Sports Medicine: Just the Facts

immobilized prior to removal from the playing field.

This is accomplished by coordinated sports medicine

care with a lead care provider at the head and neck to

provide traction and stability, particularly if the ath-

lete must be rolled onto their back prior to receiving

additional care.

• The helmet should never be removed on the field as the
  presence of shoulder pads will favor passive hyperex-
  tension of the cervical spine and may contribute to fur-
  ther cervical spine or spinal cord injury. The face mask
  should be removed to allow control of the athlete’s
  airway. Only in an appropriate acute care setting
  should the helmet and shoulder pads be removed.
  •Evaluation includes cervical spine X-rays in several
  planes and may require computed tomography(CT)
  scanning to rule out fracture in equivocal cases.
  Football padding has been shown to compromise
  proper cervical imaging in the hospital setting
  (Davidson et al, 2001). Consequently, efforts may be
  undertaken, once in a controlled setting, to remove the
  helmet and shoulder pads so as not to compromise the
  quality of cross-table lateral and odontoid view cervi-
  cal spine X-rays.
  •Every potential cervical spine injury must be treated
  with the same conservative approach and proper tech-
  nique to prevent unnecessary neurologic compromise.

LUMBAR SPINE INJURY

SPONDYLOLYSIS

• Stress injury to the pars interarticularis in the posterior
  aspect of the spine as a result of repetitive extension
  loading. Offensive and defensive linemen are most
  commonly affected.


• Athletes complain of deep pain in the low back, which
  is exacerbated by active or passive extension—partic-
  ularly when standing on one leg. X-rays may reveal a
  fracture in the pars interarticularis on oblique views or
  bone scan or MRI may be necessary to make the diag-
  nosis definitively.


• Most athletes respond well to conservative manage-
  ment including rest and rehabilitative activities.
  Occasionally thoracolumbar bracing may be utilized
  for additional spinal stability. Most athletes may return
  in 6–8 weeks if asymptomatic and with objective evi-
  dence of fracture healing.

SPONDYLOLISTHESIS

• Displacement of one vertebral body over another as a
  result of stress injury to the pars interarticularis (a
  spondylolysis). According to National Football League
  (NFL) and National Collegiate Athletic Association
  (NCAA) data (Shaffer, Wiesel, and Lauerman, 1997),

approximately 1% of both professional and collegiate

football players have a spondylolisthesis.

• The presence of a spondylolisthesis is not a con-
  traindication to playing football but may predispose to
  pain and associated dysfunction and may also lead to
  further worsening of the anatomic changes in the
  spine over time.
  •Pathologic forces on both lumbar disks and pars inter-
  articularis have been demonstrated in blocking line-
  men (Gatt, Jr et al, 1997). The mechanics of repetitive
  blocking, most notably loaded extension of the
  lumbar spine, may be responsible for the increased
  incidence of such injuries in football linemen.

CONCUSSION

GENERAL

•Concussion or mild traumatic brain injury(MTBI) is

estimated to occur at a rate of 250,000 events per year in

football players. Concussion incidence has been found to

be highest at the high school (5.6%) and division-III col-

legiate levels (5.5%) (Guskiewicz et al, 2000), suggesting

an association between level of play and risk of injury.

• Mechanisms of injury include a direct blow to the head
  by an opposing player, whip-like motion of the head
  and neck in response to a blow delivered to another
  part of the body, or a blow to the head from hitting the
  ground. Brain shearing and acceleration/deceleration
  forces result in a cascade of neurochemical changes
  including local glucose depletion, edema, and local
  vascular effects.


• Many athletes either do not realize they have suffered
  MTBI or fail to report it to their sports medicine staff.
  Tight ends and defensive linemen are most commonly
  affected (Delaney et al, 2002), and the majority of
  concussed football players suffer recurrent concussive
  injury.

EVALUATION

• Concussed athletes are dazed, disoriented, and may
  have loss or alteration in consciousness. These manifes-
  tations may be mild and transient or prolonged and quite
  profound. They may complain of dizziness, headache,
  vision disturbance, and nausea, and they often display
  changes in personality and behavioral patterns.
  •Physical examination is generally within normal limits.
  In addition to an abbreviated neurologic examination to
  rule out gross neurologic dysfunction (cranial nerve
  assessment and gross motor, sensory, and cerebellar
  testing), sideline neuropsychologic tests should be per-
  formed to screen for impairment in general orientation
  (person, place, time of day, and situation—game, game
  location, quarter, score, and opponent), short-and long-
  term memory/recall, and complex processing tasks

494 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS