The cervical spine is a relatively mobile structure commencing at the base of the skull and finishing at the relatively immobile thoracic spine. The cervical spinal cord and the paired vertebral arteries are critical occupants of the cervical spine, and injury to these structures results in catastrophic quadriplegia (spinal cord injury) or stroke (vertebral artery injury). Trauma to the neck is not uncommon in sport, but only rarely results in neurovascular injury or significant spinal instability. Every physician or trainer entrusted with the care of athletes’ fears that the next neck injury seen may be a catastrophic one and endeavours to seek every opportunity possible to prevent such disaster. The question is: which athletes are at risk? Is asymptomatic spinal canal stenosis a risk factor for spinal cord injury and does an episode of transient quadriparesis predispose an athlete to the development of catastrophic spinal cord injury?