The rotated head position of the shooting stance can compress the cervical cord in susceptible people

The summary today

There is a single reported case, and it is in kyudo. A sixteen-year-old Japanese high school student starts kyudo in April and by June has lost strength in the deltoid, biceps and brachioradialis on both sides, without the hand wasting typical of the classic form of this cervical cord disorder. Myelography with the neck rotated to the left, that is in the shooting stance, shows the cord pushed forwards and to the left with compression over three levels, C3/4 to C5/6, less marked than the compression seen in flexion; X-rays find a cervical kyphosis with no arthritis and no narrowing of the canal. With shooting stopped and flexion and rotation limited, sensation returns in two weeks, arm strength almost completely in two months and the whole picture in eighteen months, with no relapse up to the age of twenty. The case says that in a susceptible neck a sustained rotation can be enough to compress the cord; it does not say how often this happens, and the same boy studied with his neck bent over his books, so much so that the authors describe kyudo as an aggravating factor, not the cause. There are no data on any other form of archery, Olympic archery included: reported.

Also phrased as: "neck and shooting stance"; "head turned towards the target"; "kyudo and the cervical spine"; "shoulder weakness in a young archer"; "neck rotation in archery"

Evidence

• 2021
  For Kyudo archers Published later

  Single case, aged 16, a kyudo beginner: bilateral weakness of the deltoid, biceps and brachioradialis (C5-C6, strength 3 out of 5) appearing about two months after he began shooting. CT myelography with the neck rotated to the left, as in the shooting stance, shows the cord flattened and pushed forwards from C3/4 to C5/6.

  A case of proximal-type Hirayama disease associated with neck axial rotation · Uka Tsuzuki, Tetsuo Ando, Makoto Sugiura, Osamu Kawakami

• 2021
  For Kyudo archers Published later

  In the same case, images in the three positions: in neutral the cord is flattened from C3/4 to C6/7 with the surrounding space still clear; in flexion the space collapses from C3/4 to C6/7; in left rotation the cord shifts forwards and to the left with compression centred on C3/4, C4/5 and C5/6, to a lesser degree than in flexion. X-rays show a cervical kyphosis with its apex at C4/C5, with no arthritis or canal stenosis.

  A case of proximal-type Hirayama disease associated with neck axial rotation · Uka Tsuzuki, Tetsuo Ando, Makoto Sugiura, Osamu Kawakami

• 2021
  Context Kyudo archers Published later

  The picture presents as weakness of the shoulder and arm, not the hand: deltoid, biceps and brachioradialis at 3 out of 5 on both sides, triceps 4+, hand muscles 5 out of 5 with no wasting; biceps and brachioradialis reflexes absent, leg reflexes very brisk with clonus and bilateral Babinski signs. A deficit that at the range would be put down to the shoulder.

  A case of proximal-type Hirayama disease associated with neck axial rotation · Uka Tsuzuki, Tetsuo Ando, Makoto Sugiura, Osamu Kawakami

• 2021
  Context Kyudo archers Published later

  Kyudo stopped, a collar by day and a low pillow at night: at 2 weeks the sensory symptoms have almost gone, at 2 months arm strength has recovered apart from a slight biceps deficit, at 18 months strength and reflexes are normal. No relapse up to the age of 20.

  A case of proximal-type Hirayama disease associated with neck axial rotation · Uka Tsuzuki, Tetsuo Ando, Makoto Sugiura, Osamu Kawakami

• 2021
  Context Kyudo archers Published later

  Shooting was not the only exposure: the boy studied with his books on his knees and his neck bent, and the authors describe kyudo as a possible aggravating factor, not the sole cause.

  A case of proximal-type Hirayama disease associated with neck axial rotation · Uka Tsuzuki, Tetsuo Ando, Makoto Sugiura, Osamu Kawakami

Status history

1. 1990 Not studied In the registry's bibliography nobody has yet described an archer with a cervical cord disorder linked to the shooting stance, or looked at what happens to the cord when the head stays turned towards the target: not studied.
2. 2021 Reported A sixteen-year-old Japanese high school student, who joined the kyudo club in April, loses strength in the deltoid, biceps and brachioradialis on both sides by June, without the hand wasting typical of the classic form. Myelography with the neck rotated to the left, in the shooting stance, shows the cord pushed forwards and to the left with compression over three levels, less marked than in flexion, and X-rays a cervical kyphosis with no arthritis or stenosis. With shooting stopped and flexion and rotation limited, the picture resolves completely in eighteen months, with no relapse up to the age of twenty. It is a single case, in kyudo, in a boy who also kept his neck bent while studying: reported.

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• 17 studiesJapanese studies of kyudo from 1964 to 2025
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