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Cervical Spine Disorders in Football Players


Take Home Points

  1. American football athletes entering the NFL draft with pre-existing cervical spine pathology were less likely to be drafted compared to controls 
  2. Players with pre-existing cervical spine pathology demonstrated a shorter career compared to those without, but there was no difference in performance 
  3. Players with absolute cervical stenosis have successfully played in the NFL with no difference in performance-based outcomes and no reports of neurologic injury during their careers. 
  4. Players with previous cervical spine surgery have successfully played in the NFL with no difference in performance-based outcomes and no reports of neurologic injury during their careers.
There is a high rate of cervical spine pathology in football players. It is estimated an average of 23.4 days are missed per neck injury in the NFL (Mall 2006). However, the mere presence of cervical spine deformity does not correlated with symptoms. This mismatch makes difficult decisions for football physical therapists and physicians. 

Schroeder (2014) studied the medical evaluations and imaging reports of NFL combine athletes between 2003 – 2011. Then, NFL career statistics were compared to those with cervical spine diagnoses and symptoms. 
Of the 2,965 athletes, 4.8% had a pre-existing spine diagnosis. Of this 4.8%, only nine of them had a previous cervical spine surgery. Players with a cervical spine diagnosis were significantly less likely to be drafter than those without one (~14% lower draft percentage). Of the players drafted, those with a cervical spine disorder had a significantly decreased playing career by nearly a year, as well as less games played by 13. The games started and performance were lower in those with a cervical spine diagnosis, but did not reach significance. The position of the athlete did not alter the draft rate. 

The three most common diagnoses were:
  1. Spondylosis: Intervertebral disc degeneration and/or the presence of facet degeneration, or a herniated cervical disc.
  2. Stenosis: Narrowing of the spinal canal. 
  3. Cervical herniated disc: When parts of the disc are pushed through parts of the disc. 
Players with spondylosis were significantly less likely to be drafter. While, stenosis did not decrease the draft rate. Spondylosis also significantly decreased the number of years played, games played, and performance. However, stenosis or a herniated disc did not significantly impair these parameters. None of the player with cervical stenosis had symptoms. 

Seven of the nine players were previous cervical spine surgery were drafted. There was no significant difference in career length, games started, or performance compared to controls. 

Cervical Spine Disorders Prevention and Rehabilitation

Football players should strive for less cervical spine disorders for improved draft status. Football player cervical spine disorder prevention should include neck strength and soft tissue work. Continually monitoring any symptoms and decreasing the frequency of hitting can help with prevention and early detection. 

If a cervical spine injury does occur, proper rehabilitation is mandatory for resolving symptoms. Similar to cervical spine football player prevention, focusing on resolving the symptoms is possible through soft tissue management, strengthening, and motor control training. These three mechanisms can decrease symptoms and help return to prior level of function. 

Individualized prevention and rehabilitation programs are mandatory as each football cervical spine disorder is different. Ensure proper individualized care with a strength coach for football or football physical therapist. 



  1. Schroeder GD, Lynch TS, Gibbs DB, Chow I, Labelle M, Patel AA, Savage JW, Nuber GW, Hsu WK. The Impact of a Cervical Spine Diagnosis on the Careers of National Football League Athletes. Spine (Phila Pa 1976). 2014 Apr 8. [Epub ahead of print]
  2. Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ. Spine and axial skeleton injuries in the National Football League. Am J Sports Med. Aug 2012;40(8):1755-1761.


Written by Dr. John, DPT.