USCF 6 th Annual Primary Care Sports Medicine Conference: ABCs of Musculoskeletal Care

Transcription

1 USCF 6 th Annual Primary Care Sports Medicine Conference: ABCs of Musculoskeletal Care Back Injuries in the Young Athlete Lyle J. Micheli, MD Mechanism of Injury 1. Acute macrotrauma 2. Repetitive microtrauma 3. Combination Acute Injury - Overuse 1. History 2. Differential diagnosis 3. Risk factors Overuse Injury 1. Stress fracture 2. Tendonitis 3. Chondromalacia 4. Bursitis 5. Fasciitis Diagnoses in New England Baptist Hospital group Age of patients ranged from 21 to 77 years (mean age 31.9 years) Diagnosis Number Lumbosacral strain 27 Discogenic back pain 48 Herniated (24) Degenerated (22) Herniated and Degenerated (2) Osteoarthritis 4 Spinal Stenosis 6 Spondylolysis/Spondylolisthesis 5 Scoliosis 7 Neoplasm 2 Ankylosing spondylitis 1 TOTAL 100 Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med Jan;149(1):15-8.

2 Diagnosis in Children s Sports Medicine Foundation group Age of patients ranged from 12 to 18 years (mean age 15.8 years) Diagnosis Number Spondylolysis/Spondylolisthesis 47 Posterior element injury 15 Hyperlordic LBP/mechanical back pain 11 Scoliosis 8 Musculoskeletal/lumbosacral strain 6 Discogenic 11 Herniated (9) Degenerated (1) Herniated and degenerated (1) Hamstring tightness 1 Trochanteric bursitis 1 TOTAL 100 Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med Jan;149(1):15-8. Spondylolysis: Stress Fracture Stress Fracture: Sites 1. Upper extremity: humerus, olecronon, wrist 2. Lower extremity: tibia, fibula, femoral neck, metatarsals 3. Spine: pars intra-articularis, pedicle

3 Low Back Pain: Acute 1. Rest 2. Medication Pain Muscle Relaxant Anti-Inflammatory 3. Physical therapy Low Back Pain: Subacute 1. Return to activity 2. Medication 3. Physical therapy Williams (flexion)? McKenzie (extension)? ROM and strength 4. Bracing Physical Therapy Lumbodorsal fascia stretching Hamstring stretching Abdominal strengthening Low Back Pain 1. Anti-Lordosis 2. Flexibility

4 Brace & Exercise The Boston Brace System 1. For spinal deformities 2. For back pain For Scoliosis Modular - 20 sizes - Same shape - Same material - Same flexibility For Back Pain Modular -20+ sizes - 3 basic shapes 0º, 15º, 30º - 2 materials polypro, polyeth - Varied flexibility The Boston Brace (Scoliosis) The Boston anterior brace The Boston overlap brace Boston Anterior Brace 1. Anti-lordotic 2. Intimate fit 3. protective equipment Back Pain 1. Mechanical 3. Spondylolysis 4. Fracture Children s Hospital Boston 75 patients Spondylolysis and grade 1 Spondylolisthesis Treatment: February 1976 to June 1981 Patient Population 61 males (mean 16.5 years) 14 females (mean 16.0 years) Age range 7-32 years

5 4 patients > 20 years Bracing Regimen First 6 months 23/24 - hours per day Second 6 months wean out of brace After one year As necessary Activities as tolerated football, hockey, gymnastics, etc. Nature of Lesion Spondylolysis Spondylolisthesis Excellent 74% 60% (Heal) (26%) (12%) Good 14% 28% Fair-Poor 12% 12% Sports Spondylolysis 1. A fracture of the pars (one or both) 2. Most fractures do better with bony union 3. Studies suggest fibrous union of pars fracture can give satisfactory results, short term 4. The natural history of spondylolysis is not known 5. The ideal result of spondylolysis treatment is bilateral bony union Surgery? 1982: 10% 2002: 10%