Back Pain in Athletes
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Back pain in Athletes
Rajesh Rao, MDFAAPMR
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Topics
• Anatomy• Incidence• Sports associated with back injury• Prevention • Treatment approach• Take Home message• Questions
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Anatomy
• Structure of the Bones• Muscles• Ligaments• Disc• Facet joints
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Bones
• 5 Lumbar Vertebrae• Sacrum• Discs in between the bones
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Muscles
• Anterior (flexors)• Posterior (extensors)• Lateral (abdominals)
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Back pain related to sports
• Repetitive stress• Acute injuries• Relations to specific sports
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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
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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)
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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.
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Clinical syndromes
• Musculo-Ligamentous Injuries • Disc herniations• Fracture subluxations and dislocation• Osteoporotic fractures in elderly• SpondyloLysis and spondylolisthesis
( Extension based sports- Gymnastics, Cheerleading, Diving)
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Evaluation
• Clinical Examination• X Rays• MRI• CT scan • Bone scan
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Clinical Examination
• Important Clues pertaining to cause • Helps formulate a Plan of action• Important in determining any
Neurological involvement
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X rays
• Important for Bone anatomy• Look for fractures or Subluxations
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MRI
• Muscle and Ligamentous issues• Disc Hernations• Nerve compression• Stenosis
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Bone Scan
• Sensitive test for Fractures and stress reactions
• Spondylolysis
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CT scan
• Evaluation of new and old fractures
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Treatment
• Prevention• Active treatment
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Prevention
• Exercise program• Stretching program• Sport specific training
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Getting F.I.T.depends on:
• Frequency (How often?)
• Intensity (How hard?)
• Time / duration (How long?)
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Flexibility
• Stretching: especially HAMSTRINGS• Include all major muscle groups
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Motion
• Range of motion and movement (Flexion and Extension Lateral motions)
• F: daily• I: easy• T: 2-15 minutes
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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
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Strengthening
• Key component of any good exercise program
• Even more important as we get older• Pain causes inhibition which leads to
weakness
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Stabilization Exercises
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Flexion Exercises
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Treatment Approach
• Relative rest• Physical therapy• Anti-Inflammatory medications• Injection therapy• Surgical treatment
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Physical Therapy
• Exercise program• Modalities ( Heat, Ice , Estim, TENS
unit)• ROM • Pain Modulation
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Medications
• Limited use of the NSAIDS• Pain Medications• Muscle relaxants• Anti-inflammatory Steroids
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Injection therapy
• Specific Conditions are amenable to injection therapy
• Epidural injections• Facet joint injections.
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Surgical treatment
• Neurological Deficits• Instability• Persistent pain
Need to establish One to One relation between Symptoms and Pathology.
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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.
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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.
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Questions