September 23, 2022

Hockey fans love adrenaline, it's the backbone of the sport. However, nothing feels more dramatic and suspenseful than the pause of gameplay while medical professionals rush to ice. We watch hockey players sustain injuries that cause bleeding, teeth-breaking, among other gnarly issues, and we often watch them skate off the ice. But what is going when the player isn't able to leave the ice on their own and instead medical response comes to them? One possibility is that the medical team is preforming an emergency spine immobilization. 

Matthew Matava, MD, Medical Director for the St. Louis Blues, has spent 25 years with the Blues and leads the team's life-saving measures like emergency spine immobilization. His expertise provide insights about injuries on the ice for St. Louis Blues and NHL fans alike.

Emergency Spine Immobilization 

Emergency spine immobilization happens when an injury to the spinal column is suspected (usually the cervical spine [neck]). This can be caused by a fracture, dislocation, disc herniation or neurologic injury. It is first stabilized manually, by team physicians and athletic trainers while the athlete remains on the ice, followed by application of an immobilizing brace (cervical collar). The athlete is also placed on a spine board – a rigid board of various designs – that allows their removal off of the ice to a gurney and then to an ambulance for transportation to the hospital. The cervical collar and spine board allows the athlete to be transported with the least amount of movement in any direction to prevent potential injury to the spinal cord and nerves that leave the spinal cord.

Injured Until Proven Otherwise 

Emergency spine immobilization is done when there is a suspected spinal injury involving the vertebrae, spinal cord and/or nerves that leave the spinal cord. Spine immobilization is also done as a precaution when a player sustains a head injury and is rendered unconscious. In this situation, a spinal cord injury is assumed to be present until proven otherwise, by a physical exam or imaging at the hospital.

Team Physicians Take the Lead

The team physician typically is in charge of coordinating the activities to remove the player safely from the ice when suspected of having a spinal cord injury. This person is usually positioned at the player’s head to communicate to the other first responders and to provide physical support of the head and neck until the cervical collar can be applied and the player can be placed on the spine board.

Sometimes the team’s head athletic trainer is the first person to reach the player, so they assume physical support of the neck. The other team physicians, athletic trainers, and EMS personnel also participate to help control the situation, move the athlete in a safe, coordinated fashion, assist with lifting the player onto the spine board, and transport to the ambulance.

Getting it Right

"Practice doesn’t make perfect – perfect practice makes perfect," explains Dr. Matava. There is a lot of stress, anxiety, and concern when an athlete is suspected of having a spinal cord injury with possible paralysis or other neurologic injuries. Therefore, everyone who will participate in the care of the athlete following a traumatic injury has to know his or her role in this activity so that it is done safely, quickly, and in a coordinated fashion.

The potential consequences of an athlete sustaining a spinal cord injury are serious and life-changing. The NHL has mandated that each team’s medical staff simulate various immobilization and transportation scenarios in the preseason so that each person’s role is well understood and the group works as a coordinated team if and when an actual spinal injury occurs.

Team physicians will collaborate with Washington University Orthopedics spine surgeon partners if an athlete sustains a fracture, dislocation, or neurologic injury following trauma on the ice. If the athlete has an associated traumatic injury to the brain, Washington University neurosurgeons are consulted.

Fast Facts

1. Team physicians practice and rehearse spine immobilization each preseason in preparation for actual traumatic injuries encountered during play.
2. While serious spine injuries do occur in hockey, they are rather rare. Unfortunately, the ramifications of such an injury in a professional athlete are significant. Therefore, we assume the worst-case and protect the spine following a potential injury until it is confirmed that there is no structural damage.
3. There are a variety of medical subspecialists from Washington University present at each game who are trained to diagnose and manage significant spinal injuries in elite athletes.
4.  Procedures and protocols used to evaluate and treat the St. Louis Blues players following a hockey injury, are the same that are used to treat other athletes and traumatic injuries in our other patients who are victims of motor vehicle accidents, significant falls and other high-impact trauma.

Learn more about being treated like a pro by Washington University Orthopedic Sports Medicine experts. To schedule an appointment, call (314)514-2500 or request an appointment online.