The medicolegal challenges of defending claims for sports-related spinal injuries 

Active participation in sport confers many benefits: it improves physical health, enhances overall wellbeing, and fosters social interaction and a sense of belonging. However, it carries an inherent risk of injury, of which one of the most feared is spinal trauma, due to the high degree of associated morbidity and mortality. The sports-related spinal injuries most frequently reported are issues around the discs, pars stress injuries ,fractures of the cervical vertebrae, although thoracic and lumbar fractures are almost equally as common.

Not surprisingly, contact sports, such as rugby, ice hockey and American football, are associated with comparatively high rates of spinal injury. Other sports which are frequently implicated include football, skiing/snowboarding, diving/swimming, skateboarding/rollerblading, and horse-riding. Cycling is also often cited, although it differs from other sports in that most incidents of spinal injury result from being knocked off a bicycle by a motor vehicle, rather than as a result of the sporting activity itself.

Neurological recovery following a spinal injury depends not only on injury severity but also the mechanism of injury. Injury location is also important: spinal cord injuries are particularly devastating and have a lifelong impact on quality of life. The presence of serious trauma elsewhere also decreases the likelihood of a good recovery. Finally, adult patients with spinal injury are less likely to recover than paediatric patients.

If a sports-related spinal injury occurs, the risk of subsequent litigation is extremely high. Damages may be sought in respect of pain and suffering, medical expenses and loss of earning capacity, either current or future. It is therefore possible that anyone involved in treating sports participants may find themselves having to defend a claim for medical negligence. As well as the medical personnel who treated the injury, the claim could also include other individuals, such as trainers or team doctors.

For a claim of negligence to be successful, four elements must be satisfied. The first is to show that there is a duty of care owed as a result of the relationship between the two parties. This can include factors such as assessing the participant’s suitability and physical condition to compete in sport based on the presence of any existing medical conditions, informing the athlete of any risks of participation, and seeking or providing appropriate treatment should an accident occur.

Second, the defendant must have breached this duty. The defendant is expected to act as any reasonable professional would in the same or similar circumstances. Thus, the level of reasonable care is dependent on the circumstances of the event. Third, it must be proved that the breach of duty caused the harm to the plaintiff, and lastly, actual harm must have occurred. Proving that one or more of these elements cannot be demonstrated offers the most complete defence in a negligence case.

Many people are willing to accept that playing sports exposes them to a degree of risk and this is particularly true of competitive and professional athletes. This acceptance of risk can also provide a defence, on the principle that no harm can be done to someone who consents. A defendant would need to prove that the participant, or any reasonable person, would be aware of the risk, and that the risk was accepted, either expressly or by implied consent, through participation. Choosing to participate with a known injury or medical condition that could have contributed to the index accident would also constitute acceptance of risk and remove liability from the defendant. Therefore, documentation relating to acceptance of risk or relevant medical information is extremely important.

The concept of contributory negligence is also related to the assumption of risk. If it can be shown that the athlete contributed in some way to their own harm, the liability of the defendant is removed. However, in this scenario, if the defendant is also shown to be negligent, damages may be allocated on a comparative negligence basis. One common example of contributory negligence is the failure to use proper protective equipment, although determining this type of contributory negligence is complicated by variations in the level of protective equipment deemed appropriate in different sports. Participants in diving are completely unprotected, while competitors in the cross-country phase of equestrian eventing would be expected to wear a safety helmet to current mandated standards, as well as a body protector or inflatable air jacket.

Drinking alcohol before taking part in sports is surprisingly common and may also be considered contributory negligence, as it can impair the participant’s judgment and reaction times, thus making an accident more likely. It has been estimated that around 30% of all sports-related spinal cord injuries in the US occur under the influence of alcohol. Another possible defence strategy is to show that all reasonable steps were taken to prevent or mitigate the circumstances that led to the spinal injury. This could include identifying potential risks and the likelihood and seriousness of any injuries that might result, as well as evaluating and implementing risk reduction policies, resulting in a plan that details the course of action for a comprehensive list of unexpected emergencies. As well as potentially providing a defence, risk management procedures may also help to prevent spinal injuries from occurring in the first place.