Plain Roentgenograms of the Spine in the Injured Athlete

Neuromuscular function in athletes following recovery from a recent acute low back injury

STUDY DESIGN

Observational case control design.

OBJECTIVES

To examine muscle response to sudden trunk loading in athletes with and without a recent history of acute low back injury (LBI).

BACKGROUND

Impaired neuromuscular function is associated with chronic low back pain. This study examined whether such impairment persists after recovery from an acute LBI.

METHODS AND MEASURES

Seventeen athletes who had a recent history of acute LBI and 17 matched healthy controls were tested. At the time of testing (mean = 56 days postinjury, range = 7-120 days postinjury), all athletes were symptom free and had returned to regular competition. Subjects performed isometric exertions in trunk flexion, extension, and left and right lateral bending against a trunk restraining cable. Upon reaching the target isometric force, the cable was released to impose sudden loading on the lumbar spine. Surface EMG signals from 12 major trunk muscles were recorded. The shut-off and switch-on latencies and number of muscles responding to sudden loading were compared between the 2 groups.

RESULTS

In all 4 testing directions, the athletes with a recent history of acute LBI shut off significantly fewer muscles and did so with delayed latency. On average, the injured subjects shut off 4.0 out of 6.0 (SD = 1.3) muscles compared to 4.6 out of 6.0 (SD = 1.3) muscles in the control group. The average muscle shut-off latency was 71 (SD = 31) milliseconds for the injured and 50 (SD = 21) milliseconds for the control subjects. No differences were found in number or latency of muscles switching on.

CONCLUSIONS

These objective measures of neuromuscular function indicated an altered muscle response pattern to sudden trunk loading in athletes following their clinical recovery from a recent acute LBI.

Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting

This self-directed learning module highlights the underlying anatomy and biomechanics of the cervical spine and shoulder as a basis for developing a differential diagnosis of contributing pathology in an industrial injury. This includes components of the history, examination, and appropriate diagnostic testing that are necessary to develop an optimal rehabilitation plan. Treatment options are reviewed and include medications, therapy, selective injections, and return-to-work programs in the industrial setting.

OVERALL ARTICLE OBJECTIVES

(a) To be able to identify neck and shoulder pathology, (b) to effectively evaluate cervical spine and shoulder injuries, and (c) to rehabilitate acute cervical spine and shoulder injuries in the industrial setting.

Spondylolisthesis in the athlete

The diagnosis and appropriate management of spondylolysis and spondylolisthesis in the athlete can be challenging for the treating orthopaedic surgeon. With an increase in the number of skeletally immature athletes competing at more demanding levels of competition, an associated increase in the number of such cases may be seen. Management strategy is directed by the symptoms, the age of the patient, and the severity of the spondylolisthesis.

A history of low back injury is a risk factor for recurrent back injuries in varsity athletes

In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.

Low-Back Pain in Sports

In brief The younger the active patient who has prolonged, localized back pain near the midline, the more likely he or she has spondylolysis or other pars injury. A careful examination with appropriate x-rays is critical because of the high incidence of structural vertebral problems associated with children's low-back pain. Early diagnosis helps the patient to return to sports quickly; conservative therapy of relative rest and stretching is often successful.

The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis

The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.

Low back pain among retired wrestlers and heavyweight lifters

The lifetime incidence and prevalence of low back pain among 32 retired wrestlers (ages 39 to 62 years) and 13 retired heavyweight lifters (ages 40 to 61 years) were evaluated and compared to the corresponding results in a cross-sectional study of 716 men (ages 40 to 47 years). The radiologic findings and the findings upon physical examination in the athletes were compared to the findings in another study of normal, active, similarly aged men who were sampled at random. The lifetime incidence and prevalence of low back pain was higher among the wrestlers (59%) compared with both the lifters (23%) and the control group (31%). The tolerance for backache seemed to be higher among the athletes than the controls. A higher frequency of old fractures was found among the wrestlers. The athletes with fractures had a higher frequency of low back pain. A significant decrease in disk height was found among the lifters.