In brief: Careful study of the pathomechanics and epidemiology of sports-related spine injuries brings to light many common features: The incidence increases as the sport becomes increasingly aggressive. Improperly conditioned neck muscles and lack of knowledge of the proper techniques of the sport put the athlete who sustains a blow to the head at significant risk for a spine injury. While recognition of such features has resulted in a dramatic reduction in catastrophic spine injuries, the athlete remains at risk for a less severe spine injury. The author presents guidelines for the management of athletes with, for example, transient neurologic defects or asymptomatic cervical spinal stenosis. However, the physician's decision to allow a return to sports must be highly individualized.