Download - Back Pain in Athletes
Back pain in Athletes
Rajesh Rao, MDFAAPMR
Topics
• Anatomy• Incidence• Sports associated with back injury• Prevention • Treatment approach• Take Home message• Questions
Anatomy
• Structure of the Bones• Muscles• Ligaments• Disc• Facet joints
Bones
• 5 Lumbar Vertebrae• Sacrum• Discs in between the bones
Muscles
• Anterior (flexors)• Posterior (extensors)• Lateral (abdominals)
Back pain related to sports
• Repetitive stress• Acute injuries• Relations to specific sports
Incidence
• 5-8% of injuries in all sports• 15 % of spinal injuries ( all levels) in
US – related to sports and recreational activity.
• MusculoLigamentous injures of paraspinal muscles common causes in all sports involving Rotation
Incidence
• MusculoLigamentous injures of paraspinal muscles common causes in all sports involving Rotation.
• ( Golf Baseball Tennis)• Contact ( Basketball, football, soccer)• Repetitive injury mechanisms( gymnastics, swimming, diving,
volleyball)
Incidence
• Full contact sports – football and rugby common causes of spinal injury
• High speed sports such as down hill skiing and snowboarding
• Reported incidence of spinal injuries among snowboarders 3-4 times higher than Skiers.
• Jumping is responsible for 80% among snowboarders and affect the thoracolumbar spine.
Clinical syndromes
• Musculo-Ligamentous Injuries • Disc herniations• Fracture subluxations and dislocation• Osteoporotic fractures in elderly• SpondyloLysis and spondylolisthesis
( Extension based sports- Gymnastics, Cheerleading, Diving)
Evaluation
• Clinical Examination• X Rays• MRI• CT scan • Bone scan
Clinical Examination
• Important Clues pertaining to cause • Helps formulate a Plan of action• Important in determining any
Neurological involvement
X rays
• Important for Bone anatomy• Look for fractures or Subluxations
MRI
• Muscle and Ligamentous issues• Disc Hernations• Nerve compression• Stenosis
Bone Scan
• Sensitive test for Fractures and stress reactions
• Spondylolysis
CT scan
• Evaluation of new and old fractures
Treatment
• Prevention• Active treatment
Prevention
• Exercise program• Stretching program• Sport specific training
Getting F.I.T.depends on:
• Frequency (How often?)
• Intensity (How hard?)
• Time / duration (How long?)
Flexibility
• Stretching: especially HAMSTRINGS• Include all major muscle groups
Motion
• Range of motion and movement (Flexion and Extension Lateral motions)
• F: daily• I: easy• T: 2-15 minutes
Aerobic Conditioning
• More than walking, jogging or running• More than one way to get aerobic benefit
• 3-4 times per week• Atleast 20 minutes duration
Strengthening
• Key component of any good exercise program
• Even more important as we get older• Pain causes inhibition which leads to
weakness
Stabilization Exercises
Flexion Exercises
Treatment Approach
• Relative rest• Physical therapy• Anti-Inflammatory medications• Injection therapy• Surgical treatment
Physical Therapy
• Exercise program• Modalities ( Heat, Ice , Estim, TENS
unit)• ROM • Pain Modulation
Medications
• Limited use of the NSAIDS• Pain Medications• Muscle relaxants• Anti-inflammatory Steroids
Injection therapy
• Specific Conditions are amenable to injection therapy
• Epidural injections• Facet joint injections.
Surgical treatment
• Neurological Deficits• Instability• Persistent pain
Need to establish One to One relation between Symptoms and Pathology.
Overview of treatment approach
• Therapy- most useful for muscular issues
• Limited use of NSAIDS recommended• Injections useful for Pinched nerve and
facet joint issues• Surgery- useful in case of Neurological
deficit, instability.
Take Home Message
• Prevention is better than Cure• Low back pain is amenable to
conservative treatment.• Evaluation needed for specific
conditions e.g Spondylolisthesis• Small percent of cases need surgical
treatment.
Questions