Neck and Back Injuries: The Instinct to Help Is the Danger

Call 911 and do not move them. Do not straighten the neck, do not roll them over, and if they are wearing a helmet, leave it on. Hold the head and shoulders still and wait.

This is the one emergency on this site where the correct action is almost entirely inaction.

The American College of Emergency Physicians’ instruction is to start from the worst case: assume that the person has a spinal cord injury, call 911, and then keep them still.

Every helpful instinct is wrong here. Sitting somebody up. Checking whether they can stand. Getting the helmet off so they can breathe. Rolling them into the recovery position. Moving them out of the road because it seems safer. Each of those can convert an injury that would have healed into one that will not.

What not to do, in ACEP’s words

“Do not attempt to reposition, bend or twist the neck or body; and do not move or roll the person unless he or she is in danger.”

Not reposition. Not bend. Not twist. Not move or roll.

“Immobilize the head, neck and shoulder area to prevent movement.”

That is the job. Kneel, put a hand either side of the head, and hold it in the position you found it. You are a human brace until the ambulance arrives, and it is the most useful thing anybody can do.

Leave the helmet on

“If the person is wearing a helmet, do not remove it.”

This one is worth saying twice, because removing a helmet is the single most instinctive act at a motorcycle or cycling crash — it looks like freeing somebody, and taking it off moves the head and neck exactly the way the instruction above forbids.

Paramedics remove helmets with two people and a technique. Leave it.

If they genuinely have to be moved

ACEP allows it only where the person is in danger, and specifies how:

“Rolling a person requires two people, with one person stationed at the head and the other along the victim’s side. The person’s head, neck and back should be kept in line while rolling occurs.”

Two people, one of them dedicated entirely to the head, and the head, neck and back kept in a straight line. One person cannot do this correctly. If you are alone and they are not in danger, the answer is to hold the head still and wait.

The signs that mean assume the worst

ACEP names these:

• “Numbness or tingling sensations that radiate through an arm or a leg”
• “Weakness in back, neck or limbs”
• “Inability to move arms or legs”
• “Loss of bladder or bowel control”
• “Unconsciousness”
• “Neck pain, stiff neck or headache that won’t go away”

Loss of bladder or bowel control is the one people do not expect to be on a spinal list, and it is among the most important items on it. Mention it immediately and do not wait to see whether it resolves.

And numbness that radiates — travelling down an arm or a leg rather than sitting at the site of the injury — is the signature that distinguishes a spinal concern from a sore back.

Anybody unconscious after a fall or a crash is treated as a spinal injury until somebody with equipment says otherwise, and that includes somebody who was knocked out briefly and is now talking. Head and neck injuries travel together, which is why head injuries has its own page.

When it is not an emergency at the scene

Plenty of neck and back injuries are not this. A wrenched back, a strain from lifting, whiplash after a low-speed knock.

Come to an emergency room for pain after any significant force — a fall from height, a fall onto the back or head, a vehicle collision, a sporting impact — and for any of the signs above, however mild they seem.

Our emergency rooms are open every hour of every day and are walk-in, with CT and X-ray in the building, which is what answering a spinal question requires. Go to the nearest one, and if another emergency department is closer, that one is the right answer tonight.

If you are unsure, come in — this list is not exhaustive and you are not expected to rule out a spinal injury yourself.

Back pain with no injury is a different question

This page is about injury, and that is a deliberate limit rather than an oversight. Back pain that arrives without a fall, a crash or a lift is a different problem with different causes, and the source this page cites does not cover it.

What carries across is the symptom list. Loss of bladder or bowel control, new weakness in a leg, or numbness spreading into the groin or both legs should be assessed urgently whether or not anything happened to cause it. If that describes you, come in rather than working out a mechanism.

Questions people actually ask

He is lying in an awkward position and looks uncomfortable. Leave him. Comfort is not the priority for the next ten minutes, and “awkward” is not a reason to move a possible spinal injury.

She wants to get up and says she is fine. Ask her to stay still until help arrives, and explain why. People will usually cooperate once they understand what moving risks. You cannot force anybody, and you can ask well.

The helmet is making it hard for him to breathe. If somebody is not breathing adequately, that is an immediate 911 priority and the dispatcher will direct you. Do not make that decision alone off the back of a web page.

My back has hurt since I lifted something three days ago. Not this page’s situation. If there is leg weakness, numbness spreading, or any change in bladder or bowel control, be seen now. Otherwise it is a reasonable clinic question, and our clinics are open Monday to Thursday and Friday mornings.

We already moved him before reading this. Then say so at the desk — it is useful information and nobody will be annoyed. Most people who are moved come to no harm, and the reason for the rule is the minority who would.

Is a stiff neck after a car accident worth checking? ACEP lists neck pain and stiff neck that will not go away. Yes, get it checked.

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Call 911, hold the head still, do not roll them, and leave the helmet on. Both of our emergency rooms are open 24 hours a day, every day of the year, with CT and X-ray on site — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: head injuries and when to go · which door do you need

Sources

54. Neck or Back Injury — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/neck-or-back-injury

This article is general information, not a diagnosis. If you are unsure, come in — this list is not exhaustive and you are not expected to rule out a spinal injury yourself. If it might be an emergency, treat it as one and call 911.