Sports medicine expert talks spinal injury that sidelined player on MNF

If you watched Monday Night Football (MNF) this week, it’s probably safe to say that your heart dropped after Pittsburgh Steelers player Ryan Shazier grabbed his back and couldn’t move his legs after a making a tackle early in the game.

Gregory Stewart, MD, a physician at Tulane Institute of Sports Medicine, says his heart certainly skipped a beat.

“That’s really the scariest piece of any of this – having to go out on the field and seeing one of your players not being able to move something,” said Dr. Stewart, who also serves as medical director for the new clinic dedicated to former professional athletes at Tulane Medical Center and the team physician for Tulane University Athletics.

“It’s not quite as serious when a player goes down. We see that all of the time,” he added. “But when they’re down and not moving, those always become very difficult.”

It was later reported that Shazier suffered a spinal contusion – a scary back injury that is surprisingly not rare and thankfully not life-altering. According to the Pittsburgh Post-Gazette, studies have shown that as many as seven out of every 10,000 football players suffer this injury.

Shazier has since reportedly gained some movement in his lower extremities. In the meantime, we still have questions.

We asked our sports medicine expert, Dr. Stewart, to help provide clarity on the condition in question below.

On spinal cord contusion:

They say “contusion” but it’s more like a spinal cord “concussion”, which means there is a disruption of the functional aspects of the spinal cord, but not a disruption of the spinal cord itself. For this injury, we would expect everything to start working like it’s supposed to again.

On whether a spinal cord contusion results in a “bruise” or swelling:

Generally, you would end up with some sort of a bruise. It’s not like a bruise where there would be a lot of swelling. If you looked at this under a microscope, sure, you would see a little bit of swelling. But in the spinal cord, a little bit of anything goes a long way.

On whether the force of the hit or how he was hit contributed to this injury:

It was probably a combination of both. If you’re not in an awkward position, then a hard hit doesn’t make any difference. It’s a combination of being in a weird position and being on the receiving end of a hard hit that sets you up for that kind of an injury.

On what a sports medicine physician would need to do first with an injury like this:

The first thing you need to do is immobilize the player. When you first go out on the field, you don’t know whether or not their problem is a fracture or what it is. So, you need to immobilize them first and then transport them to the hospital so that an x-ray or MRI can be performed to find out exactly what’s going on. That’s really the scariest thing when they’re not moving. The fact that he was moving his arms is way better.

On whether this type of injury is common in football:

You don’t see it too often. We take care of about 20 different high schools, as well as Tulane University sports teams, and we’ll see it on occasion, especially if it’s involved at the neck level. Because Shazier was able to move his arms that meant the injury was lower in the spinal cord. That’s more unusual than in the neck, which are the ones you really worry about because you’re not able to move your arms as well as your legs. But with a spinal concussion injury, we’ll probably see it once a year or every other year. Sometimes a player will come and tell you that it happened and they couldn’t move for a couple of seconds then everything kind of came back. (Of course, we’ll evaluate accordingly.) Shazier’s injury was obviously more severe.

On what type of symptoms he might have been experiencing:

Nothing, actually. They feel the pain of the hit but once that goes away then it’s generally numbness. Part of the spinal cord is not doing what it’s supposed to do so you won’t have any feeling. It’s more numbness than anything else.

On how long symptoms normally last:

Usually, it’s a couple of days. On the ones like this, a lot of times the feeling and movement will come back relatively quick. The longer it takes for it to return, the worse the prognosis may potentially become. You just like to see these things come back sooner rather than later.

On how spinal concussions are treated:

You can do a number of things. Sometimes, by the time you get to the emergency room, everything is better – it settles down and the player can move, so you don’t necessarily need to do much of anything. But there’s a high-dose steroid – the anti-inflammatory kind – that can be administered through an IV. Also, on some people, they will now do cooling treatments in order to help with any swelling in the spinal cord.

On whether rehab is necessary:

Yes, they will have to do some physical therapy or rehab in the athletic training room to get their strength and functional ability back. Again, as all of the function comes back and the quicker it comes back, the less you have to worry about. So physical therapy will be important, but not necessarily in-patient rehab.

Dr. Gregory Stewart is the medical director of the Professional Athlete Care Team, part of HCA Healthcare’s Tulane Health System. He also is the team physician for Tulane Athletics and leads Tulane’s programs with the NFL Players Association and the NFL Player Care Foundation that provide medical care and health evaluations to retired players. Dr. Stewart is well-known for the treatment of high school, college and professional athletes.

Editor’s note: After this blog was published, it was announced that Ryan Shazier underwent spinal stabilization surgery.