Tragic death of ice hockey player underscores urgent need for improved neck injury education

Last week, American ice hockey player Adam Johnson died in a “freak accident” during a game. Johnson, 29, was allegedly “struck in the throat by an opponent's skate, causing a fatal injury,” reports The Guardian. The incident occurred when another player’s ice skate cut Johnson’s neck—slicing his carotid artery. Johnson died in the ambulance.

As a result, the National Hockey League is now "strongly recommending" players use neck guards going forward. According to reports, two other professional ice hockey players had their necks slit during games in 1989 and 2008—but both survived.^[][]

A 1996 article published in the Scandinavian Journal of Medicine & Science in Sports found that three amateur ice hockey players also experienced neck slash injuries, with two dying from their wounds. “One player died of asphyxiation secondary to hemorrhage into the respiratory passage, but the other died of hemorrhage from the main blood vessels in the neck, severed by the skate blade,” the authors write. “Neck slash injury from skate blades, as a preventable sports-related injury, and the need for neck protective equipment in preventing such injuries are discussed.”

Last month, a different type of nonfatal injury occurred when a New York Giants quarterback, Daniel Jones, was sidelined due to a disc injury which left him with “‘significant weakness on his left side.” Jones must be benched until he heals or he’ll risk reinjury, reports the NFL.^[] 

In the NFL, Jones isn’t alone. Mechanical neck injuries are commonplace. BMC Musculoskeletal Disorders found that between the 2016 and 2021 seasons, 464 players were placed on the injury reserve list due to neck injuries. Season-ending and career-ending injuries occurred every 1.82 and 1.06 per 10,000 team plays, respectively.^[]

Neck injuries—sustained outside of professional football—are relatively uncommon and usually self-limiting, according to Primary Care: Clinics in Office Practice.^[] 

These injuries can encompass anything from temporary ‘burners’ and ‘stingers’ to “severe but nonpermanent fractures and impingements, to permanently disabling spinal damage and even fatalities,” says David Woznica, MD, MS, of Woz Wellness. 

Everyday neck injuries and issues Common neck issues include cell phone neck and whiplash injuries, Dr. Woznica says. 

With cell phone neck, patients whose “near-constant flexed positions of the neck to use phones results in a gradual lengthening of connective tissues, such as ligaments, through a process called tissue creep,” Dr. Woznica says. 

This constant flexing leads to a subtle cervical instability of the neck that might not be seen on imaging, he says. This leaves patients with headaches, popping sounds, neck pain, and muscle tension in the neck and trapezius. 

This can lead to weakness and tingling, as in Jones’s case, as well as carpal tunnel–like symptoms in the arms, Dr. Woznica adds.

“Whiplash injuries [are similar] through a more forceful acute injury. Often, whiplash injuries may simply have neck spasm and tightness for the first 3 to 6 months. After the muscle spasm from the accident improves, however, the connective tissue instability can show up and result in the same types of symptoms,” Dr. Woznica describes. 

Fatalities due to neck injury

Fatal neck injuries are not common, Dr. Woznica says. When they do occur, they’re often from gunshot and stab wounds, in addition to motor vehicle accidents. Across the board, cervical spinal cord injury (SCI) makes up 8.2% of all trauma-related deaths, according to a 2011 article in the Journal of Spinal Cord Medicine. 

The above review also found a relationship between cervical SCI and an increased early mortality rate (death within 30 days of injury). Out of 1,163 patients, 109 (9.4%) died. Patients more likely to die included those who received a grade of A from the American Spinal Injury Association, those with a high cervical SCI (C1–C3), and those who did not undergo surgical intervention. 

The importance of understanding the musculoskeletal system

Neck injuries are often improperly treated by otherwise well-intentioned healthcare practitioners, says Georgiy Brusovanik, MD, a minimally invasive orthopedic spine surgeon based in Miami, FL. 

“The average medical school student gets almost no musculoskeletal education during their class time. Unless they say they're interested in orthopedics, they will [almost] never hear of the musculoskeletal system,” Dr. Brusovanik says. 

“As a spinal surgeon, I see so much misdiagnosis in the neck and spine,” Dr. Brusovanik says. “For example, shoulder blade pain represents 90% of associated neck pain. Many patients will have minimum neck pain and stiffness, however. If [a patient] has pain under their shoulder blade, they need a neck MRI.” 

Dr. Brusovanik says he also sees many patients who’ve already been unnecessarily or improperly treated in some way—to no avail. “They’ve had thoracic fusion, dental work, or shoulder work,”—or they’ve often had unnecessary surgery on the spine, he says. Often, treatments weren’t medically necessary, he adds. 

In a 2023 Frontiers in Surgery article titled “Unnecessary spine surgery: can we solve this ongoing conundrum?,” author Khaled Fares AlAli writes, “‘Do I need surgery?’ This question has become increasingly common in my spine clinic over the past decade. After carefully examining the patient's medical history, performing a clinical exam, and reviewing different radiographic imaging, I often find that surgery is not necessary in at least 80% of cases.” He says the issue comes down, in part, to financial gain and blatant resistance to change.^[]

Dr. Brusovanik agrees. “Doctors are often incentivized to do surgery,” he says. “I see reasonable MDs telling patients they have to have surgery. It's pervasive.” More so, insurance companies aren’t likely to “argue with spine and neurosurgeons…you can get an operation approved easily without much evidence [for necessity],” he says. 

What are the culprits here? It comes down to a few elements, Dr. Brusovanik says, including a lack of musculoskeletal education, the effects of managed care, and the complexity of pain. “Shoulder pain usually causes MDs to focus on the thoracic spine…when it’s cervical,”  he adds. 

Dr. Brusovanik also cites certain cultural factors, noting that female patients who can’t obtain proper imaging or who haven’t been given a firm diagnosis are sometimes told they have fibromyalgia, a sort of catch-all for when an MD can’t get to the bottom of a patient’s pain. 

Dr. Brusovanik says he doesn’t jump to surgery as a fix-all; he aims to offer advanced minimally invasive techniques, like injections. When appropriate, he also runs bloodwork on certain patients who might need to be then referred to a rheumatologist (when, for example, he suspects ankylosing spondylitis). 

Protecting your patients’ neck from injury

According to Cara Dobbertin, PT, DPT of Practitionr, patients should be advised to improve the strength in their neck and upper back muscles, which support both the neck and posture. “Optimal postural alignment can reduce stress on the neck and reduce the risk of injury,” Dobbertin adds.

Certain patients, she says, might need physical therapy for pain or injuries. “Interventions can include manual therapy techniques such as joint and soft tissue mobilizations, stretches, strengthening, and postural exercises for long-term pain management,” Dobbertin adds.