a great exercise for developing strength in the neck but it can also be a great way to injure the neck! This is a technically and physically demanding exercise and should only be attempted under close professional supervision. Some training facilities will use a head harness with an attachment for free weights to work the neck. The main problem with this is it relies on moving the weight against gravity so the resistance is variable through the exercise depending on your position (you usually have to lie down or bend over to exercise). This also means that if you injure your neck whilst training you still have a weight hanging off your head whilst in an awkward position! Strength however can be built up in the neck using isometric exercises for resistance. It’s usually easier to use either your hand against your head as resistance or a towel held in both hands, or even a soft ball against a wall. As an example; 1) place your palm of your right hand against your forehead, 2) without allowing your hand to move push your forehead against your hand, 3) continue for 10 seconds remembering to breath throughout, 3) repeat for a few sets and you’ll soon feel the difference in your neck muscles. If at anytime you feel any discomfort just stop pushing so there is no risk of additional injury during your rehabilitation. This exercise can be repeated in different directions and angles around the head with either one hand as resistance or a towel held between both hands either side of the head with the head pushing into the middle of the towel. As also mentioned that instead of using your hand a ball (a cheap kid’s football is ideal) can be placed against a wall and the forehead pushes into the ball creating resistance with some give in it for comfort and safety.

It must also be appreciated that the power, speed and angles which occur during competition may far exceed the criteria for successful completion of rehabilitation exercise. To be ready for competition you must perform over and above what you are required to do in competition.

Return to Training/Competition
Depending on the severity of the injury, it may take several months of physical therapy for you return to full training or competition. The differing types of neck injury makes for a wide range of recovery and rehab times. Muscular injuries may be days to weeks whilst ligament injuries often take months to rehabilitate and a fracture or disc injury may prevent a return to full MMA competition permanently even after many months of rehabilitation. As always two key factors exists for return to full training/competition; firstly the risk of re-injury and secondly the ability to fight/perform at a satisfactory level. These factors are often intertwined. When there is a risk of re-injury, the potential for further or permanent damage must also be considered and in the neck permanent damage can have a huge impact on the rest of your life. The criteria for return to competition after a neck injury include restoration of normal strength, flexibility and stability. With biomechanical problems it is important to identify the specific activity that caused the initial injury so that activity can be avoided or training or postures modified. Avoidance steps may include changing technique, training habits, and equipment, and modifying posture and ergonomic practices at home and at work as well as during training.

This is just a brief outline of the neck injuries you may incur during MMA training and competition and a rough guide to treatment and rehabilitation principles. If you have any specific neck or spinal problems you will need to seek first hand advice, assessment and treatment from an experienced sports injuries Chartered Physiotherapist.

Check out parts 2 & 3 in this series: Mid Back (Thoracic Spine) and Rib Injuries & Lower Back (Lumbar Spine) Injuries

This article is for the purpose of information only and it is not intended to diagnose or treat medical conditions and is not considered to be a substitute for individual medical assessment and advice.