Return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis

Background context: Fortunately, catastrophic cervical spinal cord injuries are relatively uncommon during athletic participation. Stinger and transient quadriplegia/paresis are more frequent injuries that have a wide spectrum of clinical severity and disabilities. Although the diagnosis of these injuries may not be clinically difficult, the treatment and decision about when or if the athlete may return to play after such an injury is often unclear. Purpose: This article reviews the current literature to help determine reasonable guidelines for return-to-play criteria after cervical spine injuries in the athlete. Methods: The contemporary English literature and experience-based guidelines for return to play after cervical spine injuries in the athlete were reviewed. Results: Despite the frequency of cervical-related injuries among athletes participating in contact and collision sports, no consensus exists within the medical field as to a standard guideline approach for return to preinjury activity level. Conclusion: The issue of return to play for an athlete after a cervical spine injury is controversial. Tremendous extrinsic pressures may be exerted on the physician from noninvolved and involved parties. The decision to return an athlete to a particular sport should be based on the mechanism of injury, objective anatomical injury (as demonstrated by clinical examination and radiographic evaluation) and an athlete's recovery response.