The High School Athlete’s Back

1. The High School Athlete’s Back A discussion of actual cases in the high school setting James Lioy, MA, ATC, CSCS Sturgis High School Sturgis, Michigan

2. 4 Cases of High School Student/Athletes

3. Typical Back injuries in the High School Setting • Contusions • Muscle strains/spasms • Quadratus lumborum involvement- PNF/ myofacial release! • Upper back spasms- upper trap, levator scapula, and/or rhomboids. • Posture issues- your grandmother was correct!!!! • Computers • Sitting posture- slouching in chair • Back packs • Back Pack “syndrome” • Consumer Product Safety Commission • 7227 ER visits Per year • Technique for carrying- over shoulders harness • Even with lumbar spine • Waist strap- yea right- that’s not cool • Heavy items toward body • Weight- <15% body wt. • All cause postural accommodations • Middle school students to high school. Damage done? • Does this predispose athletes to back injury? • Take history!!!- question them about back pack use habits.

4. Case #1

5. Chronic Unexplained Back Pain • 17 year old female • 5’2” 120 lbs • Volleyball, strength training (HS), track and field • Reported chronic pain-gradual over time with any activity • Pain began soph year of HS • Running • Strength training

6. Referred to Physician • Evaluated by family physician • Standard treatment- out of sports for 2 weeks- rest- anti inflam. • Progressed back into activity • Pain returned • Referred to sports medicine clinic • Evaluated by Orthopedic • X rays • mri

7. Predispositionlateral scoliosis

8. Diagnosis? • Scoliosis • Spondylolysis at L4 • MRI revealed - Stress fx of Pars Interarticularis

9. Recommondations • 4-5 weeks of inactivity • Return to sports- to pain tolerance • Manage symptoms with treatment modalities. • Long term results- remainder of HS career • Intermittent back pain through senior year. • Attempted hurdle training-

10. Case #2

11. Upper Extremity Numbness/ Tingling after contact Chronic over years

12. History • 14 year old male • Freshman playing JV football • 5’3” 140 lbs muscular build • Played rocket football since age 5 • Competitive wrestler since age 7 • Overzealous father/concerned mother • Mother and father separated • 8/09- Observed young man hanging arm after almost every contact during first week of padded practice. • Questioned coaches- they see it daily • Began to question the player.

13. Athlete exam • Considerable weakness in upper extremity on involved side • Pain at midline of cervical spine • Athlete reports • Numbness on impact • Tingling down arm • Cannot move arm • Been occurring in wrestling and football for years • Athlete was honest and seemed scared • First impression was brachial plexus stretch

14. Course of Action • Called and informed father of my findings • What do you think he said? • “Oh yea he has had this for a couple of years in wrestling and football.” • Explained to him a sense of urgency to see a neurologist for a definitive diagnosis. • I was surprised/relieved with his response.

15. Diagnosisby Neurologist and Orthopedic Physicians • Normal C2-C5 spinal levels • No spinal stinosis • No facet joint issues • No central canal narrowing • C6-C7 level • Central disc bulging w/o herniation • C spine degeneration causing symptoms

16. Physician Recommendations • Discontinue contact sports indefinitely • rehabilitation

17. Case #3

18. Chronic Back Painwith activity Female student athlete

19. History • 16 year old female athlete- sophmore • Chronic back pain with activity. • Youth sports- high level of gymnastics, swim team • High school sports: gymnastics, diving, pole vault. • Predispositions: • Gymnist since age 6- high level • lateral scoliosis • High pain tolerant • Highly motivated athlete • Radiological report: • Irregularity of epiphyseal plate at T9-10, T10-11, and T11-12 • Schmorl’s node defect (protrusion of disc material through a defect in subchondral bone plate of vertebrae.) detected at superior endplate of T12. secondary to trauma

20. Diagnosis • Scoliosis • Scheuermann's disease • Juvenile osteochondritis of spine

21. Recommendations • Control pain with rehab and modalities • Limit activity level • Activity to tolerance.

22. Long Term Results • Constant rehab daily • Modified strength training programs • Senior year • Ranked top 5 in state – diving • Gymnastics- 1st beam, 3rd bars, 3rd all around at final state meet.

23. Case #4

24. Acute Neck Pain • 15 year old wrestler • 130 lb weight class

25. History • Athlete was dropped on head during practice. • Axial compression/load • Neck pain • No numbness, no weakness in extremities, no tingling in either extremity.

26. Diagnosis • No nerve damage at any level • Joint segments unstable at C6 and C7 • Ligament damage • Physician recommended arthrodesis procedure (fusion) if student is to continue collision and contact sports. • Incision posterior C spine

27. Posterior Fusion Arthrodesis University of Maryland Medical Center Spine Program

28. Recommendations • No sports for 3-4 months. • Rehab • Return to collision/contact sports in fall

29. Conclusions • Improper sizing/fitting of back packs could cause long term postural changes and muscle spasms in students. • Scoliosis predisposes student athletes to chronic conditions of the spine • pre screening will assist in identification of those students with higher risks. • Early diagnosis of unexplained back pain could alleviate long term issues. • We are on the front lines • Wrestlers do get dropped on their heads • With our assistance- high school athletes with back injuries have a good chance to continue high level activity. • Injury management is the key.

30. Thank You James Lioy, MA,ATC,CSCS