Sports Medicine: Just the Facts

CHAPTER 42 • THORACIC AND LUMBAR SPINE 255

• There is ossification of the anterior and lateral spinal
  ligaments without disk narrowing.


• It typically affects middle aged to elderly individuals,
  and generally males more than females.
  •Patients may be asymptomatic or may find associated
  pain, stiffness, and decreased range of motion.
  •Treatment is generally conservative and includes
  NSAIDs therapeutic modalities and range of
  motion/flexibility exercises.

COSTOCHONDRITIS (TIETZE’S SYNDROME)

• Costochondritis involves a painful inflammatory
  process of the costal cartilage.


• The second rib is most commonly affected (Errico,
  Stecker, and Kostuik, 1997).
  •Palpation of the chest wall often reproduces the pain
  and is important in distinguishing this syndrome from
  a cardiac source of pain.


• Bone scan may help confirm the diagnosis and the
  extent of involvement.
  •Treatment often consists of anti-inflammatory med-
  ications or in refractory cases, a corticosteroid injec-
  tion.

RIB-TIP SYNDROME

• This syndrome involves pain that radiates, generally
  from the lower four ribs, anteriorly to posteriorly.


• It is often reproducible with palpation.
  •Treatment may include a steroid injection or in
  extremely rare cases, excision of a rib has been per-
  formed (Errico, Stecker, Kostuik, 1997).

CLINICAL SYNDROMES OF THE
LUMBAR SPINE

MECHANICAL LOW BACK PAIN

• Mechanical low back pain is often a term used to
  describe nondiscogenic pain that is often provoked by
  physical activity and relieved by rest (Sinaki and
  Mokri, 2000).


• There is often an associated stress or strain type mech-
  anism of injury to the spinal musculature, tendons, or
  ligaments.


• The symptoms are typically described as dull, achy,
  varying in intensity, and are generally localized to the
  low back region with possible involvement of the but-
  tocks.
  
  
  • There are no neurologic deficits.
    •Treatment should focus on therapies that emphasize
    postural training, abdominal and spine stabilization,
    and stretching and strengthening exercises.
  
  
  
  

FACET SYNDROME

• Please refer to this section in the clinical syndromes of
  the thoracic spine.

LUMBAR DISC HERNIATION

AND RADICULOPATHY

• Disc herniation is a common cause of acute, chronic,
  or recurrent low back pain.


• The herniation may occur centrally or laterally and
  may cause unilateral or bilateral pain.


• The mechanism of injury is often a flexion-based
  movement with a component of rotation.


• Symptoms of pain may often be described as radiating
  to the buttocks, posterior thigh or to the level of the
  calf or foot.


• The most common level of herniation occurs at
  L5–S1, followed by L4–L5, L3–L4, and L2–L3.


• The diagnosis can often be made based on the history
  and physical alone, but is often confirmed by further
  diagnostic testing in the event of confusing objective
  findings or to help in prognostication.


• Conservative treatment is often most appropriate and
  may include activity modification, NSAIDs, a rapid
  steroid taper, McKenzie program, squat program,
  abdominal and spine strengthening, and possibly
  epidural steroids.
  •Surgical intervention is indicated in refractory cases
  with progressive neurological deficit or persistent
  unrelieved pain.

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

• Spondylolysis is a bony defect of the pars interarticu-
  laris.


• Studies suggest that spondylolysis is caused by repet-
  itive microtrauma during growth (Morita et al, 1995).


• It is commonly seen with high-risk sports activities,
  such as a football block, military press, tennis serve,
  baseball pitch, gymnastic back walkover, and the but-
  terfly swim stroke.


• Athletes who participate in these high-risk sports may
  be five times more likely to have an unfavorable out-
  come than those who participate in low risk sports
  (d’Hemecourt et al, 2002).