A hush fell over the crowd in Philadelphia on Sunday when San Diego Chargers wide receiver Malcom Floyd went down following a frightening collision with Philadelphia Eagles linebacker DeMeco Ryans. A video of the injury is below, courtesy of NFL.com:
As Bleacher Report's official Twitter account shows, Floyd left the field on a stretcher and in a stabilizing cervical-spine collar.
The hit shook both teams to the point of prayer, and anyone watching held their breath.
Fortunately, good news surfaced just a few hours later from NFL.com's Ian Rapoport:
#Chargers WR Malcom Floyd, taken off on a stretcher, has feeling in his limbs and is coherent, source says. On his way to the hospital— Ian Rapoport (@RapSheet) September 15, 2013
Following a hit like the one Ryans laid on Floyd, doctors and medical personnel move fast.
They have to.
Head and neck trauma carry with them the potential for serious consequences—some of them life-threatening—such as spine fractures, damage to the spinal cord and brain bleeds. Many of them occur immediately after the hit and can require prompt intervention to prevent permanent damage.
Fortunately, it seems Floyd avoided such outcomes. Let's take a look at the hit itself and the events that likely followed to see how.
1. The Hit Itself
Another defender engaged Floyd prior to the collision, forcing Floyd's head downward. As a result, it met Ryans' shoulder in line with Floyd's neck and back.
In other words, Floyd's neck experienced a large amount of "axial loading"—where a hit applies force lengthwise along the cervical spine.
Since they compress the spine, axial loading injuries threaten the integrity of the neck's vertebrae—the bones that encase and protect the spinal cord. As such, they frequently result in vertebral fractures.
If a fracture causes the broken vertebrae to move out of alignment any more than a few millimeters, they can compress the spinal cord and cause neurological symptoms.
In the worst-case scenario, a fracture severs part or all of the spinal cord, producing permanent, devastating neurological damage—up to and including paralysis.
2. Medical Personnel Place Floyd on a Stretcher and in a Cervical Collar
As seen in the above photograph, doctors and trainers placed Floyd's neck in a red collar. The collar prevents Floyd from moving his head up, down, left or right.
Why is that important?
Not all fractures threaten the spinal cord at that very moment. However, additional motion after the fact can move the broken vertebrae further out of alignment—an "unstable" fracture—causing more damage.
The stretcher similarly discourages Floyd from moving his body. It also protects against worsening other spinal injuries that may also exist but remain undiagnosed.
3. Floyd Has Feeling in His Limbs
NFL.com's Ian Rapoport brought the first good news when he tweeted that Floyd had sensation in his limbs.
In other words, the nerves that run down the spinal cord and control sensation in his arms and legs stayed intact throughout and after the injury.
That said, different areas of the spinal cord control sensation and movement, so while Rapoport's report represented the first positive step, many questions remained unanswered.
4. Floyd Undergoes Initial Radiographic Studies and Tests at a Nearby Emergency Department
Though exact medical details are unavailable to the public, standard protocol usually dictates the type and order of medical tests Floyd likely underwent soon after his injury.
First up? The CT scan.
Severe head trauma can shear blood vessels within the skull and cause intracranial bleeding, and CT scans can quickly eliminate or diagnose such an injury.
Severe brain bleeds can quickly progress to coma and death, so a concerning CT scan usually buys an athlete intense, prolonged monitoring and even emergency brain surgery.
A CT of the cervical spine is often done at the same time as a head CT. Cervical spine imaging allows radiologists to visualize the vertebrae in the neck in fine detail to ensure no fractures exist.
According to ESPN, Floyd's CT thankfully came back negative.
5. Doctors "Clear" Floyd's Cervical Spine—or Don't
No reports of a "broken neck" surfaced throughout the day on Sunday, so it seems safe to assume that doctors did not find any evidence of vertebral fractures on Floyd's imaging.
If doctors can make such a determination, they can remove Floyd's cervical collar.
However, even something as simple as removing a padded collar requires extra caution. After all, imaging is not perfect and does not always identify fractures.
Furthermore, any mistake involving the cervical spine—and the spinal cord within it—could prove tragic.
To guard against disaster, one member of Floyd's medical staff likely held his head perfectly still while another removed the collar. He or she then pressed down the back of Floyd's neck, asking if doing so produced pain.
Floyd likely then turned his head to the left, right, up and down—one motion at a time.
If any of the above tests or motions caused pain, the collar went back on. If not, it came off. Unfortunately, according to Rapoport, it looks like the former scenario unfolded.
#Chargers WR Malcom Floyd, who was carted off, getting a 2nd opinion. But out indefinitely, source says. In a neck brace for at least a week— Ian Rapoport (@RapSheet) September 16, 2013
6. Doctors Look for Other Associated Injuries
Even though it seems Floyd didn't suffer any fractures, other injuries are possible. To investigate, he may have also undergone an MRI.
MRIs look at the soft tissues in the neck—such as the ligaments that hold the vertebrae together and in proper alignment.
No reports of an official diagnosis yet exist, but one possible outcome is a neck sprain.
Neck sprains are over-stretches or tears of the aforementioned vertebral ligaments.
While not as frightening as vertebral fractures, sprains are worrisome in and of themselves.
As stated, cervical spine ligaments help keep the spine in alignment. That said, injured ligaments are weaker ligaments—and therefore less able to resist the force that caused the injury in the first place.
Without optimal stability, the cervical spine becomes more vulnerable to serious or paralyzing injuries.
A spinal cord contusion—where fluid collects around the spinal cord due to surrounding soft tissue injury—is also a possibility. Baltimore Ravens linebacker Jameel McClain remains inactive after suffering one last year.
7. The Road Ahead
How big of a loss to the Chargers is an injured Malcom Floyd?
If Floyd escaped without significant ligament injury—seemingly unlikely, but possible—he could return as early as a week or two after the collision.
However, more extensive ligament damage could result in multiple weeks of missed time. A spinal cord contusion could cost him even more than that.
Mentally preparing himself to return to the field is no easy feat, either.
The picture will become clearer as more reports and diagnoses begin to surface over the coming days.
Fortunately, though, the scariest moments are likely already in the rear-view mirror.
Dr. Dave Siebert is a resident physician at the University of Washington. Information discussed above is based on his own knowledge and experience in a level-one trauma center.