Burners and Stingers: What to Know and How to Treat Them
Burner or stinger injuries are typically associated with contact sports. The impact most often occurs around the head, neck and shoulder area. The head and shoulders are stretched apart from each other causing sudden tension on the brachial plexus nerves exiting from the neck. This also happens in auto and cycling accidents when whiplash occurs or the person is tossed off the motorcycle or bicycle.
Jump to a specific section:
- What is a Burner/Stinger Injury?
- Symptoms of Stinger Injuries
- Causes of Burner & Stinger injuries
- Stinger Types
- Sports Injuries Associated with Stingers
- Treating Stinger/Burner Injuries
- Rehab and Recovery
What is a Burner/Stinger Injury?
The sensation that occurs is not just a sharp pain, it is often described as an “electric shock” or “lightning bolt” down the arm, followed by intense heat. These are typical sensations the nerves feel. When a sudden compression or stretch occurs and then it is released, the nerves in essence shut off all at once and turn back on all at once. Picture that time when you woke up and your arm was asleep and some of those sensations occurred. A burner and stinger injury are much more rapid and far more intense. Other symptoms include tingling, muscle weakness in the neck, arm, and hands. The immediate intensity lasts 10 to 30 seconds but can linger for hours to days and result in residual whiplash symptoms.
Symptoms of Stinger Injuries
Symptoms and the extent of how long they will persist are dependent on a number of factors such as age, mechanism of injury, number of occurrences to the injured site, strength, and their own anatomy.
Common symptoms of a stinger can closely resemble whiplash and more. If you can picture or have seen stinger injuries, the mechanism is very similar minus the 2 tons of metal. Symptoms include:
- “Electric shock” or “lightning bolt” down the arm.
- Sharp and shooting pain down the neck and into the arm.
- Lower grade pain lasting hours to days
- Neck, hand and arm weakness that may be present throughout the injured side
- Temporary paralysis or paresthesia lasting minutes to weeks
- Cramping and spasms to the muscles specifically in the neck
- Numbness and tingling on-and-off weeks post injury
- Permanent damage to the arm if this is a second occurrence or more.
Causes of Burner & Stinger injuries
The most common causes of a burner or stinger injury are hard hits or a fall involving the shoulder. With regards to car accidents and motorcycle accidents, the same can be true when getting rear-ended, T-boned or thrown from a motorcycle. What occurs is the shoulder is depressed downward while the neck simultaneously is flexed sideways away from the shoulder. Also, these injuries may happen as a result of a hit from behind that causes the head and neck to be hyperextended backward.
Sports Injuries Associated with Stingers
Impact sports and stingers have a high correlation. Below are examples of stinger injuries in various sports:
- What is a Stinger Injury in Football or Rugby? Football and rugby injuries can occur, as mentioned when hit from the side or the rear. Similarly, the head can be forced away from the shoulder during a tackle. While these tackles may not be intentional, the sport can be emotional on the field and players often break the rules causing intentional harm to others. Football linemen are at the highest risk because they engage in tackling more often than quarterbacks or wide receivers.
- Wrestling has stinger injuries that occur as part of a takedown when the head strikes at an angle followed by the shoulder.
- Similar to football, hockey stingers occur when players cross check or do an illegal hit from behind.
- Gymnasts can experience stingers as well. While not an impact sport, falls while on the bars, beam, or pommel horse can occur in a similar fashion to those of wrestlers.
Sometimes athletes may have congenitally narrow spinal canals, often referred to as congenital spinal stenosis, and are prone to these and other neck related injuries.
The mechanism of injury is more important than the direction of impact. But, informing your doctor on the direction and the intensity and speed of impact can be helpful in determining things like recovery time diagnostic testing.
- Brachial plexus is stretched. This occurs when one shoulder is depressed while the neck is flexed away from the shoulder being depressed. This places maximal tension on the nerve bundle as well as the joint capsules and the surrounding muscles. This can occur from sports impacts or car accidents.
- Direct impact to the brachial plexus bundle. This is when a person hits another person in the triangular space where the shoulder and the neck join. This can occur from an object such as a bat, hockey stick or even ball. Similarly, some martial arts kicks, such as a crescent kick or roundhouse kick can have the same effect.
- The final type is when the neck is forced backward while rotated to the side to some degree. This injury maximally closes the facet joints in the neck and narrows the opening for the nerves exiting the spinal canal. This type of injury can be the most severe because it can also cause the most nerve and bone damage.
Stinger injuries are not stand alone injuries, they are accompanied by other injuries often seen in whiplash injuries. Some other injuries may include disc protrusions, herniated discs, fractures, ligament tears, and muscle spasms.
Associated Stinger Injuries
When a stinger injury occurs either due to sports, car accident, motorcycle accident or bicycle accident, other injuries to the head, neck, and shoulder will occur in conjunction. These associated injuries may need more conservative or advanced treatment and imaging.
- Concussions: With impact, there is a higher risk for concussions. Symptoms of concussions should be assessed with an ACE concussion evaluation by your doctor. Concussions are not seen on MRI but symptoms are becoming more and more recognized. If you have one or more symptoms of tinnitus, blurry visions, memory loss or difficulty, sensitivity to light or headaches following an impact or car accident let your doctor know.
- Nerve injuries: Once you have experienced the symptoms of a stinger or burner, those nerves have been injured. Pain, numbness, tingling, heat, and pins and needles are immediate and can last for days, weeks, or may be permanent. These symptoms are not isolated to the injured area and can travel down the arm to the hand.
- Because of the intensity of impact forward, the spinal processes of the neck may fracture. When the neck is forced back and to the side, the facet joints may undergo a compression fracture. Likewise, compression type of stinger may be severe enough to cause fractures in the surrounding area.
- Spinal Cord Injuries: In the even the symptoms are bilateral or on both sides, the spinal cord itself may have been injured. Proper imaging and consultation with a neurologist are imperative. Immobilization of the neck should occur immediately and the person should be transported to the hospital.
- Muscles and ligaments: Bruising and tearing of these structures will occur. Severity is dependent on the injury. Ligaments take longer to heal, but once they are stretched they cannot return to their original state. Because both occur, strengthening the muscles can help to stabilize loose ligaments and rehabilitate torn muscles simultaneously.
Because of the severity of this kind of injury, conservative treatment is important. Doctors and coaches should take precaution in helping the person recover.
X-ray’s should be taken to rule out any fractures, but ultimately an MRI will be able to show you all structural injuries. Diagnostic ultrasound may be used to determine if any vascular injuries have occurred as a result of the injury. For chronic symptoms, it is recommended you get ultrasounds to monitor the recovery process.
Treating Stinger/Burner Injuries
Pain is usually the first thing to go away and athletes are very anxious to return back to their sports so they think they can avoid reporting it to their coach, parent, or trainer. It is very important that if this injury occurs, medical attention is sought to rule out other injuries
There are piles of research evidence to show that once this a person gets a stinger, it is likely to occur again especially if the ligaments have become stretched and the person has not gone thru rehab to strengthen and stabilize the injured area. Repeated stinger injuries, in rare cases, have been linked to permanent nerve damage.
RICE stands for rest, ice, compression and elevation. Whereas METH stands for movement, elevation, traction, and heat. Both have their place in the recovery process. RICE has been taught for years and equally has been misused for years, especially the ice part.
Rest has its place depending on the severity of the injury. If the injury is small rest may be an inappropriate treatment method. Rest can be counter to healing if it is a simple sprain/strain, in which case rehab would be appropriate. With a stinger injury, rest may be effective if there is lots of inflammation and swelling around the neck, but ideally strengthening the neck and shoulder again is key.
From a patient perspective, it is a great tool to provide patient comfort by eliminating pain. Unfortunately, barring extreme swelling or 72 hours post-injury ice should only be used for that long. Because ice is cold and the body doesn’t want to lose excess heat, the body shunts blood away from the area, hindering the healing process.
Much like with ice, but not as effective, compression shunts blood away from injured areas. A great example of compression on tissue is the sponge in hand. Squeezing a soaked sponge represent blood in the muscles and capillaries. Compression restricts blood flow by squeezing the micro-sized capillaries of the skin and muscles.
This may be an effective method for profuse swelling initially, but after the majority of the swelling has gone down, this becomes ineffective. Once compression is released, blood flow can return to normal. Again, when you have profuse swelling the internal compartments of the body become compressed, so you may have to help by compressing initially. For example, when a balloon expands and contracts. Balloons have a maximum capacity and so does your body.In the case of stingers, there isn’t an area to compress anyway, so avoid this.
Related to compression, elevation of a joint can help with profuse swelling initially. Unless, in rare cases, the arm swell, in the case of a stinger injury there isn’t anything to elevate above heart level.
Of course, we do not mean the street drug. METH is the acronym for movement of the injury, elevation of the limb, traction of a joint, and heating the injured site (i.e. movement, elevation, traction, heat). Immediately you will notice that other than elevation, we are doing everything opposite R.I.C.E. is telling you to. Remember, both RICE and METH have a time and place.
If movement in your body hurts, do it, but stop before the range where the pain starts, or lighten the load to complete the range of motion. Movement helps with swelling as well. The muscles help pump blood and lymphatic fluid. Performing a simple range of motion exercises can significantly help reduce swelling.
When swelling is still present at the injury site, and it is recurring, rather than completely restricting blood flow with compression, elevate it to allow gravity to help drain the swelling away. Couple this with movement and you have already started your rehab program. For example, a player rolls his ankle playing football and now he has a softball sized ankle. By elevating the ankle above his hard he can prevent increased swelling. If he does this coupled with movement by tracing the ABC’s he can do several things: pump the blood and lymph fluid away, regain his range of motion, and strengthen the weakened muscles.
When injuries occur it is normal to feel stiff at the injured joint. This is common because muscles spasm to protect the body. Physical therapists and chiropractors use traction to encourage healing. Traction is the act of separating or gapping a joint. It is important to only do as little as possible to gap the joint to attain relief because too much traction can be counterproductive. If you have ever had a shoulder in a sling and you take it off and just let your arm hang, that is a form of traction.
Heat is important in the promotion of blood flow. It feels good and loosens muscles. But that does not mean you should be on a hot pack for too long. Too much heat can permanently dilate capillaries leaving a distinct rash called erythema ab igne. (Wikipedia)
Rehab and Recovery
Whether it is a car accident, football, rugby, or gymnastics having a burner and stinger injury still needs to go thru a rehab recovery process. There are a lot of structures in the neck and shoulder, from nerves, muscles, tendons, and ligaments that need to be repaired. Having the right approach to your recovery is important. It’s important that your doctor clears you to return to work or physical activities. Also, make sure they refer you to an appropriate therapist. Here at Performance Rx Sports Care, we encounter burners and stingers from a car accident, bicycle accidents, motorcycle accidents, and sports injuries daily.
Our sports medicine chiropractors and physical therapists are up to date on the latest spine and sports injury research to aid in your recovery. We don’t use gimmicks tools that make embellished claims to suck you into care. At PRX Sports Care we use what works and personalize it to repair you. We are athlete’s treating athlete’s, and we will take you from injury to recovery or send you to a specialist who can get you there.