Combat Arts Neck Injuries Overview
Fighters have an extraordinary tolerance to pain. They can power through a move, a grueling workout, or a fight and roll with the punches without batting an eyelid. MMA referee and BJJ black belt John McCarthy knows about it first-hand.
He wasn’t even fighting but teaching when he experienced a neck injury that changed his life. While demonstrating how to put on a proper d’arce choke, he let a student apply one to him. The student did everything right. The move lasted ninety seconds. The following morning he had numbness and burning below his left shoulder running down into his arm. By his own account the choke did serious damage to a neck already worn down by years of training. The exact diagnosis is his to give rather than ours to assume — but the lesson stands: a neck can be wrecked in a drill, not only in a fight.
Mixed martial arts can strain your neck muscles and the cervical spine. And this is even though many fighters do neck strengthening exercises. These exercises can reduce the amount of energy transferred but over time, the sustained injury can affect the vertebrae, the muscles, and ligaments that supply them.
Neck Injury Causes
Several moves in mixed martial arts put the cervical spine at risk. In judo, the o-goshi or hip toss is a simple and common maneuver. The fighter will step into the clinch and will swing the opponent over his hips. The opponent will fall on his back. The suplex move in jujitsu, the fighter grabs the opponent by his waist.
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With their combined center of gravity moving, the fighter will fall on his back to the mat maintaining his hold on the opponent. A variant of this move, the souplesse, is where the fighter lifts the opponent by the waist and throws him over his shoulder. Before the throw, the opponent is rotated over the upper chest and slammed down. Then there are the chokeholds. A fighter will reach around the neck of an opponent with one hand and complete the choke with the other hand.
All these moves cause force displacement of the head, hyperextension of the neck ligaments, strong flexion of the cervical spine and it’s junction with the occiput. The constant acceleration, sudden deceleration, and biomechanical forces don’t allow the muscles and joints sufficient time to prepare for impact. Therefore, the kinematics of these moves can affect the structures in the neck causing injuries that could be life-altering.
Neck Injury Symptoms
Types of Neck Injuries
Injuries in the neck region are more than simply a pain in the neck. They can involve the bones and joints of the cervical spine, the intervertebral discs that act as shock absorbers between the vertebrae, and the muscles and ligaments that hold them all together.
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Related Injuries
This neck injury is due to forceful, rapid back-and-forth movement of the neck. It is similar to the cracking of a whip and hence the name. It may involve sprains or strains, injured nerve roots, intervertebral joint stress, and/or hyperextended cervical muscles, ligaments, or discs.
Causes
Whiplash damage may occur during MMA and UFC chokes, uppercuts, throws, or incorrect landings.
Symptoms
Whiplash symptoms may be felt immediately, or it may be hours or even days before they appear. A substantial share of athletes go on to report whiplash-associated symptoms months or years after the original injury — so a neck that feels fine the next morning is not proof that nothing happened.
To learn how Whiplash is diagnosed, click here.
Overview
In mixed martial arts, the neck encounters forces which cause the neck to be strained. Headgear can lessen the impact of the forces due to linear acceleration. However, most martial arts don’t use any headgear at all. A mat may decrease the impact but the forces acting on the cervical spine and the velocity tends to strain these cervical spinal ligaments and the muscles.
Most cervical sprains and strains are self-limiting. However, it's worth noting that the repeated cervical sprain and strains can further deteriorate the stability of the spine and the integrity of the intervertebral discs.
Causes
There are multiple causes of cervical sprains and strains. A cervical sprain is an injury to the ligaments. These are the connective tissue that holds the vertebrae in place. Cervical strains are injuries to the muscles that support the cervical spine. The cervical spine has to stretch considerably to resist flexion, side flexion and hyperextension.
Several muscles must contract isometrically to hold the neck’s position, and eccentrically to resist the forced displacement of the head by an opponent. Beyond takedowns and grappling, the environment is part of the problem too — a large share of neck and spine injuries in cage sports come from impact with the ground or the cage rather than from strikes, although the exact proportion is not well established.
Symptoms
To learn how Cervical Sprain/strain is diagnosed, click here.
The cervical spine is most susceptible to injury. This is because it highly mobile and the vertebral bodies that make up the cervical spine are small. It supports a heavy head and, in most cases, acts as a lever. The most dislocations and fractures involve the C2 spine in 30% of cases and C7 spine in 27% of cases.
Fractures of the transverse foramen of the vertebral bodies are associated with a blunt cerebrovascular injury. A fighter can have a dislocation where the ligament is torn or fractured or both.
There are four major mechanisms of actions that are associated with various fracture patterns. These are shearing, rotational, flexion, and extension forces. Flexion is associated with bilateral facet dislocation, anterior wedge fracture, flexion teardrop fracture, clay-shoveler fracture, anterior subluxation, and anterior atlantoaxial subluxation.
An extension is associated with posterior atlantoaxial subluxation, hangman fracture, and C1 arch fracture. Lateral flexion causes unilateral occipital condyle fracture. Flexion rotation causes rotatory atlantoaxial dislocation. Extension rotation is associated with articular pillar fracture. Axial loading is seen causing burst fractures or Jefferson fractures. Shearing forces can cause more complex fractures such as odontoid process fractures and occiput condylar fractures.
Fractures are classified according to location or the fracture pattern. Since the anatomy of the spine is unique, cervical injuries are classified occipital-cervical (occiput-C2) and subaxial cervical spine (C3-C7) injuries. Atlas fractures, axis fractures, odontoid fractures fall under the occiput-C2 category. Facet fractures, teardrop fractures, and burst fractures come under C3-C7 fractures.
The fractures may also cause the underlying blood vessels and nerves to be injured. This is what results in the injury to the spinal cord and leads to neurological deficits. In some cases, this deficit can be irreversible.
Learn how Dislocation of the Spine is diagnosed, click here.
Ricardo Libório, co-founder of American Top Team, has said he trains around seven herniated discs — a serious back problem that hasn't kept him off the mats. A herniated disc is when the spongy cushion that acts as a shock absorber between your spine, gets compressed, damaged, or starts spilling out into the bony skeleton. A slipped disc is also called a ruptured disc.
A bulging disc is when the ring or annulus that protects the nucleus is intact but protrudes and compresses the nerves. Sometimes, the herniation is severe enough for a free fragment to break through into the spinal canal. Depending on which disc is injured the spine symptoms for a herniated disc differ.
With age, our discs lose their elasticity. They become shorter, less elastic, and less effective as shock absorbers. Repeated trauma can also cause a disc to rupture even if the pressure is slight.
The tough fibrous outer wall, the annulus, degenerates with time, and that degeneration runs faster with repeated trauma. Add smoking, unhelpful genetics, and occupational load, and the chance of disc degeneration climbs further. Herniations are far less common in the neck than in the lower back, but the cervical canal has much less room to spare around the spinal cord, so a cervical disc problem can carry heavier consequences.
To learn how Ruptured Disc is diagnosed, click here.
Common Injuries
Visit our Common Injuries section to learn more about tendinopathies and how they should be managed.
Neck Injury Diagnosis
The diagnosis of spine injuries requires imaging but also a good physical examination. It’s important to distinguish spine injuries from head injuries. Both require immediate testing and treatment. While most aches and pains are self-limiting, neurological deficits point to a more serious underlying pathology.
If fighters sustain neck injuries, they shouldn’t simply power on. They must test motor and sensory function in every limb and then seek medical attention rather than finishing the session. A fighter with neck pain plus numbness, weakness, or tingling should not be helped up and walked off — that is the moment an unstable neck becomes a spinal cord injury.
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There may be a delay in symptoms and in case of neurological symptoms, the absence of sensation might flag one’s attention rather than their presence.
Injury Specific Diagnosis
Physical Exam
A physical exam is important to determine the extent of a whiplash injury. The doctor will test the range of motion of the neck and shoulder. These tests ask fighters to turn from side to side, rotate chin to shoulder, and other flexion and extension movements. Trigger points are assessed. The sensorimotor function is tested and deep tendon reflexes are also tested to rule out any neurological deficit.
Imaging:
A CT scan or MRI may be required to ascertain the severity of the injury since extreme whiplash may cause spinal damage to the adjacent bones or discs. MRIs are more sensitive for evaluating the surrounding soft tissue in the cervical area.
Lab Tests
For fighters with whiplash-associated disorders (WAD) to have a few basic blood tests. The complete blood count to check the presence of any infection.
The erythrocyte sedimentation rate (ESR) is done to determine any increased inflammation in the body. The C reactive protein CRP has been a god marker of inflammation to identify injury to muscles and is also done in WAD.
To learn how Whiplash is treated, click here.
Physical Exam
A complete physical examination is done to test all neurological functions. The range of motion of the neck is tested along with deep tendon reflexes. The doctor will also check for point tenderness.
Imaging:
Cervical sprains and strains do not need diagnostic imaging. However, Xrays are ordered just to make sure there’s no underlying fracture. If Xrays prove inconclusive or there is a finding that needs to be seen clearly a CT or MRI is done.
Lab Tests
Blood tests are usually unnecessary for cervical sprains or strains. Inflammatory markers such as CRP and ESR are done if the condition does not resolve in a few days.
To learn how Cervical Sprain or Strain is treated, click here.
The doctor will perform a restricted but thorough neurological exam. This includes testing cranial nerves, sensory function, motor, function, coordination, and reflexes. The respiratory and bowel bladder will also be examined to check for spinal never integrity.
Xrays are the first step to visualize a spine fracture. A CT then provides more detail about the fracture and is usually recommended. CT is the preferred method to examine cervical spine fractures. CT can visualize the shape and size of the canal. The content of the spinal canal and the structures around it are also visible on a CT. The MRI can amplify the nerve roots and any degeneration which is why it’s also helpful to do it.
If immediate surgery is advised, the blood tests are required. These include the CBC, BMP, PT, PTT, ESR, CRP, HbA1c, and urinalysis.
To learn how Dislocation or Fracture of the Spine is treated, click here.
On physical exam, the fighter may or may not have any neurological deficits. However, a neurological exam is important. The doctor will look for signs of numbness and weakness. The fighter is asked to walk normally and on tiptoes. Muscle strength and reflexes are tested. Range of motion tests are done to test flexibility and movement in the joints.
For a ruptured disc, a series of tests are done. Xrays are usually done in the beginning not to confirm or diagnose a herniated disc but to rule out other problems like a fracture, presence of a tumor, or secondary causes of spinal syndromes. MRI provides the most accurate assessment of the cervical spine.
It provides a detailed view of which spine is affected, where the herniation has occurred, and which nerves are affected. An MRI can demonstrate how the nerve has impinged. A CT is not as accurate as an MRI and is usually not helpful for herniated discs unless there’s a reason an MRI cannot be ordered.
A CT myelogram can also demonstrate the size and location of the herniated disc. However, it is invasive. A contrast dye is injected in the spinal fluid and a CT is done. An electromyograph can also show which nerve root is affected by a herniated disc. It’s a helpful test to differentiate between nerve degeneration and nerve root compression.
Blood tests are usually not required to diagnose a herniated disc. If a person is scheduled for surgery then pre-surgical lists of tests are done.
To learn how Ruptured Disc is treated, click here.
Common Diagnoses
In our Common Diagnoses section, read how physicians examine, test and treat common neck injuries.
Neck Injury Treatment
The treatment of cervical injuries runs the gamut from ice to surgery and physical therapy. It depends on the type and severity of the injury. Cervical spinal injuries that cause difficulty of breathing or paralysis are worse and need an immediate surgical intervention when possible.
Associated dislocations and disabilities also affect the treatment. The timing of the intervention is also subject to the type of injury and the symptoms. The medical team will decide the type and timing of the intervention after considering all of the above.
Injury Specific Treatment
Emergency
Before anything else, assume the neck could be fractured. The same chokes, uppercuts, throws, and bad landings this page lists as causes of whiplash are the causes of cervical fracture. If the fighter has severe neck pain, tenderness down the middle of the neck, numbness, tingling, weakness, trouble breathing, or any loss of consciousness — or if you simply cannot be sure — do not move them and do not reposition their head or neck. Keep them still, support the head where it lies, and call emergency services. Only once a clinician has excluded a fracture or cord injury does ordinary care apply: ice to the sore area, simple pain relief, rest, and monitoring.
Medical
Once examination and imaging have excluded a fracture, whiplash treatment is active rather than passive. Current guidance favours early, gentle movement and physical therapy over immobilisation. A collar is used sparingly and briefly, if at all, because resting the neck in one tends to slow recovery rather than speed it. Simple pain relief and short-term muscle relaxants may be used to let you move more comfortably.
Home
Heat or cold can be applied to the painful area for about fifteen minutes at a time. Once a clinician has cleared the neck, gentle movement beats staying stiff — controlled turns and small nods, within a comfortable range, progressed as the pain settles. Skip full-circle neck rolls. Taking the neck through extension and rotation compresses the facet joints and the vertebral arteries, and it is not the route back to range of motion. Physical therapy is worth starting if home exercises do not relieve the pain, since a therapist can load the neck safely. Current whiplash guidance discourages foam collars: resting the neck in a collar tends to slow recovery, and it offers false reassurance that the neck is protected. One more thing — if you have fatigue, memory trouble, poor concentration, or low mood after a neck injury, do not file them under whiplash. They overlap with concussion, and that needs its own assessment before you go back to training.
Emergency
First, rule out something worse. If there is severe or midline neck pain, numbness, tingling, weakness in the arms or legs, or any suspicion of a fracture, do not move the neck — get emergency assessment. Do not reach for a collar as your first response to post-fight neck pain: it does not protect a damaged neck, and it delays the assessment that would. Once the neck has been checked and only muscle and ligament strain is in play, apply an ice pack for 15 to 20 minutes at a time, several times a day, to reduce inflammation. Moist heat can loosen tight muscles later on, but keep it off in the first day or two after the injury.
Medical
Pain medications like aspirin and ibuprofen can help relieve inflammation and reduce pain. Muscle relaxants can relieve spasms. With the supervision of a medical doctor, massage therapy and ultrasound therapy is started. Some may even recommend, cervical neck traction or isometric exercise.
Home
Rest and ice are enough for most simple cervical strains. Many settle within a few weeks, but recovery is genuinely variable and a proportion of people carry symptoms for far longer — this same page notes that whiplash-associated problems can surface months or years later. Return to training only when the pain has settled and range of motion is back, and only after a clinician has cleared the neck if there was any red flag at the time of injury. Going back early strains the same muscles and ligaments all over again. Severe injuries take longer.
This is a true medical emergency. Do not move the fighter. Keep the head and neck still and do not attempt to move them. Place rolled towels on both sides of the neck and avoid disturbing that area. Assume a spinal injury after any spike on the head, slam, stacked guard pass, or takedown that folds the neck — and whenever the fighter has severe neck pain, weakness, numbness, or paralysis. Do not remove headgear, do not sit them up, and do not let them walk it off. Call emergency services and let them do the moving.
Medical treatment can be conservative or surgical. Initial treatment often involves skeletal traction and closed reduction, with pins placed in the skull and a pulley and rope attached. Cervical orthoses — soft collars or halo vest immobilisation — are used to stabilise the spine. Surgery usually involves cervical fusion and instrumentation, and surgical decompression is another option. There are various guidelines for surgery of the cervical spine. Atlanto-occipital dislocation is reduced with positioning and a halo vest, and almost all cases need posterior spinal fusion. Occipital condyle fractures are treated with a cervical orthosis for eight weeks in Types I and II, while Type III usually needs fusion. Atlantoaxial instability from transverse atlantal ligament insufficiency needs surgery beyond roughly 7mm of instability, because the spinal cord is at risk. Atlantoaxial rotary subluxation is reduced with halo traction. Whether a C1 or C1-C2 injury is braced or operated on comes down to stability, not to a blanket rule: a stable Atlas fracture is managed in a cervical orthosis, while an unstable one — a Jefferson fracture with transverse ligament rupture, for instance — needs surgical stabilisation. Traumatic spondylolisthesis of the axis is reduced surgically when severe. Subaxial fractures from C3 to C7 are treated with closed reduction and an orthosis where there is no spinal canal compromise; unstable C3-C7 fractures need open reduction and surgery. Beyond that, treatment depends on the type, location, and severity of the fracture, how much displacement there is, and whether the cord or nerve roots are compressed. Persistent neurological deficit pushes treatment to be more aggressive. The fighter’s age, medical condition, and associated injuries all influence the choice.
Home care for spinal injuries is difficult depending on the type of injury. Most often fighters are kept in traction at the hospital for months especially if there are severe neurological complications. After surgery, complete bed rest is advised.
Ice the sore area for about fifteen minutes at a time, with breaks in between. Heat is generally avoided in the first days after a disc injury because it can increase swelling; gentle heat may help tight muscles later on, so follow what your clinician tells you rather than switching between the conflicting rules you will find online. Numbness, weakness, worsening arm pain, or any loss of bowel or bladder control means stop and get emergency medical attention — do not wait it out.
Pain medication is started to reduce inflammation and decrease pain. Muscle relaxants can ease muscle spasm in the cervical area. Spinal injections such as epidurals or nerve blocks, delivering cortisone or another steroid near the irritated nerve, can reduce inflammation and improve movement. For fighters who do not improve with conservative treatment, or whose bowel or bladder function is affected, surgery may help — and bowel or bladder involvement is not something to sit on, it needs same-day assessment. The most common cervical operations are microdiscectomy, laminectomy, and foraminotomy. In a microdiscectomy, an operating microscope is used to remove fragments of a herniated disc. In a laminectomy, the lamina — the bony roof of the vertebral arch, not a part of the spinal cord — is removed to take pressure off the spinal cord and nerve roots. Recovery from that operation takes roughly six to eight weeks. If these do not work, surgeons may perform a spinal fusion after removing the herniated material, or replace the disc with an artificial one. A disc replacement preserves movement at that level; a fusion does not.
Physical therapy is advised for those with ruptured discs. This helps strengthen and stretch the muscles of the neck, shoulder, and arms. Alternative therapy includes acupuncture, acupressure, and biofeedback.
Common Treatments
Refer to the Common Treatments section to find out how physical therapy and medications can help neck injuries.
