Back Pain in Athletes

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Back pain is not restricted to one cause. Dr. Rajesh Rao discusses the most common causes and the things you can do to help prevent it.

Published in: Health & Medicine, Sports
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Back Pain in Athletes

  1. 1. Back pain in Athletes Rajesh Rao, MD FAAPMR
  2. 2. Topics • • • • • • • Anatomy Incidence Sports associated with back injury Prevention Treatment approach Take Home message Questions
  3. 3. Anatomy • • • • • Structure of the Bones Muscles Ligaments Disc Facet joints
  4. 4. Bones • 5 Lumbar Vertebrae • Sacrum • Discs in between the bones
  5. 5. Muscles • Anterior (flexors) • Posterior (extensors) • Lateral (abdominals)
  6. 6. Back pain related to sports • Repetitive stress • Acute injuries • Relations to specific sports
  7. 7. 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
  8. 8. 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, volleyba ll)
  9. 9. 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.
  10. 10. Clinical syndromes • • • • • Musculo-Ligamentous Injuries Disc herniations Fracture subluxations and dislocation Osteoporotic fractures in elderly SpondyloLysis and spondylolisthesis ( Extension based sports- Gymnastics, Cheerleading, Diving)
  11. 11. Evaluation • • • • • Clinical Examination X Rays MRI CT scan Bone scan
  12. 12. Clinical Examination • Important Clues pertaining to cause • Helps formulate a Plan of action • Important in determining any Neurological involvement
  13. 13. X rays • Important for Bone anatomy • Look for fractures or Subluxations
  14. 14. MRI • • • • Muscle and Ligamentous issues Disc Hernations Nerve compression Stenosis
  15. 15. Bone Scan • Sensitive test for Fractures and stress reactions • Spondylolysis
  16. 16. CT scan • Evaluation of new and old fractures
  17. 17. Treatment • Prevention • Active treatment
  18. 18. Prevention • Exercise program • Stretching program • Sport specific training
  19. 19. Getting F.I.T. depends on: • Frequency (How often?) • Intensity (How hard?) • Time / duration (How long?)
  20. 20. Flexibility • Stretching: especially HAMSTRINGS • Include all major muscle groups
  21. 21. Motion • Range of motion and movement (Flexion and Extension Lateral motions) • F: daily • I: easy • T: 2-15 minutes
  22. 22. 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
  23. 23. Strengthening • Key component of any good exercise program • Even more important as we get older • Pain causes inhibition which leads to weakness
  24. 24. Stabilization Exercises
  25. 25. Flexion Exercises
  26. 26. Treatment Approach • • • • • Relative rest Physical therapy Anti-Inflammatory medications Injection therapy Surgical treatment
  27. 27. Physical Therapy • Exercise program • Modalities ( Heat, Ice , Estim, TENS unit) • ROM • Pain Modulation
  28. 28. Medications • • • • Limited use of the NSAIDS Pain Medications Muscle relaxants Anti-inflammatory Steroids
  29. 29. Injection therapy • Specific Conditions are amenable to injection therapy • Epidural injections • Facet joint injections.
  30. 30. Surgical treatment • Neurological Deficits • Instability • Persistent pain Need to establish One to One relation between Symptoms and Pathology.
  31. 31. 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.
  32. 32. 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.
  33. 33. Questions
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