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.
Frequently
Asked Questions
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