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.

1. Back pain in Athletes
Rajesh Rao, MD
FAAPMR

2. Topics
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Anatomy
Incidence
Sports associated with back injury
Prevention
Treatment approach
Take Home message
Questions

3. Anatomy
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Structure of the Bones
Muscles
Ligaments
Disc
Facet joints

4. Bones
• 5 Lumbar Vertebrae
• Sacrum
• Discs in between the bones

5. Muscles
• Anterior (flexors)
• Posterior (extensors)
• Lateral (abdominals)

12. Back pain related to sports
• Repetitive stress
• Acute injuries
• Relations to specific sports

15. 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

16. 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)

17. 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.

18. Clinical syndromes
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Musculo-Ligamentous Injuries
Disc herniations
Fracture subluxations and dislocation
Osteoporotic fractures in elderly
SpondyloLysis and spondylolisthesis
( Extension based sports- Gymnastics,
Cheerleading, Diving)

21. Evaluation
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Clinical Examination
X Rays
MRI
CT scan
Bone scan

22. Clinical Examination
• Important Clues pertaining to cause
• Helps formulate a Plan of action
• Important in determining any
Neurological involvement

23. X rays
• Important for Bone anatomy
• Look for fractures or Subluxations

24. MRI
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Muscle and Ligamentous issues
Disc Hernations
Nerve compression
Stenosis

25. Bone Scan
• Sensitive test for Fractures and stress
reactions
• Spondylolysis

26. CT scan
• Evaluation of new and old fractures

27. Treatment
• Prevention
• Active treatment

28. Prevention
• Exercise program
• Stretching program
• Sport specific training

29. Getting F.I.T.
depends on:
• Frequency (How often?)
• Intensity (How hard?)
• Time / duration (How long?)

30. Flexibility
• Stretching: especially HAMSTRINGS
• Include all major muscle groups

31. Motion
• Range of motion and movement (Flexion
and Extension Lateral motions)
• F: daily
• I: easy
• T: 2-15 minutes

32. 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

33. Strengthening
• Key component of any good exercise
program
• Even more important as we get older
• Pain causes inhibition which leads to
weakness

34. Stabilization Exercises

35. Flexion Exercises

36. Treatment Approach
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Relative rest
Physical therapy
Anti-Inflammatory medications
Injection therapy
Surgical treatment

37. Physical Therapy
• Exercise program
• Modalities ( Heat, Ice , Estim, TENS
unit)
• ROM
• Pain Modulation

38. Medications
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Limited use of the NSAIDS
Pain Medications
Muscle relaxants
Anti-inflammatory Steroids

39. Injection therapy
• Specific Conditions are amenable to
injection therapy
• Epidural injections
• Facet joint injections.

40. Surgical treatment
• Neurological Deficits
• Instability
• Persistent pain
Need to establish One to One relation
between Symptoms and Pathology.

41. 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.

42. 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.

43. Questions