Sports Medicine: Just the Facts

CHAPTER 77 • BASKETBALL 467

and help prevent tooth fracture, jaw injury, and even

neck injury. Custom molded guards are inexpensive

and preferable to off-the-shelf products.

• Dental literature reports injury rates from 4 to 14%,
  more occurring in males than females. Most dental
  trauma occurs to the upper anterior teeth, especially
  the upper lip and two central incisors. The highest
  injury rates are in young participants aged 8–15 years
  (Amy, 1996).


• Mouthguards and protective eyewear have been
  shown reduce rates of injury (Zagelbaum et al, 1995;
  Kerr, 1986).

SPINE AND PELVIS

• Back injuries make up more than 5.3% of all basket-
  ball injuries (McKay et al, 2001).


• The dynamic nature of basketball including fast
  changes in direction, repetitive jumping, twisting,
  rapid starts and stops, high velocity, and overhead arm
  use produces significant strain on the spine. The ver-
  tebral column and intervertebral discs carry 70% of
  forces and the posterior spine transmits 30%.


• Muscles of the spine and abdominal wall serve as
  strong stabilizers and create significant motion.
  Muscular strain resulting in pain and local inflamma-
  tion is common. Muscular trigger points are another
  source of pain in athletes and should be treated with
  stretching, strengthening, direct massage. If this fails
  to produce results, nonsteroidal anti-inflammatory
  drugs(NSAIDs) can be utilized for general muscle
  inflammation as well as local treatment with acupunc-
  ture or injection with saline, local anesthetics, or cor-
  ticosteroids.


• Cervical injury from acceleration/deceleration injuries
  (whiplash) occur in basketball but are less severe than
  other contact sports. Pain and muscular dysfunction
  are common but radicular symptoms can be a warning
  of more significant injury. Treatment includes relative
  rest, motion and strength exercises, NSAIDs, ice, heat,
  and modalities. If pain persists consider facet dysfunc-
  tion or intervertebral disc degeneration.


• Basketball typically involves repetitive extension and
  hyperextension from rebounding, guarding oppo-
  nents, and shooting. This can lead to excessive forces
  on the lumbar spine and injury. Defects of the poste-
  rior portions of the vertebra can lead to significant
  low back pain exacerbated by extension and axial
  loading.


• Spondylolysis is the presence of a defect in the pars
  interarticularis from any etiology including congenital
  defects, chronic stress, or acute fracture. This is the
  most common source of back pain in people under age

26 (Borenstein and Boden, 1995). Symptoms include

low back pain with radiation into buttock and ham-

strings from resulting spasm. Pain is worse with

standing and back extension and there is an absence of

radicular pain. Treatment involves back strengthening

with a focus on flexion exercises, avoidance of back

extension that produces pain, and analgesia as needed.

Radiographs for suspected patients are indicated and

may need to be repeated if symptoms persist to detect

any instability of the spine.

• Spondylolisthesis is the resulting anterior–posterior
  subluxation of the one vertebra on another when
  bilateral defects occur. Slippage greater than 50%
  may need surgical attention. Otherwise treat patients
  conservatively with exercise and follow them closely
  for development of symptoms of nerve root impinge-
  ment or spinal stenosis. Many athletes can return to
  basketball after aggressive strengthening and reha-
  bilitation.


• Sacroiliac(SI) dysfunction is commonly seen, misdi-
  agnosed, and treated as muscular low back pain and
  athletes fail to improve significantly. Patients usually
  cannot find any comfortable position for more than
  10–15 min and have pain radiating into the posterior
  thigh. Pain is worse with motion that involves com-
  bined back flexion/extension and trunk rotation.
  Physical examination with focused attention to palpa-
  tion of SI joints and functional testing (Faber’s test,
  Gaenslen’s test, Gillet’s test, Trendelenberg’s test) will
  allow identification and more appropriate treatment.

UPPER EXTREMITY

• There are relatively few upper extremity injuries in
  basketball due to the nature of the sport. In high
  school players, 10 to 12% of all basketball injuries
  occur to the hand and wrist and 2–4% occur to the
  shoulder. In recreational athletes 39% of all injuries
  involve the upper extremity.


• The most common upper extremity injuries are
  sprains and dislocations of the proximal interpha-
  langeal (PIP) joints of the finger (Wilson, 1993;
  Zvijac, 1996).

LOWER EXTREMITY

•Lower extremity injuries account for the majority at

every level of competition. Lower extremity injuries

account for 51% in recreational players (Kingma,

1998), between 56 and 69% in high school athletes

(Gomez and Farney, 1996; Messina and DeLee, 1999;

Powell, 2000).