To Play Or Not To Play: A Head-turning Case Of Football, Neck Stiffness, And Brainy Decisions

HISTORY: Patient is an 18-year-old male, high school football player and incoming college freshman playing quarterback. He presented with chronic neck pain and trapezius tightness, which worsened during games in his junior and senior years. He reported around 20 “stingers” without radicular symptoms, bilateral weakness, or arm numbness. In 2023, he sustained a concussion with complete recovery. During his preparticipation physical, he had persistent neck stiffness and low white blood cell count which led to further imaging and specialist consultations to assess his fitness for continued sports participation. PHYSICAL EXAMINATION: Full cervical range of motion with pain-free neck movement. Neurological findings were normal, with intact motor function, sensation, and reflexes. No spinal cord symptoms were reported. DIFFERENTIAL DIAGNOSIS: ÏCervical Disc DiseaseÏCongenital Cervical Spine/Spinal Cord AbnormalityÏBrachial PlexopathyÏCervical Spine MassÏNeuromuscular Disorder TEST AND RESULTS: ÏCervical Spine MRI (June 14): Revealed Chiari I malformation with 13-16 mm herniation and syrinx at C6-C7.ÏBrain MRI (June 19th): Confirmed Chiari without intracranial issues.ÏFollow-up Cervical Spine MRI (July 1st): Stable findings with no progression. FINAL WORKING DIAGNOSIS: Chiari I malformation with associated syrinx. TREATMENT AND OUTCOMES: After multiple consultations, the patient and family were informed of the low but present risks of continuing football, including the potential for neurological injury, paralysis, or death. While advanced testing was discussed, the family opted to decline. The primary provider cleared the patient for full participation with instructions to monitor for symptoms, continue neck strengthening, and avoid axial loading. The patient’s twin is scheduled for MRI to assess potential familial risk. Further imaging and follow-up will occur if symptoms develop.