Spinal Pain in Athletes Flashcards
What is the common cause of a pars stress fracture?
Extension load with axial compression
What sports is pars stress fracture most common in?
- Gymnastics
- Cricket
- Tennis
- Any sport that involves extension/rotation & axial loading of LSp
What are the risk factors for pars stress fracture in cricket?
- Mixed bowling action (counter rotation of thorax to side on position during delivery stride)
- Crunch factor – excessive trunk LF & pelvis axial rotation
What are the risk factors for pars stress fracture in women’s gymnastics?
- Lots of jumping & extension
- Vault: Lots of extension with axial compression, landing in extension
What are should be considered in the management for female gymnasts with pars injuries?
- Training load
- Technique
- Equipment
- Muscle length/strength
What is the best type of imaging for detecting a pars stress fracture?
CT: Best for bony detail, no radiation, shows bony oedema
What could be included in the OE for a gymnast with a suspected pars stress fracture?
- PAIVMs for thoracic spine
- Psoas, hamstrings, rec fem length
- TA, glut med strength
What are some of the common interventions for spinal pain in gymnasts?
- 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)
Why should athletes training at a high load only be prescribed relative rest as a treatment?
- 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
What does research show regarding the use of imaging in determining return to sport?
Imaging doesn’t provide great value in determining level of function & readiness to return to sport, - use outcome measures instead
What are the characteristics of rib stress fractures?
- Vague thoracic discomfort
- Progresses to sharp, pinpoint pain
- Exacerbated by cough
What is the common cause of rib stress fractures?
- Not weight-bearing bones, so generally muscular forces (usually serratus anterior/external obliques)
- Common in rowing (amateur & elite)
What is the relationship between the abdominals and the rib cage?
Large contractions of RA can put large forces on the rib cage & cause stress fractures
Why are rib stress fractures more common in elite rowers than amateur rowers?
- 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
Which ribs are most commonly affected by stress fractures?
Ribs 4-8, but especially 5th rib (opposing forces of SA & external obliques
What extrinsic factors can contribute to rib stress fractures in rowers?
- 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
What intrinsic factors can contribute to rib stress fractures in rowers?
- CT/CV joints
- Bone density (female athlete triad)
- SA & abdominal muscles
- Other muscles (rhomboids, pec minor)
What are the proposed mechanisms of TOS in sports?
- 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
What are the common features of traumatic injuries to the cervical spine in sport?
- Mechanism of injury: CSp hyperflexion
- Level for fracture dislocation: C4/5 or C5/6
- Outcomes: Ranges from complete recovery to death
- Sports: Rugby, gymnastics
What are the extrinsic risk factors for cervical spine injury in rugby?
- 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
What are the player-related risk factors for cervical spine injury in rugby?
- 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
What is the relationship between head and neck injuries in sport?
- Share same mechanism & often occur simultaneously
- Assess the neck first (cannot move player until neck is cleared)
What are the most common symptoms of concussion?
- Vacant stare
- Headache
- Nausea
- Dizziness
How should concussion be assessed?
- 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)
What are the most commonly used concussion assessment guidelines?
Cantu guidelines for management of concussion (3 grades)
What should on-field assessment of head & neck injuries include?
- Assess LOC
- Assess peripheral strength/sensation without moving head/neck
- Palpate neck
- Assess isometric neck strength
- Assess AROM
- Perform axial compression & Spurling test (if negative, athlete may be moved)
- Assess recent memory & postural instability
- Inquire about symptoms
