Spinal Pain in Athletes

Question 1

What is the common cause of a pars stress fracture?

Answer 1

Extension load with axial compression

Question 2

What sports is pars stress fracture most common in?

Answer 2

• Gymnastics
• Cricket
• Tennis
• Any sport that involves extension/rotation & axial loading of LSp

Question 3

What are the risk factors for pars stress fracture in cricket?

Answer 3

• Mixed bowling action (counter rotation of thorax to side on position during delivery stride)
• Crunch factor – excessive trunk LF & pelvis axial rotation

Question 4

What are the risk factors for pars stress fracture in women’s gymnastics?

Answer 4

• Lots of jumping & extension

- Vault: Lots of extension with axial compression, landing in extension

Question 5

What are should be considered in the management for female gymnasts with pars injuries?

Answer 5

• Training load
• Technique
• Equipment
• Muscle length/strength

Question 6

What is the best type of imaging for detecting a pars stress fracture?

Answer 6

CT: Best for bony detail, no radiation, shows bony oedema

Question 7

What could be included in the OE for a gymnast with a suspected pars stress fracture?

Answer 7

• PAIVMs for thoracic spine
• Psoas, hamstrings, rec fem length
• TA, glut med strength

Question 8

What are some of the common interventions for spinal pain in gymnasts?

Answer 8

• TA activation
• Maintaining a neutral spine in crook lying
• Single leg squats
• Maintaining a neutral spine in squatting
• Correct landing technique
• Take out hard landings (use mats/foam pits instead)

Question 9

Why should athletes training at a high load only be prescribed relative rest as a treatment?

Answer 9

• Complete rest for 1-2 weeks would result in large de-training
• When returning to a high training load after a short break, they are at a higher risk of developing stress fractures

Question 10

What does research show regarding the use of imaging in determining return to sport?

Answer 10

Imaging doesn’t provide great value in determining level of function & readiness to return to sport, - use outcome measures instead

Question 11

What are the characteristics of rib stress fractures?

Answer 11

• Vague thoracic discomfort
• Progresses to sharp, pinpoint pain
• Exacerbated by cough

Question 12

What is the common cause of rib stress fractures?

Answer 12

• Not weight-bearing bones, so generally muscular forces (usually serratus anterior/external obliques)
• Common in rowing (amateur & elite)

Question 13

What is the relationship between the abdominals and the rib cage?

Answer 13

Large contractions of RA can put large forces on the rib cage & cause stress fractures

Question 14

Why are rib stress fractures more common in elite rowers than amateur rowers?

Answer 14

• Elite have more efficient technique, so can generate more force through the oars
• More force going through the trunk
• Poorer technique = loading the lower limbs more

Question 15

Which ribs are most commonly affected by stress fractures?

Answer 15

Ribs 4-8, but especially 5th rib (opposing forces of SA & external obliques

Question 16

What extrinsic factors can contribute to rib stress fractures in rowers?

Answer 16

• Oar shape & size
• Long-endurance rows at low stroke rates of boat speed
• Training level
• Technique
• Dominant side (are they only training one side)
• Position in the boat (7th usually has heavier work load)
• On & off water training: Ergometer, strength & conditioning

Question 17

What intrinsic factors can contribute to rib stress fractures in rowers?

Answer 17

• CT/CV joints
• Bone density (female athlete triad)
• SA & abdominal muscles
• Other muscles (rhomboids, pec minor)

Question 18

What are the proposed mechanisms of TOS in sports?

Answer 18

• Tennis: Interscalenes compression due to downward displacement of upper extremity
• Costoclavicular compression: Post-clavicular fractures (e.g. rugby players)
• Pec minor compression in throwers/pitchers

Question 19

What are the common features of traumatic injuries to the cervical spine in sport?

Answer 19

• Mechanism of injury: CSp hyperflexion
• Level for fracture dislocation: C4/5 or C5/6
• Outcomes: Ranges from complete recovery to death
• Sports: Rugby, gymnastics

Question 20

What are the extrinsic risk factors for cervical spine injury in rugby?

Answer 20

• Laws of game
• Illegal play
• Match play
• Phase of play (tackle, scrum, ruck)
• Time of season
• Environmental conditions
• Pitch hardness/condition
• Referee’s control of the game
• Coach’s instructions
• Importance of game

Question 21

What are the player-related risk factors for cervical spine injury in rugby?

Answer 21

• Grade
• Age/maturity
• Experience
• Position
• Skull
• Anthropometric characteristics (body size/shape)
• Congenital abnormalities
• Physiological & psychological characteristics
• Visual acuity
• Information processing ability
• Impairment
• Occupation
• Gender
• Ethnic origin

Question 22

What is the relationship between head and neck injuries in sport?

Answer 22

• Share same mechanism & often occur simultaneously

- Assess the neck first (cannot move player until neck is cleared)

Question 23

What are the most common symptoms of concussion?

Answer 23

• Vacant stare
• Headache
• Nausea
• Dizziness

Question 24

How should concussion be assessed?

Answer 24

• Ask orientation questions that evaluate recently acquired memory (e.g. where are the playing, who are they playing, who won last week)
• Athletes should not return to play until all symptoms of concussion have cleared (follow guidelines)

Question 25

What are the most commonly used concussion assessment guidelines?

Answer 25

Cantu guidelines for management of concussion (3 grades)

Question 26

What should on-field assessment of head & neck injuries include?

Answer 26

1. Assess LOC
2. Assess peripheral strength/sensation without moving head/neck
3. Palpate neck
4. Assess isometric neck strength
5. Assess AROM
6. Perform axial compression & Spurling test (if negative, athlete may be moved)
7. Assess recent memory & postural instability
8. Inquire about symptoms