A reconditioning program to lower the recurrence rate of brachial plexus neurapraxia in collegiate football players.
OBJECTIVE
To present clinical techniques for managing class I brachial plexus neurapraxia (BPN) in collegiate football players.


BACKGROUND
During a football career, up to 50% of college football players develop BPN. It is difficult to return the player to practice and competition without many recurrences during the same season. Postseason reconditioning programs may improve the outcome by allowing the injured nerves a chance to heal adequately. Flexibility and strength of the neck and shoulder girdle are the focus of this proposed postseason BPN reconditioning program. This clinical technique is designed to reduce or eliminate inflammation, weakness, and hypomobility that contribute to reinjury of the brachial plexus and the resulting class I BPN.


METHODS
After the football season, the team physician performs a mandatory follow-up examination. Any pathology that may be exacerbated is ruled out before beginning this program. Conservative management is prescribed during the first 4 weeks postseason. Then an 8-week period of aggressive reconditioning is initiated. Players begin manual resistance and Nautilus neck machine exercises 3 times per week. A cervical spine mobilization and modified shoulder resistance program is performed 2 days per week. Subsequently, players proceed with modification of the general neck and shoulder program used by the rest of the squad. Shoulder pad and neck orthoses selection should be reviewed to ensure that the best protection against reinjury is used when the athlete returns to play. To minimize any chance of recurrence, a progressive pattern of gradually increasing collision work is employed after the athlete is cleared by the physician.


CONCLUSIONS
Postseason observation of players after 1 year should reveal decreased recurrence of brachial plexus injury. The reconditioning program format, together with protective equipment considerations, may have a significant effect in reducing or eliminating the recurrence of BPN in football players.
Cramer
C R
CR
Barry University, Miami, FL.