1. Spine & Sport From Mechanics to Dynamics Dr. Julia Alleyne BHSc(PT) MD CCFP(F) MScCH Dip Sport Toronto Rehab, MSK OP Lead Physician Associate Professor, DFCM, University of Toronto

2. Objectives 1) Describe common body mechanic classifications for spinal analysis and their related sport injuries. 1) Identify the key assessment factors to categorize a treatment approach.

3. CORE Back Tool & Guide Endorsed by Ontario College of Family Physicians Nurse Practitioners’ Association of Ontario Canadian Spine Society Orientation to the CORE Tool available: www.effectivepractice.org/lowbackpain Or from the training videos in the online module

6. Are Athletes Spines Different ? Training during Growth Trauma during Training Repetition Prolonged Position Hypermobility

8. Are Athletes Spines Different ? Gymnastics Large Forces 13 x Body Weight Landing Load Transmission Spine Absorption Short powerful bursts and holds Diving Controlled speed at water Target Area: Wrist and Low Back Large Forces Regain Neutral Alignment Wrestling Pelvic positioning Unexpected Impact Contact Rotational Force

9. Pattern Classification FlexionExtensionRotation Impact Contact Endurance Combined

10. Flexion Leg Up Head down Repeated Sustained

11. Extension Back Arch Leg Up Behind Repeated

12. Rotation Fast Movement Sustained Sudden Movement

13. What is the Key Risk Factor ? 1. Early or Late Age 2. Skill and Stage 3. Overuse and Repetition 4. Hyper Mobility 5. Lack of Core Stability

14. What is the Key Risk Factor ? 1. Early or Late Age 2. Skill and Stage 3. Overuse and Repetition 4. Hyper Mobility 5. Lack of Core Stability

16. Think Sport Mechanics Key Questions: 1. In training, what are your most challenging skills to master? 2. Tell me about your warm-up and cool down? 3. What are you working on that will give you a competitive edge ?

17. What muscle do you test for Core Stability ?

18. Side Plank

19. Risk Factors - Instability Athletes with lower extremity acquired ligamentous laxity or overuse may be at risk for the development of noncontact low back pain during athletic competition. Female athletes appeared to have a higher incidence of low back. Inflexibility of the lower extremities or leg length discrepancy were not associated with future low back pain treatment Low Back Pain in College Athletes: A Prospective Study Correlating Lower Extremity Overuse or Acquired Ligamentous Laxity With Low Back Pain Nadler, Scott F. DO*; Wu, Karen D. BS*; Galski, Thomas PhD†; Feinberg, Joseph H. MD‡§

21. RESULTS : Males were stronger than females and had significantly less low back pain 2 Key Muscles that were predictive of poor core stability

22. RESULTS : Males were stronger than females and had significantly less low back pain 2 Key Muscles: Quadratus Lumborum External Hip Rotation

23. RESULTS : Males were stronger than females and had significantly less low back pain 2 Key Muscles: Quadratus Lumborum External Hip Rotation

24. Abduction and Ext Rotation

25. Physical Exam Posture Movement Screening Neuro Screening Stability Strength Testing Balance and Neuromuscular Reaction Time

26. Stork Test for Balance Practice Position Test on Hold Reliable Validated

27. Standing Balance Stork Test

28. Common Sport Related Low Back Diagnosis Mechanical Strain Spondylolysis Spondylolisthesis Sacroiliac Strain Pelvic Instability

29. Common Sport Related Low Back Diagnosis Mechanical Strain Spondylosis Spondololythesis Sacroiliac Strain Pelvic Instability

30. Pilates Donzelli, S., et al., Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial. Europa Medicophysica. 2006. 42(3), 205-210. Rydeard, R., et al. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy. 2006. 36 (7), 472-484. Results: Both randomized trials showed that pilates was superior to usual care in reducing pain and in one study noted less disability which was assess over 12 months.

31. Summary Athletes are different but…. Screen the Same Lower Extremity is Weakest Link Hip External Rotators/ Hip Abductors Indicates poor Core Stability Standing Balance Stork Test Strengthen stability to Performance levels Maintain – Pilates type of program Stability is Key treatment for all sport related overuse syndromes