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Management-Nonoperative Management

The athlete with no sign of cervical spine injury should be removed from play and observed on the sidelines. Symptoms usually are self-limited and mild. Athletes with prolonged burner symptoms are treated with removal from play, modification of activities, ice, and nonsteroidal anti-inflammatory medications.

A soft neck collar can be used for severe symptoms. Physical therapy includes neck range of motion; strengthening of the neck stabilizers, shoulder, and periscapular muscles; stretching; gentle traction; and soft-tissue myofascial techniques.

The common practice is that an athlete can return to full contact activities dependent on painfree, full passive and active range of motion of the neck and shoulders and a normal neurological examination, including full and symmetrical strength of the shoulders and neck. If underlying neck pathology must be ruled out, the athlete should be investigated first before being cleared to play.

Because most athletes have resolution of symptoms and a normal examination within minutes, most can return to play during the same game in which they were injured. The natural history of athletes who have sustained burners has not been studied.

The key to management of a burner is the prevention of recurrence. Prevention is initiated by practicing proper tackling technique from a more vertical, upright position rather than by dropping the shoulder and rotating the head, which can result in lateral bending and extension of the neck.

Tackling with the crown of the helmet or “spearing” must be avoided, because axial load to the neck is particularly dangerous. The shoulder pads should be checked for appropriate fit. A protective neck-roll or collar that limits neck extension is anecdotally useful in preventing recurrence of burners.

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