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A stinger, also called a burner, is a sudden nerve injury that causes a sharp, burning or electric shock sensation from the neck or shoulder into one arm. It is usually linked to a temporary irritation or traction injury of the brachial plexus, which is the network of nerves that runs from the neck, across the shoulder and into the arm. In sport, the term “stinger” is often used because the pain can feel like a hot sting shooting down the arm. Stingers are most common in contact and collision sports such as rugby league, rugby union, AFL, American football, wrestling, martial arts and ice hockey. They can also occur after falls, tackles, heavy shoulder contact, awkward landings, cycling crashes or gym injuries where the head and shoulder are forced in opposite directions. Although many stingers settle quickly, they should not be ignored, especially if there is weakness, numbness, repeated episodes or symptoms on both sidesPhysiotherapy for stingers and brachial plexus injury focuses on accurate assessment, ruling out more serious neck or spinal cord involvement, restoring neck and shoulder function, and reducing the risk of recurrence. A physiotherapist will assess neck movement, shoulder strength, reflexes, sensation, nerve sensitivity, tackling or contact mechanics, and sport-specific readiness before return to play. Stingers physiotherapy exercises often include neck strengthening, shoulder blade control, upper limb strength, mobility work and graduated return-to-contact drills. A stinger is not the same as general neck soreness or a corked shoulder. It is a nerve-related injury. The key feature is a sudden one-sided nerve sensation into the arm, often with brief weakness or heaviness. Because symptoms can overlap with cervical radiculopathy, disc injury, spinal cord injury, shoulder dislocation, clavicle injury or concussion-related trauma, athletes should be assessed by a qualified health professional. Brachial plexus injury physiotherapy is particularly important when symptoms last more than a few minutes, keep returning, or affect confidence with tackling, scrummaging, bumping, landing or gym loading.

Key Facts

  • Stingers are reported as one of the most common cervical spine injuries in American college football, with an NCAA injury surveillance study reporting 229 stingers over six seasons and an injury rate of 2.04 per 10,000 athlete exposures. 🔗
  • In a National Football League study from 2015 to 2019, the average single-season injury risk for an incident stinger was 3.74%, and 76.41% of stingers did not result in missed time. 🔗
  • A 2020 review reported that stingers are traumatic transient neuropraxias of the cervical nerve root or brachial plexus that commonly last from minutes to hours in collision athletes. 🔗
  • Research in Canadian university football players reported a 26% season incidence and 62% lifetime prevalence of brachial neuropraxia, commonly known as a stinger or burner. 🔗

Causes

A stinger usually occurs when the brachial plexus or nearby cervical nerve roots are stretched, compressed or directly hit. The brachial plexus is like a bundle of electrical cables running from the neck into the arm. If that bundle is pulled, pinched or shocked during a collision, the arm can briefly feel painful, weak, numb or disconnected. The most common mechanism is traction. This happens when the head is forced away from the shoulder while the shoulder is pushed down. For example, a rugby player may be tackled across the shoulder while the head moves in the opposite direction. This stretches the nerves between the neck and shoulder. Physiotherapy for stingers often addresses this mechanism by improving neck strength, shoulder girdle strength and tackling positions so the athlete is less vulnerable to the same stretch again. Compression can also cause a stinger. This occurs when the neck is forced backwards, sideways or rotated towards the painful side, narrowing the space around the nerve root. Athletes with reduced neck mobility, previous stingers, cervical joint stiffness or anatomical narrowing may be more sensitive to this type of compression. A physiotherapist will often test whether certain neck positions reproduce symptoms and then build a rehab plan that improves movement control, strength and tolerance. A direct blow can irritate the brachial plexus where it passes between the neck and shoulder. This can happen when an opponent’s shoulder, hip, knee or helmet contacts the area above the collarbone. This is why some athletes describe a stinger after a “shoulder-to-neck” collision rather than a classic neck stretch. Not every stinger is mild. A brief episode that resolves fully is usually a temporary neuropraxia, meaning the nerve has been stunned but not structurally torn. More severe brachial plexus injuries can involve longer-lasting nerve damage, ongoing weakness or muscle wasting. For this reason, physiotherapy management should always include neurological screening and clear return-to-play criteria rather than simply waiting for pain to settle.

How Is It Diagnosed?

A stinger is usually diagnosed from the mechanism of injury, symptoms and a neurological examination. A physiotherapist or sports doctor will ask what happened, which direction the head and shoulder moved, where symptoms travelled, how long they lasted, and whether there was weakness, numbness or symptoms in both arms. The assessment should include neck range of motion, shoulder range of motion, pain response, reflexes, sensation, muscle power and grip strength. A physiotherapist will often compare both sides to identify subtle weakness in the deltoid, biceps, rotator cuff, shoulder blade muscles, wrist or hand. This is important because pain may settle quickly while weakness remains. A key part of diagnosis is making sure the injury is truly a stinger and not something more serious. Symptoms in both arms, symptoms in both legs, loss of balance, severe neck pain, spinal tenderness, altered consciousness, dizziness, headache, facial symptoms, or ongoing neurological changes require urgent medical assessment. In these situations, the athlete should not be moved casually or returned to play. For a typical first-time stinger that is one-sided, resolves quickly and leaves a normal examination, imaging may not be needed. However, recurrent stingers, symptoms lasting more than 24 hours, persistent weakness, bilateral symptoms, severe neck pain or suspicion of cervical spine injury should be investigated further. Physiotherapists play an important role in identifying when imaging or specialist referral is needed and when a gradual stingers rehab program is appropriate.

Physiotherapy Management

Exercise

Exercise is central to physiotherapy for stingers because the injury often occurs when the neck and shoulder cannot control collision forces. Early exercises are usually gentle and symptom-guided. The physiotherapist may begin with pain-free neck range of motion, shoulder mobility, scapular setting and low-load isometric neck contractions. Isometric exercises involve pushing gently without moving, which can help restore muscle activation around the neck without provoking nerve symptoms. As symptoms settle, stingers physiotherapy exercises usually progress to neck strengthening in multiple directions, including flexion, extension, side-flexion and rotation control. This matters because athletes need the neck to resist sudden contact from different angles. Shoulder rehab is also important. The physiotherapist may prescribe rotator cuff strengthening, deltoid strengthening, serratus anterior work, lower trapezius control, rows, carries, pushing drills and grip work. These exercises help the shoulder stay stable during tackles, bumps and falls, reducing traction on the brachial plexus. Later-stage stingers rehab should become sport-specific. A rugby or AFL player may progress from controlled contact preparation, resisted neck holds and shoulder bracing drills to tackle technique, landing drills and graded return to full training. A gym-based athlete may progress pressing, pulling and overhead loading only if these do not reproduce tingling, numbness or weakness. Return to play should not be based on pain alone. A physiotherapist should confirm full neck movement, full shoulder function, normal sensation, normal strength and confidence with contact exposure.

Activity Modification

Activity modification after a stinger is not just “rest”. It means removing the specific positions and impacts that irritate the nerve while maintaining safe fitness and strength. In the first stage, this may involve avoiding contact training, tackling, scrummaging, wrestling, heavy overhead lifting, loaded neck positions and any drill that brings on arm symptoms. A physiotherapist will usually help the athlete maintain conditioning with options such as bike, running, lower body strength or non-contact skills, provided symptoms are not reproduced. This approach keeps the athlete fit while protecting the brachial plexus. For athletes in season, physiotherapy management also involves communication with coaches about modified drills, limited contact exposure and objective return-to-training markers. Activity modification is especially important for recurrent stingers. Repeatedly returning to play because symptoms “only lasted a minute” can hide ongoing weakness or nerve vulnerability. A physiotherapist can identify whether the pattern is linked to a specific tackle side, shoulder position, scrummaging posture, head placement or gym exercise, then adjust training while rehab addresses the underlying issue

Manual Therapy

Manual therapy may be used when neck, upper back, rib or shoulder stiffness is contributing to poor mechanics after a stinger. For example, restricted thoracic rotation or stiff lower cervical joints may force an athlete into awkward neck positions during contact. Gentle joint mobilisation, soft tissue techniques and assisted movement can help restore comfortable motion. Manual therapy for a brachial plexus stinger should be specific and cautious. It should not involve aggressive neck manipulation when there are neurological symptoms, acute trauma concerns or signs of instability. The goal is not to “put a nerve back in place”. The goal is to reduce protective muscle guarding, improve movement quality and allow the athlete to perform rehab exercises more effectively. Physiotherapists may also use soft tissue treatment around the upper trapezius, scalenes, pectoral region, posterior shoulder and upper back if these areas are limiting shoulder girdle control. This is usually paired with strengthening, because improved mobility without better control may not reduce recurrence risk.

Postural Retraining

Postural retraining for stingers is about improving neck and shoulder position under load, not simply telling someone to sit up straight. In collision sport, athletes often get into low, braced positions where the head, neck, shoulder blade and trunk need to work together. If the shoulder drops, the neck side-bends, or the head leads into contact, the brachial plexus can be placed under more traction or compression. A physiotherapist may work on head position during tackling, shoulder blade control during pushing and pulling, trunk stiffness during contact, and the ability to keep the neck strong without excessive extension. For office workers or students recovering from a stinger, prolonged slouched postures may also increase neck sensitivity, so ergonomic advice and movement breaks may be helpful while nerve symptoms settle.

Bracing & Taping

Bracing and taping can sometimes help athletes with recurrent stingers, particularly in contact sports where limiting excessive neck side-bending or shoulder depression may reduce nerve stretch. In some sports, neck rolls, collars or shoulder pad modifications may be considered. These should be fitted carefully and must not replace proper rehabilitation. Physiotherapy taping may be used short term to improve awareness of shoulder position, support the upper trapezius region, or cue better scapular control during training. However, taping does not heal the brachial plexus. It is best used as an adjunct while the athlete builds neck strength, shoulder control and safer contact technique.

Heat & Ice

Ice may be used in the first 24 to 48 hours if there is local soreness around the neck or shoulder after contact. It may help with pain modulation, especially if there is bruising or soft tissue irritation around the collision site. Heat may be more useful later if there is muscle tightness or guarding around the neck and shoulder. Neither heat nor ice treats the nerve injury directly. They are comfort strategies that may allow better movement and participation in physiotherapy exercises. If heat or ice changes arm numbness, tingling or weakness, the athlete should stop and be reassessed.

Education

Education is one of the most important parts of physiotherapy management for stingers. Athletes often minimise these injuries because symptoms can disappear quickly. A physiotherapist should explain that pain settling does not always mean the nerve has fully recovered. Strength, sensation, reflexes, neck motion and sport-specific function must be checked. Education should also cover red flags. Bilateral symptoms, leg symptoms, severe neck pain, collapse, altered consciousness, ongoing weakness, worsening numbness or repeated stingers require medical review. Athletes should understand that playing through neurological symptoms is different from playing through general soreness. For recurrent stingers, physiotherapy education should include tackling mechanics, contact preparation, gym modifications, recovery planning and when to seek imaging. The aim is to help the athlete return safely rather than create unnecessary fear. A well-designed brachial plexus injury rehab plan gives clear stages, measurable goals and confidence for return to sport.

Other

Sport-specific technique coaching is often essential. Physiotherapists may work with coaches to review tackle height, head placement, shoulder contact, falling technique, scrummaging position or wrestling posture. In many athletes, the recurrence risk is not only about neck strength, but also about how contact is absorbed. Graduated return-to-contact testing may include resisted neck holds, controlled shoulder contact, wrestling hand-fighting, tackle bag drills, low-speed contact, then full-speed sport drills. The athlete should remain symptom-free at each level before progressing. Any return of burning, tingling, numbness or weakness means the program should be stepped back and reassessed.

Prognosis & Return to Activity

The outlook for a first-time, one-sided stinger that resolves quickly is usually good. Many athletes recover within minutes to hours. However, return to play should only occur when symptoms have completely resolved and assessment shows normal neck movement, normal shoulder function, normal strength, normal sensation and no concerning signs. Athletes should not return to sport on the same day if they have persistent weakness, numbness, neck pain, bilateral symptoms, symptoms into the legs, repeated episodes, or any concern for cervical spine injury. A physiotherapist can help decide whether the athlete is ready for non-contact training, controlled contact, full training or competition. Stingers rehab timelines vary. A mild neuropraxia may settle rapidly, while a more significant brachial plexus injury may take days, weeks or longer. Persistent weakness is more important than pain when judging recovery. If the arm still feels heavy, weak, clumsy or numb, return to contact sport is not appropriate. Recurrent stingers require a more cautious approach. The physiotherapy plan should look beyond symptom relief and address neck strength, shoulder girdle strength, contact technique, playing position, training load and possible structural risk factors. Athletes with multiple stingers in a season may need imaging and specialist clearance before returning to collision sport.

When to See a Physio

  • After any first-time stinger to confirm it is safe to return to sport and not a more serious neck or shoulder injury
  • If burning, tingling, numbness or weakness lasts more than a few minutes
  • If the arm feels weak, heavy or clumsy after the initial pain settles
  • If symptoms return with tackling, overhead lifting, gym work or neck movement
  • If you have had more than one stinger in a season
  • If you feel nervous returning to contact because of previous brachial plexus symptoms
  • If you need stingers physiotherapy exercises and a clear return-to-play plan
  • If you play a collision sport and want to reduce recurrence through neck and shoulder strengthening
  • If symptoms affect both arms, involve the legs, or occur with severe neck pain, urgent medical assessment is required before physiotherapy treatment

Frequently Asked Questions

What is a stinger injury?
A stinger is a sudden nerve-related injury that causes burning, zapping, tingling or weakness from the neck or shoulder into one arm. It usually involves temporary irritation of the brachial plexus or cervical nerve roots.

Is a stinger the same as a brachial plexus injury?
A stinger is a type of mild or transient brachial plexus or nerve root injury. More severe brachial plexus injuries can last longer and cause persistent weakness or sensory loss, so ongoing symptoms should be assessed.

How long does a stinger take to heal?
Many mild stingers settle within minutes to hours, but some last days or weeks. Recovery depends on whether the nerve was briefly stunned or more significantly injured. Persistent weakness, numbness or recurrent symptoms need physiotherapy and medical review.

Can I keep playing after a stinger?
You should not keep playing if you have ongoing pain, numbness, tingling, weakness, neck pain, symptoms in both arms or any symptoms in the legs. Return to play should only occur once strength, sensation, neck movement and shoulder function are normal.

What are the best stingers physiotherapy exercises?
The best exercises depend on the assessment, but they commonly include neck isometrics, resisted neck strengthening, shoulder blade control, rotator cuff strengthening, rows, carries, grip work and sport-specific contact drills. Exercises should not reproduce arm tingling or weakness.

Why do I keep getting stingers?
Recurrent stingers may be linked to previous nerve irritation, poor tackling position, reduced neck strength, weak shoulder control, cervical stiffness, shoulder depression during contact or anatomical narrowing around the nerve root. A physiotherapist can assess these factors and build a prevention plan.

Do I need an MRI for a stinger?
Not always. A first-time, one-sided stinger that resolves quickly and has a normal examination may not need imaging. MRI is more commonly considered for recurrent stingers, symptoms lasting more than 24 hours, persistent weakness, bilateral symptoms or concern for cervical spine injury.

Can physiotherapy help a brachial plexus stinger?
Yes. Physiotherapy for stingers helps confirm the diagnosis, monitor neurological recovery, restore neck and shoulder strength, improve contact mechanics and guide safe return to sport. It is especially important for recurrent or prolonged symptoms.

Are stingers dangerous?
Many stingers are short-lived, but they can be serious if symptoms persist, recur or involve both sides. Because stingers affect nerves, athletes should take weakness, numbness and repeated episodes seriously.

What should I do immediately after a stinger?
Stop playing, report the symptoms and have your neck, shoulder and neurological function assessed. Do not stretch aggressively or try to “run it off” if there is weakness, numbness or neck pain.

Can a stinger cause permanent damage?
Most typical sports stingers recover well, but repeated or more severe nerve injuries can lead to prolonged weakness, sensory changes or muscle wasting. Persistent symptoms should be assessed early.

When can I return to rugby, AFL or contact sport after a stinger?
You can return when symptoms have fully resolved, neurological testing is normal, neck range of motion is pain-free, shoulder and arm strength are equal to the other side, and you can complete graded contact training without symptoms. Recurrent stingers need a more cautious plan.