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42 THORACIC AND LUMBAR SPINE

Scott F Nadler, DO

Michele C Miller, DO

INTRODUCTION AND EPIDEMIOLOGY

• Back pain is a frequent complaint and source of mor-
  bidity among athletes in all sports, with low back pain
  accounting for 5–8% of injuries (Stanish, 1987).
  •Fortunately, most episodes are self-limiting and
  respond to conservative treatment.


• By age 20, 50% of the general population has experi-
  enced low back pain (Sinaki and Mokri, 2000).
  •Low back pain is second only to the common cold for
  reasons to visit a physician (Agency for Health Care
  Policy and Research, 1994).
  •Low back pain is second only to headache as a cause
  of pain (Agency for Health Care Policy and Research,
  1994).


• In contrast to the general population, the mechanism of
  injury in athletes may be more likely secondary to a
  sprain or strain, contusion or fracture from a direct
  blow to the spine (including a compression fracture,
  comminuted fracture, fracture of the growth plate at
  the vertebral end plate, lumbar transverse process frac-
  ture, and fracture of the spinous process), facet syn-
  drome, spondylolysis, and spondylolisthesis related to
  repeated and forceful hyperextension maneuvers, and
  disc herniations (Harvey and Tanner, 1991).
  
  
  • Female athletes have demonstrated to be more likely
    to suffer from its occurrence than males for unknown
    reasons (NCAA, 1998).
  
  
  • Risk factors for back pain in the general population
    may include—history of low back pain, obesity,
    increasing age, lack of fitness, poor health, smoking,
    drug or alcohol abuse, postural factors and scoliosis,
    occupational hazards, and psychosocial issues.
  
  
  • Risk factors in athletes usually have more to do with
    strength and flexibility imbalances, and functional
    deficits (Nadler et al, 1998; 2002b).
  
  
  • Additional risk factors in young athletes may include
    growth spurts, an abrupt increase in the intensity or dura-
    tion of training, improper technique, poor equipment,
    and leg length discrepancies (Harvey and Tanner, 1991).
  
  
  • Hip extensor imbalance has been found to play a sig-
    nificant role in the past history and in the future occur-
    rences of low back pain in female college athletes
    (Nadler et al, 2000; 2001).
  
  
  
  

ANATOMY

ANTERIOR ELEMENTS

VERTEBRALBODY

• The vertebral body functions as the weight bearer of
  the spine.


• They are mainly trabecular bone surrounded by a thin
  layer of cortical bone.


• The cortical layer can proliferate with age at the sites
  of ligamentous attachment and result in osteophyte
  formation.


• The vertebral bodies are weakest anteriorly, a poten-
  tial site for collapse, and often seen with compression
  fractures.


• There are 12 thoracic vertebral bodies.


• The vertebrae in T1–T3 diminish in size and then
  increase progressively in size until T12.


• The thoracic vertebral bodies are unique in that they
  have facets for the ribs as do the transverse processes.


• The anterior height of the vertebral body is shorter by
  approximately 1.5–2 cm than the posterior height and
  this results in the normal thoracic kyphosis.


• Conditions in which there is prominence of the tho-
  racic kyphosis include the following:
  
  
  1. Gibbus (or humpback), caused by a localized sharp,
     posterior angulation often resulting from a wedging
     of the body of one or two vertebrae
  
  
  2. Dowager’s hump caused by postmenopausal osteo-
     porosis
     3.Postural round back resulting from decreased
     pelvic inclination (20°, normal 30°) with a thora-
     columbar or thoracic kyphosis (Bogduk, 1997).
  
  
  
  

248 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE