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Sidestepping Burners: A Preseason Strategy

Edward R. Laskowski, MD; Susan J. Nissen, MD; Thomas D. Rizzo, Jr, MD


If you play football or any other contact sport, you might have experienced or heard about "burners" or "stingers." These are nerve injuries that can result from a blow to or a fall on the head, neck, or shoulder. Burning and stinging in the neck and arm are common symptoms, but some athletes also experience numbness, tingling, or shoulder weakness.

Players often shrug burners off, but it's best to let someone on the medical team know about your symptoms-nerve injuries are nothing to mess with. Shoulder weakness can develop, even after your symptoms go away. And a weak shoulder can make a player vulnerable to another burner. Regardless of how serious your burner is, your doctor or trainer can recommend specialized neck and shoulder rehabilitation exercises that help you maintain or regain your muscle strength. The payoff for you is peak performance and fewer injuries.

Your best bet, though, is to prevent a burner from ever occurring. The game plan for that includes improving your muscle balance with a targeted muscle strengthening program, well-fitted protective equipment, and proper blocking and tackling technique.

Perfect your muscle balance. Many players spend a lot of time building up their "glamour" muscles: the pectorals, front of the shoulder, and biceps. However, weight lifters who neglect the muscles behind the shoulder and the muscles of the upper back can develop a round-shouldered, head-forward posture that throws the neck out of alignment. In other words, poor muscle balance leads to bad posture, which can make a player vulnerable to nerve problems. Proper posture, with the shoulders back and the chest out, keeps nerve pathways free and clear.

Exercise to improve your posture consists of stretching the neck and pectoral muscles and strengthening the upper-back, shoulder, and armpit muscles. Start by warming up your neck muscles. Gently turn your head back and forth and bend your neck from side to side. Strengthening exercises are described in figures 1-5. Start out slow with light weights on machines or lightweight free weights.

[FIGURES 1, 2, 3]

Push-up "plusses" can be added to this group of exercises without any equipment. Do a traditional push-up, then add an extra push by fully extending your arms. "Scapular squeezes" are also a very effective posture-enhancer: Simply try to squeeze or touch your shoulder blades together by moving your elbows toward each other behind your back.


Equipment. Shoulder pads and neck rolls are designed to prevent extreme neck movements; however, they can't do their job if they don't fit properly. Equipment that attaches to the chest should be firmly fixed. Make sure your pads and equipment are appropriate for your weight and height. Coaches and the medical staff may have additional fitting tips. If burners are a recurring problem, consider placing lifts under your shoulder pads or wearing a Cowboy Collar (McDavid Knee Guard, Inc, Chicago) or other device that limits neck motion.


Technique. Poor blocking or tackling technique is responsible for some burners, especially in players who sustain repeated burners. Ask a coach to observe your technique and recommend changes.

Remember: This information is not intended as a substitute for medical treatment. If you have concerns about your health, consult a physician.

Dr Laskowski is a consultant in the Department of Physical Medicine and Rehabilitation and codirector of the Mayo Sports Medicine Center at the Mayo Clinic in Rochester, Minnesota. Dr Nissen is a staff physician at MeritCare Medical Group in Fargo, North Dakota. Dr Rizzo is a consultant in the Department of Physical Medicine and Rehabilitation at the Mayo Clinic Jacksonville in Jacksonville, Florida. Drs Laskowski and Rizzo are assistant professors of physical medicine and rehabilitation at Mayo Medical School in Rochester, Minnesota. Dr Rizzo is an editorial board member of The Physician and Sportsmedicine..