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CHAPTER 5:
The Head and Neck

Since the head houses all of the body's vital control centers, any injury to the head other than a mild bump or scrape should be seen by a doctor. I always consider head injuries to be serious until it is proven otherwise since they can be lifethreatening. No one has ever laughed at me for being overcautious with a head injury.

CONCUSSION

A player who has suffered a head injury may feel better later in the game and may try to sneak back into action. This is especially easy for a football player since there are many players intermittently running on and off the field. To make sure an injured Giants player doesn't return without permission, we take away his helmet. That works for everyone except Lawrence Taylor. When he has had his head "dinged," Taylor, though dazed, will holler at me to let him back in. By the end of the shouting match, I know he's okay, and I've accomplished what I wanted to.

A concussion is any loss of consciousness, even for a moment, or disorientation after a blow to the head. There are many degrees of concussion. A player may be unconscious for several minutes with a severe concussion. Another player may be stunned for a few seconds and have trouble remembering where he is or what he is doing.

There is no way to predict which athletes are likely to suffer concussions. The severity of a concussion depends strictly on how much force is applied to the head and whether it is a headon or a glancing blow. People who wear helmets, which absorb shock, will probably get milder concussions than those who don't.

Treating a Concussion

The treatment for a concussion is rest to protect against further injury to the head. If you immediately regain consciousness or are out for just a short time, you should be watched carefully for signs of headache, nausea, and further loss of consciousness. These are the danger signs of possible bleeding inside the head. Even if you appear normal after the injury, you should be watched for the next 24 hours for any of these signs.

If you do not recover immediately, you should be transported to a hospital as soon as possible for observation and a neurological examination. A typical neurological exam after a concussion will include checks on your reflexes, muscle strength, balance, and pressure in the back of your eye.

Returning to Action

Even if you recover immediately, you should not be allowed to reenter the game or return to activity under any circumstances. When you suffer a concussion your brain swells, and until the swelling subsides completely, another, lesser blow can cause severe damage to the brain. So if you have had a concussion, you are at high risk for another one until you are completely recovered.

Sometimes, it's hard for me to tell whether a player who has been hit in the head has had a memory lapse. He may insist he is all right and may even answer general questions correctly. That's why we have another Giants player ask the injured player about his assignment in particular situations, and we base the diagnosis on his response.

Although we do allow a professional player back in the game, it is only after we are sure he has recovered. He is constantly monitored, and he is not returned to the game if it is not safe. However, this degree of care is not available at any other level of participation, so it is necessary to keep an injured amateur athlete out as a precaution.

The rule of thumb I use to determine when an athlete can return is

  • First concussion: Wait seven days or until any postconcussion symptoms cease, whichever is longer. For example, a touch football player who suffers a concussion on Saturday should miss next Saturday's game, even if it was a mild concussion.

  • Second concussion: Wait three weeks or until symptoms cease.

  • Third concussion: Remain out of action for the remainder of the season.

Anyone who suffers a severe concussion should not return to sports without a physician's recommendation. The physician usually bases the decision on the results of neurologic tests and a review of the symptoms.

Postconcussion Syndrome

After a concussion, some symptoms may persist, including headache, dizziness, loss of memory of the event, fatigue, and general weakness. For some people, these symptoms clear up and they feel fine, but the symptoms recur when they become active again. This is called postconcussion syndrome.

As soon as these symptoms return, you should stop all activity and rest again. You may need a prolonged period, as much as several months, before the symptoms cease. No athlete should return to heavy physical activity until the symptoms clear completely. Giants quarterback Jeff Hostetler had to sit out four weeks of the 1992 season with postconcussion syndrome.

SKULL FRACTURE

A hard blow to the head can fracture the bones of the skull. This is an extremely dangerous injury. A depressed skull bone from a fracture may put pressure on the brain or tear blood vessels in the lining of the skull, causing bleeding on the brain. The pressure and bleeding can cause coma and even death if not relieved.

Blood or clear fluid leaking from the ear or nose may be a sign of a skull fracture. Though I rarely see skull fractures, they do occur, and I consider any severe blow to the head as a possible fracture.

If you suspect a skull fracture, get the player to an emergency room immediately for treatment to relieve the pressure or bleeding on the brain.

BROKEN NOSE

I have been leveled several times on the sidelines while watching Giants games, mostly because I can't see over the heads of the players to see if anyone is coming at me. I remember walking toward the sidelines in 1982 when all of a sudden the players in front of me parted and an opposing defensive back came flying toward me, head first. I turned to get most of my body out of his way, but the edge of his face mask clipped me on the nose and broke it.

A blow to the nose can fracture the nasal bones or the cartilage of the septum, the area dividing the two nostrils. A broken nose often is obvious: The nose appears to be flattened or crooked, there is lots of bleeding from the nose, and breathing is difficult.

Any nose suspected to be broken should be iced down to limit swelling and bruising. Then have the nose x-rayed and examined by a doctor. If the broken bone has been at all displaced, it can cause later breathing problems if it's not fixed in place. Once fixed, the nose should be protected with a splint until it heals completely, which can take four to six weeks.

BROKEN CHEEKBONE

The same athletes who are prone to nose breaks may also break cheekbones. A hard blow to the cheek can fracture the bone.

In case of a break, ice the cheek and apply pressure to reduce swelling and bleeding. Then have the cheek x-rayed. If it's broken, surgery may be required to repair it. The player must rest until it heals, which could take several weeks.

BLOWOUT FRACTURE

A blow to the eye or cheek can fracture the bones surrounding the eyeball, called the orbit. A blowout fracture is easy to spot: Since the orbit connects to one of the sinuses, when the victim blows hard through the nose, the eye will suddenly swell shut as air gets into the tissues right under the eye.

As with any fracture, the victim of a blowout must see a doctor for treatment, which may include surgery. If the fractured orbit is displaced, as often happens, it can trap one of the eye muscles. Then the eyes won't move in conjunction, which can cause double vision unless surgically corrected.

SCRATCHED CORNEA

A scratched cornea commonly occurs when you get poked in the eye by a finger. This usually is an extremely painful, though minor, injury: but if severe and not cared for, it can lead to loss of vision. You can't differentiate the severity by the amount of pain you feel. If you suffer a scratched cornea, cover the eye with a patch and see a doctor as soon as possible.

Direct blows to the eye from a ball in racquet sports, particularly racquetball, can also cause a variety of severe injuries. To protect their eyes, many athletes now wear protective gear, especially if they have already had an eye injury. Every eye injury must be considered serious. Sight is one of our most precious gifts and should be protected at all times. Again, cover the eye and get to a doctor.

CAULIFLOWER EAR

If an unprotected ear is bent over, punched, or caught in a wrestling hold, the cartilage in the ear can break. Bleeding under the skin will result, and if the blood is not drained, scar tissue will form and the ear will take on the look of a cauliflower.

To treat such an injury, apply ice and compression to the ear to limit bleeding, and then get to a doctor to have the excess blood drained from the ear.

BROKEN JAW

When Giants tight end Mark Bavaro broke his jaw, he kept it wired for one week and then removed the wires himself so that he could get a good meal. He played with an enlarged face mask for the rest of the 1985 season, but I don't recommend that others follow his example. The average athlete has a much lower pain tolerance than a Mark Bavaro.

A blow to the jaw can break it. You will feel pain on one side of the jaw and may not be able to clench your jaw because of the pain. Or, if you can clench your jaw, your teeth will not meet properly.

A broken jaw must be wired shut by a dental surgeon to allow it to heal, which usually takes six weeks. Many athletes can compete with their jaws wired shut, but their diet is limited to liquids taken through a straw. This can lead to loss of weight and strength. You are not at risk by playing as long as your jaw is wired.

A blow to the jaw can also injure the hinge where the lower jaw fits into the upper jaw, called the temporomandibular joint (TMJ). The ligaments may become torn, causing the joint to slide in and out of place. The jaw may even get stuck in an open position, requiring manipulation by an oral surgeon to close it. This injury usually heals within six to eight weeks, but a mouthpiece may be necessary to hold the jaw in position until the ligaments heal.

TMJ pain is one of the reasons athletes wear mouthpieces. The mouthpiece protects the jaw and teeth and disperses the shock from a blow. This also reduces the possibility of a concussion and is the main reason a boxer uses a mouthpiece: It helps prevent him from being knocked out.

All kinds of mouthpieces are available, from hand-molded, individualized ones for professional athletes to $1 rubber or plastic mouthpieces found in your local drug store. The rubber or plastic mouthpiece, which can be heated to become form-fitting, may not be as good as the customized ones, but any mouthpiece is better than none at all.

I believe that mouthpieces should become part of the uniform for most high school sports and some recreational sports. Yet only high school football and hockey players routinely wear mouthpieces. Certainly in basketball, where elbows are flying everywhere, and in wrestling, everyone should wear some type of mouthpiece. Racquetball players should also wear them as protection against being hit in the face with the ball.

THE NECK

Along with the head, the neck is the area of most of the serious injuries I see. Knee injuries may end careers, but neck injuries may end lives or cause paralysis.

The neck is much less stable and much more prone to injury than the rest of the spine. At the top of the spinal column, the vertebrae in the neck become progressively smaller. The neck is tremendously mobile to allow the head to swivel, so the range of motion between the vertebrae in the neck must be greater than in the lower spine. Also, neck muscles are much weaker than those in the lower back, where the strongest muscles in the body support the spine.

Don't move a person with a neck injury. I consider every neck injury to be serious. When you feel neck pain, check for numbness or the inability to move a body part. If either is present, don't move. Stay where you are until a trained ambulance or emergency first-aid crew arrives. These medical personnel have the training and equipment to minimize further injury. An injury can easily turn into a permanent disaster if the neck isn't properly stabilized. Moving a fractured neck can cut the spinal cord.

At Giants games, we don't move a player with a suspected neck injury off the field even though we have two doctors and three trainers present. Emergency medical technicians move neck injury victims every day, and we don't, so we wait for them. I strongly urge anyone delivering first aid to a neck injury to wait for professional help.

BROKEN NECK

The most serious neck injury damages the cervical vertebrae in the neck; this is commonly called a broken neck. Each year a few football players, from the high school level on up to the professionals, suffer spinal cord injuries that leave them quadriplegics. However, the most common cause of a broken neck is diving. The diver misjudges the depth of the pool and hits the bottom head first.

A head-on blow causes a compression fracture of the neck, in which the force to the top of the head compresses and shatters some of the cervical vertebrae. This may be as mild as a simple chipping of the vertebrae, or it may cause compression or severing of the spinal cord. Compression or cutting of the cord can cause quadriplegia or even death, depending on where the injury occurs along the spinal column.

An equally severe injury can occur from a blow when the neck is bent down. This is more common in football, where a tackler ducks his head as he makes contact.

SPRAINED NECK

Ligaments hold the vertebrae together, and those ligaments can be sprained or stretched, often by the head snapping backward. If the injury is severe, one vertebra may slide forward out of place and compress the spinal cord--the same injury as a fracture. If the sprain is mild, you will just feel pain and stiffness in the neck area. Anything more than a mild sprain should be seen by a physician.

PINCHED NERVE

An injury that seems like a sprain but is more complex is a pinched nerve. This happens when a cervical disc ruptures or degenerates. Commonly, when a disc ruptures, jellylike material from inside the disc presses on a nearby nerve and causes sharp pain that extends down into your arm. You may feel a sudden onset of severe pain in your neck, or the pain may come on slowly over time.

Any athlete who makes fairly violent neck motions is prone to pinched nerves. A pinched nerve usually responds to some form of cervical traction for two to six weeks, with accompanying physical therapy to reduce muscle spasm. However, if severe symptoms persist, particularly in the arm and the hand, you may need surgery to repair damage to the disc.

NARROWED CANAL

Athletes who have recurrent, short episodes of numbness or weakness in their arms and hands may have a narrowed spinal canal. This condition is called cervical stenosis. A magnetic resonance imaging (MRI) scan will show a narrowing of the cervical canal, which is the area from the base of the skull to the shoulder. The symptom may occur after relatively mild trauma to the neck because the spinal cord does not have adequate room in the canal.

A "BURNER" VERSUS STRETCHED NERVES

There are two nerve injuries to the neck that feel the same at first. Both are caused by a blow to the head or neck, and both cause burning pain down the arm and weakness in the arm and hand. One, a "burner," is a simple injury that won't keep you out of action; but the other, stretched nerves, is a serious injury that requires rehabilitation.

A "burner" or "stinger" is characterized by sudden burning pain down one arm, which feels weak. This is due to a pinched nerve in the neck. Usually, the pain disappears and full strength in the arm returns within five minutes. If your arm strength is normal, then you can return to full activity.

It's very important to know which side of the head was hit and on which side you feel the pain. If you sustain a blow to the left side of your head, your head will be knocked toward your right shoulder, and you will suddenly feel the burning pain down your right arm. The pain comes from the nerve being pinched as vertebrae in the neck flex sharply to the right.

The similar but more dangerous injury, a brachial plexus stretch, has almost the same symptoms. This time, however, the pain and weakness persist because of stretched nerves. This is a serious injury, and you must not return to action until you have recovered full strength, which may take weeks.

In this case, when you sustain a blow to the left side of the head and your head is knocked toward your right shoulder, you feel pain down your left arm. This is due to the nerve being stretched on the left side of the neck as the head is pushed to the right.

If you still feel pain at the end of activity, see a doctor. Do not return to action without the doctor's approval. An earlier return may reinjure the nerves and cause permanent damage.

NECK MUSCLE INJURIES

When you wake up in the morning and can turn your head only one way, you are suffering from wryneck, or spastic torticollis, which is due to a pulled muscle or a muscle spasm. The same type of injury can happen in sports, such as when you look up and serve or hit an overhead smash in tennis. You feel the pain on one side of the neck, and your neck may be pulled over slightly to that side. It's particularly painful to turn your head in the direction of the pain. That is, if the pain is on the left side of your neck, you can turn to the right but not to the left.

The proper treatment is to apply ice for 20 minutes at a time and gently stretch the neck (see the stretching program at the end of this chapter). If the pain is severe, you may need medication, such as a muscle relaxant or antiinflammatory agents, and physical therapy.

TRAPEZIUS TRIGGERS

Severe muscle spasm in a localized area of the neck can cause another injury, called triggers of the trapezius, characterized by a very painful area at the base of the neck or extending out above the collarbone. Any athlete can suffer this injury by pulling fibers in the trapezius muscle or from a direct blow to the muscle fibers in the neck.

The muscle spasm in the neck sets up a reflex arc that feeds on itself. The spasm causes nerves to fire and gives the sensation of pain. This electrical impulse causes other nerve fibers to fire and the muscle to contract more. This, in turn, causes the pain fibers to fire, starting the whole cycle all over again.

For treatment, ice the neck for 20 minutes and then massage it gently with your fingers while stretching the muscle (see Trapezius Stretch).

If the pain is severe, you may need physical therapy, including electrotherapy, which involves electrical stimulation of the neck muscles. Very severe pain may require an injection of cortisone and novocaine.

WHIPLASH

The neck muscles, as well as the ligaments that hold the bones of the neck, can become severely strained. A combination of muscle and ligament strain to the neck due to a sudden, violent movement is called whiplash.

This can be a severe injury that takes up to six months to heal. It should be seen by a physician and x-rayed to make sure that the vertebrae in the neck have not slipped out of alignment or become fractured.

The treatment for whiplash is rest for two or three days, followed by physical therapy. Antiinflammatory drugs can also help ease the discomfort. The injury may also require a cervical collar, which is a high collar that supports the weight of the head and takes the strain off the ligaments.


Preventing Neck Injuries

Probably the best way to prevent a neck injury is to strengthen your neck muscles. The huge necks you see on college and professional football players do not happen by accident. They are the result of long hours of exercise to increase neck muscle strength.

Every athlete should work on improving neck strength. You can do basic exercises by applying resistance against yourself or by working with a partner.

Neck-Strengthening Exercises


A Stretching Program for Pain Relief

To help alleviate minor neck pain, here are some simple exercises. Probably the best stretch of them all is the Trapezius Stretch. If you have serious neck problems, consult your physician before trying these exercises.

Neck-Stretching Exercises




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