Sports and the spine


Sports and the Spine


The Spine is a wonderfully complex and sophisticated structure. As a dynamic support of the trunk, the spinal column permits significant motion across individual segments and stabilizes the trunk. In addition the naturally curved (when seen from the side) form of the spine permits significant ability to absorb forces of daily living and vigorous activity or trauma. And yet, the spinal column has limits of normal function beyond which injury may occur. Age, physical condition and physiologic predisposition all play a role in determining the tolerable limits of proper functioning for the spinal column in an individual. So, we all have our limits and yet these may vary enormously between people and in the same person can change dramatically with aging and physical condition.


Most of us are not high performance athletes and in fact many of us enjoy sports but may not be in that optimal condition which we were once in. Although we feel mentally fit and eager to push ourselves physically in our sporting endeavors, our bodies may not be in optimal physiologic condition and thus prone to injury. This, unfortunately, is a growing problem with normal aging. As the saying goes, each day we are older than we have ever been before.


One must not exaggerate the risks of aging and in fact although many of us develop the occasional back ache, this is rarely a serious problem. The great news is that there is also something to do about this frustrating condition (read on), and furthermore in the majority of sports related back injuries no serious harm has been done. Not to say that every sports injury is completely benign. So lets review some of the more common injuries that can arise.



Common Injuries


Numerous studies have shown that proper physical conditioning, warming up before vigorous sports (10 minutes of mild exercise) and stretching can avoid injury. It also clear that proper body mechanics and avoidance of crazy activity (jumping off cliffs comes to mind here) will reduce your chances of becoming injured in a sports activity.


The soft tissues:

By the far the most common sports injury to the back involves a soft tissue problem. That is to say that unless a significant impact or force is involved, the non-bone tissues get injured. Amongst the soft tissues the muscles and their tendons are most vulnerable. A tremendous demand is placed upon these structures during sports activity, in fact one can easily exceed ten times the usual force across back musculature even with mild activity. Muscle fatigue, tears and tendinous inflammation are commonly noted after sports and this can lead to significant pain, stiffness and disability for days even weeks (also see stingers, burners). Some medication, heat, activity modification and occasionally physical therapy or chiropractic can help ease the common acute back ache. The soft tissues also include the intervertebral discs. These shock absorbers and intervertebral binders can be injured in a variety of ways. Sudden and severe trauma can lead to a large tear or rupture of the disc, this is a very painful and significant injury that is only seen quite rarely. Much more common is a small tear or disc bulge (herniated disc, slipped disc) which can be noted in the evaluation of back pain (usually by MRI) and in fact may have been present for some time and is only noted after a sports injury. The good news (once again the optimist) is that very few herniated or torn discs lead to persistent trouble or require surgery. Although pain can last a few weeks, the majority of disc related problems resolve with activity modification, medication, and sometimes temporary bracing and physical therapy. The few large disc herniations or disc disruptions that lead to persistent pain or nerve related symptoms may require surgery. Techniques applied today give an excellent success rate should surgery become necessary (over 90%).


Bone injuries:

Common smaller bone injuries include the posterior portion of the vertebra such as the pars interarticularis (commonly called spondylolysis) and are commonly seen in gymnasts and football players. Other smaller bone injuries include the facet joints and transverse processes. Although the fracture may be small, these injuries can be a source of continued pain and must be properly diagnosed initially to pursue proper treatment. Often temporary bracing and activity restriction is all that may be required until bone healing has occurred. More significant bone injuries that can occur after trauma in a sport setting include the compression fractures, burst fractures and fracture/dislocations. Marked pain and disability usually follow the initial injury. A hospital evaluation with proper evaluation with CT or MRI is often required. If the injury pattern is stable and there is no involvement of neurologic structures then bracing or cast treatment may be all that is required. Surgical treatment is generally reserved for significant deformity or loss of stability in the spinal column.



How to reduce your risk of a sports spine  injury


This brings us back to the discussion in the introduction, namely that most injuries are avoidable and not very serious. Given that we can not change our genetic predisposition to injury (not yet at least), and that we can also not avoid the aging process (also not yet), one of the things that we can affect is our overall physical condition and of course our physical activity level. So? these are things to work on.


Numerous studies have shown that proper physical conditioning, warming up before vigorous sports (10 minutes of mild exercise) and stretching can avoid injury. It also clear that proper body mechanics and avoidance of crazy activity (jumping off cliffs comes to mind here) will reduce your chances of becoming injured in a sports activity. Some specific back strengthening points to consider are developing the back stabilizers such as the erector spinae, the abdominals (including oblique muscles) the quadratus and the muscles attached to the shoulder area such the latissimus dorsi, and the trapezius. Isometric strengthening is probably the best to develop these without risking too vigorous motion across a susceptible back. This involves muscle contraction without actual change in muscle length, ie, contracting the muscles without much motion across the back or extremities. A few sessions with a physical therapist or a qualified trainer can set you in the right direction for a good back rehabilitation program.


 

 

 

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