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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.

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Presentation on theme: "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."— Presentation transcript:

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!!!! Posture issues- your grandmother was correct!!!! ComputersComputers Sitting posture- slouching in chairSitting posture- slouching in chair Back packsBack packs  Back Pack “syndrome” Consumer Product Safety Commission Consumer Product Safety Commission 7227 ER visits Per year7227 ER visits Per year Technique for carrying- over shoulders harnessTechnique for carrying- over shoulders harness Even with lumbar spine Even with lumbar spine Waist strap- yea right- that’s not cool Waist strap- yea right- that’s not cool Heavy items toward body Heavy items toward body Weight- <15% body wt.Weight- <15% body wt. All cause postural accommodationsAll cause postural accommodations Middle school students to high school. Damage done?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 X rays mri mri

7 Predisposition lateral scoliosis

8 Diagnosis?  Scoliosis  Spondylolysis at L4 MRI revealed - Stress fx of Pars Interarticularis 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. Intermittent back pain through senior year. Attempted hurdle training- 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 Numbness on impact Tingling down arm Tingling down arm Cannot move arm Cannot move arm Been occurring in wrestling and football for years Been occurring in wrestling and football for years  Athlete was honest and seemed scared  First impression was brachial plexus stretch

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

15 Diagnosis by Neurologist and Orthopedic Physicians  Normal C2-C5 spinal levels No spinal stinosis No spinal stinosis No facet joint issues No facet joint issues No central canal narrowing No central canal narrowing  C6-C7 level Central disc bulging w/o herniation 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 Pain with 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 Gymnist since age 6- high level lateral scoliosis lateral scoliosis High pain tolerant High pain tolerant Highly motivated athlete Highly motivated athlete  Radiological report: Irregularity of epiphyseal plate at T9-10, T10-11, and T11-12 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 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 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 Ranked top 5 in state – diving Gymnastics- 1 st beam, 3 rd bars, 3 rd all around at final state meet. Gymnastics- 1 st beam, 3 rd bars, 3 rd 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 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. 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 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


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