The Athlete’s Lumbar Spine: Current Spine...This presentation is the intellectual property of the author. Contact them at apjoshimd@yahoo.com for permission to reprint and/or distribute

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Text of The Athlete’s Lumbar Spine: Current Spine...This presentation is the intellectual property of the...

  • Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.

    TheAthletesLumbarSpine:CurrentConcepts

    AjeyaP.Joshi,M.D.40th AnnualSportsMedicineSymposium

    January18,2013

    FinancialDisclosureDr.AjeyaJoshihasdisclosedthathehasownershipinterestfromPhygenandSpineSmith;healsoreceivesnonCMEservicefeesfromEliLily,Inc.

    SpeakerBackground SpineSurgeon,SouthTexasSpinalClinic ClinicalAssociateProfessor,UTHSCSA Spinetraining:Baylor(Houston) InpracticeinSanAntonio8+years

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    Content/ObjectivesOnfieldscreeningredflagsandmanagement

    Lowbackpain Epidemiology Trends Treatments Prevention

    Spinous process/transverseprocessfractures

    Content/Objectives Spondylolysis (parsfractures) updates

    Hottopics/Onthehorizon

    Acute/Traumatic(Fall,Collision) LookforonthefieldRedFlags:

    Weakness,incontinence,cannotstandorjog,impairedflexibility,lossofconsciousness

    (Concussion,upperextremityweakness,allpartofhead/neck/spinebroadertraumaconsiderations)

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    NeurologicTesting L2Hipflexors(iliopsoas) L3 Kneeextensors(quadriceps)

    L4 Ankledorsiflexors(tibialisanterior)

    L5 Longtoeextensor(extensorhallucislongus)

    S1Ankleplantiflexors(gastrocsoleus)

    GradingStrength05

    AcuteInjuryAlgorithm RedFlagfinding=Assumestructuralproblem(fracture/instabilityoftheCTLSspine)

    ExpediteER/spinalevaluation,with: Spinalprecautions(headneckimmobilizationandspineboard) AdvancedTraumaLifeSupport,ABCs

    AthletesandLowBackPain Trend/suggestionofhigherincidenceofLBP15

    Age,priorinjury/LBP,females,Volleyball,timespentwatchingTV

    Myobservations:MATCH/CONCUR Significantlosttimefromathleticparticipation68

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    LBPContributingfactorsAcuteLBP:GrowthspurtAbruptincreasesintrainingintensityorfrequency

    ImpropertechniqueUnsuitablesportsequipment

    Leglengthinequality

    ChronicLBP:PoorcorestrengthStructuralissues(pars,disk)Tighthamstrings

    SubacuteorChronicLBPMusclestrain/ligamentsprainDegenerativediscdiseaseIsthmicspondylolysis (noslip)IsthmicspondylolisthesisFacetsyndromeRingapophyseal injury(adolescents)SacralstressfractureCentraldischerniation(withoutradiculopathy)Sacralization ofL5/tranverse processimpingementFacetstressfractureLumbarvertebralbodyfractureDiscitis/osteomyelitisNeoplasm(CANCER)

    Intrapelvic, gynecologic conditions (e.g., ovarian cysts)Renal diseaseSacroiliac joint dysfunction

    LowBackPain Treatment(strain,nofracture)

    Corestrengthening(PT) StretchHamstrings Shorttermmedications:antiinflammatory(NSAIDs),musclerelaxant

    Weightoptimization Lessenimpactactivitiesduringactivesymptoms

    Prevention Sportsspecifictraining Rest Manageablereps/goals

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    Spinous/transverseprocessinjuries Typicallynotunstable Duetomusclepullingordirectimpact

    Treatsymptomatically Brace,meds,PT

    Specialisttoclearathleteassymptomssubside

    Flexionextensionxraysonoccasion X

    Spondylolysis akaparsfracture,stressreaction/fracture

    36%prevalence910

    Nonathleticpopulation: Oftenasymptomatic Oftenincidental Riskofslip:2550%

    Maydevelopasstressfractureinathletics

    Adolescentathletes: 38%withslipprogression(avg.10%) 8%withslipdecrease

    11

    Spondylolysis Risks Twisting,hyperextension

    Repetitiveaxialloading

    Offensivelylinemen,gymnasts,soccer,baseball,volleyball,weightlifting,rowing,wrestlers

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    Spondylolysis

    Exam Tighthamstrings Painwithlumbarhyperextension Restrictedrangeofmotion StorkTest

    Diagnosis Imaging Obliquefilmsnotuseful;extraradiation RelyonSPECTbonescan+CT(radiation)MRIusefulforexcludingotherprocesses(diskdegeneration,herniation)

    Spondylolysis ScenariosandTreatment Spondylolysis (crack,stressfracture) Developingspondylolysis =stressreaction(nocrackyet)

    Treatmentofthesetwosituations Bracing(+/ 3months),wean,rehab(CORE),rampuptosports StablefibrousunionwithresolvedsymptomsisOK CheckvitaminD????Doesnthurt.youllfindlowlevelstoRx

    Futuretreatments Externalelectricalstimulation Bonegrowthstimulators(external)(magneticfield) OxygenOzoneCTguidedtherapy Hyperbaricoxygen?

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    Onthehorizon Stemcells(mesenchymal stemcells)

    Adiposebased Bonemarrowbased

    NeedsrigorousstudynogreatEBMtosharewithyouatpresent Europe>>>U.S.

    Thank you!!

    Dr. Jesse DeLeeDr. Pablo Vazquez

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