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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<ul><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>TheAthletesLumbarSpine:CurrentConcepts</p><p>AjeyaP.Joshi,M.D.40th AnnualSportsMedicineSymposium</p><p>January18,2013</p><p>FinancialDisclosureDr.AjeyaJoshihasdisclosedthathehasownershipinterestfromPhygenandSpineSmith;healsoreceivesnonCMEservicefeesfromEliLily,Inc.</p><p>SpeakerBackground SpineSurgeon,SouthTexasSpinalClinic ClinicalAssociateProfessor,UTHSCSA Spinetraining:Baylor(Houston) InpracticeinSanAntonio8+years</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>Content/ObjectivesOnfieldscreeningredflagsandmanagement</p><p> Lowbackpain Epidemiology Trends Treatments Prevention</p><p> Spinous process/transverseprocessfractures</p><p>Content/Objectives Spondylolysis (parsfractures) updates</p><p>Hottopics/Onthehorizon</p><p>Acute/Traumatic(Fall,Collision) LookforonthefieldRedFlags:</p><p> Weakness,incontinence,cannotstandorjog,impairedflexibility,lossofconsciousness</p><p> (Concussion,upperextremityweakness,allpartofhead/neck/spinebroadertraumaconsiderations)</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>NeurologicTesting L2Hipflexors(iliopsoas) L3 Kneeextensors(quadriceps)</p><p> L4 Ankledorsiflexors(tibialisanterior)</p><p> L5 Longtoeextensor(extensorhallucislongus)</p><p> S1Ankleplantiflexors(gastrocsoleus)</p><p> GradingStrength05</p><p>AcuteInjuryAlgorithm RedFlagfinding=Assumestructuralproblem(fracture/instabilityoftheCTLSspine)</p><p> ExpediteER/spinalevaluation,with: Spinalprecautions(headneckimmobilizationandspineboard) AdvancedTraumaLifeSupport,ABCs</p><p>AthletesandLowBackPain Trend/suggestionofhigherincidenceofLBP15</p><p> Age,priorinjury/LBP,females,Volleyball,timespentwatchingTV</p><p>Myobservations:MATCH/CONCUR Significantlosttimefromathleticparticipation68</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>LBPContributingfactorsAcuteLBP:GrowthspurtAbruptincreasesintrainingintensityorfrequency</p><p>ImpropertechniqueUnsuitablesportsequipment</p><p>Leglengthinequality</p><p>ChronicLBP:PoorcorestrengthStructuralissues(pars,disk)Tighthamstrings</p><p>SubacuteorChronicLBPMusclestrain/ligamentsprainDegenerativediscdiseaseIsthmicspondylolysis (noslip)IsthmicspondylolisthesisFacetsyndromeRingapophyseal injury(adolescents)SacralstressfractureCentraldischerniation(withoutradiculopathy)Sacralization ofL5/tranverse processimpingementFacetstressfractureLumbarvertebralbodyfractureDiscitis/osteomyelitisNeoplasm(CANCER)</p><p>Intrapelvic, gynecologic conditions (e.g., ovarian cysts)Renal diseaseSacroiliac joint dysfunction</p><p>LowBackPain Treatment(strain,nofracture)</p><p> Corestrengthening(PT) StretchHamstrings Shorttermmedications:antiinflammatory(NSAIDs),musclerelaxant</p><p> Weightoptimization Lessenimpactactivitiesduringactivesymptoms</p><p> Prevention Sportsspecifictraining Rest Manageablereps/goals</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>Spinous/transverseprocessinjuries Typicallynotunstable Duetomusclepullingordirectimpact</p><p> Treatsymptomatically Brace,meds,PT</p><p> Specialisttoclearathleteassymptomssubside</p><p> Flexionextensionxraysonoccasion X</p><p>Spondylolysis akaparsfracture,stressreaction/fracture</p><p> 36%prevalence910</p><p> Nonathleticpopulation: Oftenasymptomatic Oftenincidental Riskofslip:2550%</p><p> Maydevelopasstressfractureinathletics</p><p> Adolescentathletes: 38%withslipprogression(avg.10%) 8%withslipdecrease</p><p>11</p><p>Spondylolysis Risks Twisting,hyperextension</p><p> Repetitiveaxialloading</p><p> Offensivelylinemen,gymnasts,soccer,baseball,volleyball,weightlifting,rowing,wrestlers</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>Spondylolysis</p><p>Exam Tighthamstrings Painwithlumbarhyperextension Restrictedrangeofmotion StorkTest</p><p>Diagnosis Imaging Obliquefilmsnotuseful;extraradiation RelyonSPECTbonescan+CT(radiation)MRIusefulforexcludingotherprocesses(diskdegeneration,herniation)</p><p>Spondylolysis ScenariosandTreatment Spondylolysis (crack,stressfracture) Developingspondylolysis =stressreaction(nocrackyet)</p><p> Treatmentofthesetwosituations Bracing(+/ 3months),wean,rehab(CORE),rampuptosports StablefibrousunionwithresolvedsymptomsisOK CheckvitaminD????Doesnthurt.youllfindlowlevelstoRx</p><p> Futuretreatments Externalelectricalstimulation Bonegrowthstimulators(external)(magneticfield) OxygenOzoneCTguidedtherapy Hyperbaricoxygen?</p></li><li><p>Thispresentationistheintellectualpropertyoftheauthor.Contactthematapjoshimd@yahoo.comforpermissiontoreprintand/ordistribute.</p><p>Onthehorizon Stemcells(mesenchymal stemcells)</p><p> Adiposebased Bonemarrowbased</p><p> NeedsrigorousstudynogreatEBMtosharewithyouatpresent Europe&gt;&gt;&gt;U.S.</p><p>Thank you!!</p><p>Dr. Jesse DeLeeDr. Pablo Vazquez</p><p>References1. 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Lumbar spondylolysis and spondylolisthesis in college football players. A </p><p>prospective study. Am J Sports Med.1986; 14:404 67. Hainline B. Low back injury. Clin Sports Med.1995; 14:241 658. Duda M. Golfers use exercise to get back in the swing. Phys Sportsmed.1989; 17:109 -139. Iwamoto J, Abe H, Tsukimura Y, Wakano K. Relationship between radiographic abnormalities of lumbar spine and </p><p>incidence of low back pain in high school rugby players: a prospective study. Scand J Med Sci Sports. 2005 Jun;15(3):163-810. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000;28:57 -6211. Muschik M, Hahnel H, Robinson PN, Perka C, Muschik C. Competitive sports and the progression of spondylolisthesis. </p><p>J Pediatr Orthop.1996; 16:364 912. Standaert C, Herring S. Spondylolysis: a critical review. Br J Sports Med. 2000 Dec;34(6):415-2213. Elliott S, Hutson MA, Wastie ML. Bone scintigraphy in the assessment of spondylolysis in patients attending a sports</p><p>injury clinic. Clin Radiol 1988;39:2697214. Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. </p><p>Spine 1985;10:9374315. Blanda J, Bethem D, Moats W, et al. Defects of pars interarticularis in athletes: a protocol for nonoperative treatment. </p><p>J Spinal Disord 1993;6:4061116. Bono C. Low-back pain in athletes. J Bone Joint Surg Am. 2004 Feb;86-A(2):382-96</p></li></ul>