Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group. The athlete with fractures involving a significant structural portion of the vertebral column, ligament instability, spinal cord contusion, or congenital cervical stenosis, is advised not to return to contact sports. Other radiological abnormalities, such as compromise of the ligaments, congenital fusion, degenerative disease, and herniated cervical disc require individual consideration. The rationale for treatment and advising for participation in sports are discussed. We believe that this classification of sports injuries offers clinicians a framework within which to make rational judgments and recommendations in the management of athletes with cervical spine injuries.