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Foreword Mark D. Miller xiii
Preface Lyle J. Micheli Pierre A. d'Hemecourt xv
Sport-Specific Biomechanics of Spinal Injuries in the Athlete (Throwing Athletes, Rotational Sports, and Contact-Collision Sports) Robert Donatelli Donn Dimond Matt Holland 381
Athletes consistently recruit or transfer high levels of repetitive force through the spine and injuries to the cervical, thoracic and lumbar spine are relatively common. The paper's introduction includes a review of the functional anatomy of the spine as it relates to movements of the spine during sporting activities. Following the review of functional anatomy the paper will review special considerations and rehabilitation of spinal injuries in various sports. The specific sports reviewed in this paper will include the overhead throwing athlete in crewing, golf, football, soccer, baseball, and tennis.
Sport-Specific Biomechanics of Spinal Injuries in Aesthetic Athletes (Dancers, Gymnasts, and Figure Skaters) Pierre A. d'Hemecourt Anthony Luke 397
Aesthetic athletes are well recognized to suffer back pain. It is often overuse and growth related. Each aesthetic sport has biomechanical factors that are specific to the sport. These factors are crucial in understanding the injury patterns and prevention.
Overview of Spinal Interventions Daniel V. Colonno Mark A. Harrast Stanley A. Herring 409
Spinal pathology is relatively common among athletes. Spinal injections represent an appealing treatment option for athletes with spine conditions, as they have the potential to facilitate earlier return to play. This article reviews the utility of epidural, facet, and sacroiliac interventions in athletes with lumbar spine conditions. The existing literature regarding efficacy and potential complications of these interventions are discussed. General guidelines for the use of these procedures in athletes and for return to play are also presented.
Back Pain in the Pediatric and Adolescent Athlete Brian M. Haus Lyle J. Micheli 423
Back pain is becoming more common in young athletes, due in part to injuries sustained during organized sports. The spectrum of clinical entities in young athletes is different from that in adults; back pain usually arises from either an acute traumatic event or chronic overuse. Acute injuries include thoracolumbar fractures, spinal cord injury with out radiographic abnormality, acute disc herniation, apophyseal ring fractures, and muscular sprains. Problems associated with overuse include spondylolysis, spondylolisthesis, degenerative disc disease, hyperlordotic mechanical back pain, and atypical Scheurmann disease. It is important to remember that infection, neoplasm, or a rheumatologic condition may be mistaken for a sports injury.
Spinal Deformity in Young Athletes Pierre A. d'Hemecourt M. Timothy Hresko 441
Spinal deformity refers to abnormal or excessive curvature of the spine, which may occur during growth unrelated to sports but may be aggravated by sports. This article discusses these variances and their relationship to sports activities.
The Young Adult Spine in Sports Ken R. Mautner Mandy J. Huggins 453
The prevalence of low back pain in young adult athletes is surprisingly high, with internal disc disruption being the most common etiology in this population. This article provides a brief review of the pertinent anatomy. It also addresses key findings in the clinical history, physical examination, and imaging for discogenic pain, radiculopathy, and pain from the sacroiliac joint. Nonoperative treatment recommendations are the focus, including medications, physical therapy, and interventional procedures.
The Aging Spine in Sports Joanne Borg-Stein Lauren Elson Erik Brand 473
As the baby boomers age, there are an increasing number of masters athletes aged 50 and beyond who remain active in sports and physically demanding recreational activities. This population is at risk for degenerative disorders of the lumbar spine, including degenerative disc disease, lumbar facet arthropathy, spinal stenosis, and osteoporosis with compression fracture, deformity, and kyphosis. The clinical presentations of spine pathology can include axial back pain, radiculopathy, neurogenic claudication, or acute/subacute fracture and deformity with resultant pain, impairment of alignment, and decreased balance. Comprehensive treatments may include medications, exercise, injection, activity modification and biomechanical correction, sports-specific training, and surgery.
Lumbar Spine Surgery in Athletes: Outcomes and Return-to-Play Criteria Ying Li M. Timothy Hresko 487
Athletes can return to their preinjury level of performance after discectomy for lumbar disc herniation. Athletes who undergo direct pars repair for spondylolysis may be able to return to sports, but their participation level may vary. Athletes and military personnel who undergo lumbar total disc replacement can return to contact sports and unrestricted full-service military duty. Distal fusion level may be a significant negative predictor of successful return-to-play after fusion for scoliosis. There is great variability in published return-to-play criteria. Physicians must base their decision to release athletes back to sport on each individual's condition and the sport.
Injuries and Abnormalities of the Cervical Spine and Return to Play Criteria Christopher K. Kepler Alexander R. Vaccaro 499
Sporting injuries are a relatively common cause of spinal cord injury in the United States, particularly among those younger than 30 years. Many cervical injuries have characteristic mechanisms of injury, which often helps to understand the nature of resulting neurologic injury. Return-to-play guidelines are presented for cervical fractures, stingers, transient neurdpraxia, and other acquired and congenital forms of cervical pathology. The role of the sideline physician in treating cervical spine injury is reviewed. Literature that documents the rate of return to play after cervical injury can help treating physicians counsel players about the likelihood of return to play after their own cervical injury.
Degenerative Disease of the Cervical Spine and Its Relationship to Athletes Konstantinos M. Triantafillou William Lauerman S. Babak Kalantar 509
Cervical spine degeneration incidence appears higher in athletes with long-term participation in competitive collision sports. However, the clinical relevance of premature cervical degeneration in athletes is unknown. Degenerative disease of the cervical spine is one cause of cervical stenosis, which is thought to increase the severity of irreversible spinal cord injury and the frequency of reversible spinal cord injury. Athletes with transient spinal cord injury should be screened for functional cervical stenosis and counseled against return to play if discovered. Treatment guidelines will continue to evolve as magnetic resonance imaging and a focus on clinical outcomes are emphasized in future studies.
Spinal Cord Abnormalities in Sports Mark R. Proctor R. Michael Scott 521
Brain stem and spinal cord anomalies are common in the general population and therefore may be seen incidentally in athletes. These include Chiari malformation, cysts within and around the spinal cord, tethered spinal cord, prior spinal cord injury, and spinal cord tumors. Although much is known about these conditions, relatively little is written about how they affect competitive athletes. In this report we provide a practical approach to the management of these conditions in athletes and how they affect return to play, based on review of the literature and expert consensus.
Infectious, Inflammatory, and Metabolic Diseases Affecting the Athlete's Spine Lionel N. Metz Rosanna Wustrack Alberto F. Lovell Aenor J. Sawyer 535
Spines of athletes compromised by infection, autoimmune disease, genetic factors, or malnutrition are at increased risk of injury. The most common spinal infections include pediatric discitis, pyogenic vertebral osteomyelitis, spinal brucellosis, and Pott disease. Inflammatory disease is also a well-established cause of spinal dysfunction. Metabolic bone disorders generally result in decreased bone strength from abnormal mineralization or structural deficits, such as osteoporosis and osteomalacia. Spinal fractures may result from intense activity beyond capacity of bones or from bone fragility associated with sedentary lifestyle, inadequate nutrition, or genetic factors.
Spinal Tumors Found in the Athlete Megan E. Anderson 569
This article summarizes tumors of the spine that the clinician may encounter when evaluating an athlete with a suspected spine "injury. Included is an overview of the workup for such tumors, specifics of some of the most common tumors, and treatment information.