Approximately 5 to 10 percent of the professional athletes with medical issues report injuries to their lumbar spine from a specific event or repetitive trauma. Spine surgeons and specialists who are seeing these patients must consider their status as professional athletes when recommending treatment. Ian Armstrong, MD, medical director of the Southern California Spine Institute in Los Angeles, discusses five points associated with treating professional athletes.
1. The athlete needs a quick diagnosis. It's important for surgeons to quickly pin point and diagnose professional athletes to find out what the pain generator is and start them on the path to recovery. Surgeons should order MRI, CT scans instead of waiting to see if the pain resolves on it's own early in the work-up, as they do with most patients. "With a professional athlete, you need to be more aggressive with diagnosis and treatment," says Dr. Armstrong. "In order to get the athlete back to play, you need to define the anatomy of the pain. Once you define the anatomy, rapid resolution of the pain or discomfort is important."
2. Athletic culture often minimizes pain. Professional athletes are taught to work through any pain they might have, adhering to the mantra "No pain, no gain." This can be true when the athlete is experiencing muscle pain, but it's a completely different story with nerve pain. "Athletes shouldn't push through nerve pain," says Dr. Armstrong. Spine surgeons and specialists can recommend a regimen of treatment, which might include physical therapy or pain medication, for these athletes.
In some cases, it can be challenging for surgeons to assess exactly how much pain the athletes are in even after a problem is identified. "Part of the problem is that athletes don't want to deal with the consequences of having back problems, which could include less practice, decreased training, losing a position or missing a qualification meet," says Dr. Armstrong. "If they can't perform, they feel like they're letting the team down." Sometimes, athletes might not give a full or accurate medical history to minimize their condition, so surgeons should be aware of that possibility.
3. Degeneration occurs earlier in athletes. While spine surgeons might not consider disc degeneration in most young patients they see, they must realize that degeneration comes at an earlier age in professional athletes. "When we are looking for disc herniations in the average population, we can expect to see them in patients age 35 to 60," says Dr. Armstrong. "In athletes, you have to have the mindset to look for disc problems at an earlier age and be suspicious for that." Disc degeneration is especially common among athletes in sports with a lot of flexion, extension and rotation, such as gymnastics, volleyball or contact sports like football and hockey.
"A particular condition I see frequently among these athletes is a stress fracture, where there is slippage of one vertebrae or another," says Dr. Armstrong. "The physician treating the athlete needs to be aware of the spondylolysis problem because it generally presents just as back pain. Being focused on the fact that you are working with an athlete is an essential part of making the right diagnosis and treatment for them. When I see athletes now, spondylolisthesis is in my differential."
4. Educate the athlete on their options and possible outcomes. Surgeons educate all their patients about the different types of surgical and nonsurgical treatment options, but counseling professional athletes brings along its own set of challenges. The athletes are expecting their bodies to perform high-level activities, and if that won't be possible, they must have the appropriate expectations and understand the implications of continuing at a high level. "I like to educate my athletes on the lifelong implications of chronic injuries," says Dr. Armstrong. "I understand that they are sacrificing a lot for the game. Many have had chronic head injuries, which have implications long after they stop playing the game."
Additionally, as professional athletes are deciding the best mode of treatment, they are being influenced by family, friends, agents and their teams. Surgeons should understand how these influences are impacting the athletes as they work with them throughout the recovery process.
5. Most injuries can be treated without surgery. Surgery is often the last resort for treating patients, including professional athletes. Most athletes are treated for acute injuries with a combination of ice, a contrast between application of heat and ice, chiropractic care and physical therapy. The chiropractor and physical therapist can also incorporate deep tissue or soft tissue work into the routine for professional athletes. "They are more muscular and their muscles spasm, which means that the soft tissue pain that goes along with the injury can be helped with soft tissue work," he says.
Other treatment options for athletes include prescribing anti-inflammatory medication, pain medication or steroids to manage the pain. "If there is leg pain associated with the back injury, one might consider oral steroids for a short period of time, or an epidural steroid may be used earlier in the treatment path for professional athlete than for other patients," says Dr. Armstrong.
6. If you perform surgery, minimally invasive procedures are best. Performing minimally invasive spine surgery for athletes who have a massive disc herniation can help them return to play quicker because the procedure minimizes tissue damage and allows the athlete to begin rehabilitation quicker. Minimally invasive procedures are often also associated with less blood loss and fewer complications and infections because the incision is so small.
7. Put athletes through a conditioning programs during recovery. During the rehabilitation process for back injuries, athletes should undergo conditioning programs to make sure they keep their bodies in peak physical condition for returning to play. Even though the athletes should avoid pain-provoking activities, they can do other exercises to strengthen unaffected muscles. "Studies have shown that elite athletes have clinically measurable evidence of de-conditioning within 7-10 days of not working out," says Dr. Armstrong.
Good work-outs for athletes with back injuries include recumbent bicycles and treadmills that allow for un-weighted walks and jogs. Water therapy can also help keeping up cardiovascular strength. "Knowing the anatomy allows you to work around the injury with safety, and athletic trainers can be more aggressive with professional athletes when they know where the trauma is," says Dr. Armstrong.
8. Strengthen the spine for athletes with chronic injuries. Spine surgeons are often working with professional athletes to help them perform through as many years of their contracts as possible. If an athlete has chronic back pain, strengthening the muscles around the spine, such as the abdominal and oblique muscles, becomes important. Mild training can help the average patient protect the injured area, but athletes expect 120 percent out of their spine and they must engage in rigorous strengthening activities.
"If you have a knee injury, the athlete knows they have to strengthen the muscles around the knee to protect it," says Dr. Armstrong. "It's more challenging for us as physicians to get patients, especially athletes, to understand that the spine is much the same way. Even if the athlete as has a six-pack, if they've got back pain, I recommend strengthening the abdominal muscles and back muscles to protect and support the spine."
Learn more about Dr. Ian Armstrong.
Read Articles Related to Treating Professional Athletes:
8 Biggest Challenges Facing Team Physicians for Professional Athletes
12 Spine Surgeons for Professional Athletes
8 Points to Consider Before Becoming a Team Physician for Professional Athletes
1. The athlete needs a quick diagnosis. It's important for surgeons to quickly pin point and diagnose professional athletes to find out what the pain generator is and start them on the path to recovery. Surgeons should order MRI, CT scans instead of waiting to see if the pain resolves on it's own early in the work-up, as they do with most patients. "With a professional athlete, you need to be more aggressive with diagnosis and treatment," says Dr. Armstrong. "In order to get the athlete back to play, you need to define the anatomy of the pain. Once you define the anatomy, rapid resolution of the pain or discomfort is important."
2. Athletic culture often minimizes pain. Professional athletes are taught to work through any pain they might have, adhering to the mantra "No pain, no gain." This can be true when the athlete is experiencing muscle pain, but it's a completely different story with nerve pain. "Athletes shouldn't push through nerve pain," says Dr. Armstrong. Spine surgeons and specialists can recommend a regimen of treatment, which might include physical therapy or pain medication, for these athletes.
In some cases, it can be challenging for surgeons to assess exactly how much pain the athletes are in even after a problem is identified. "Part of the problem is that athletes don't want to deal with the consequences of having back problems, which could include less practice, decreased training, losing a position or missing a qualification meet," says Dr. Armstrong. "If they can't perform, they feel like they're letting the team down." Sometimes, athletes might not give a full or accurate medical history to minimize their condition, so surgeons should be aware of that possibility.
3. Degeneration occurs earlier in athletes. While spine surgeons might not consider disc degeneration in most young patients they see, they must realize that degeneration comes at an earlier age in professional athletes. "When we are looking for disc herniations in the average population, we can expect to see them in patients age 35 to 60," says Dr. Armstrong. "In athletes, you have to have the mindset to look for disc problems at an earlier age and be suspicious for that." Disc degeneration is especially common among athletes in sports with a lot of flexion, extension and rotation, such as gymnastics, volleyball or contact sports like football and hockey.
"A particular condition I see frequently among these athletes is a stress fracture, where there is slippage of one vertebrae or another," says Dr. Armstrong. "The physician treating the athlete needs to be aware of the spondylolysis problem because it generally presents just as back pain. Being focused on the fact that you are working with an athlete is an essential part of making the right diagnosis and treatment for them. When I see athletes now, spondylolisthesis is in my differential."
4. Educate the athlete on their options and possible outcomes. Surgeons educate all their patients about the different types of surgical and nonsurgical treatment options, but counseling professional athletes brings along its own set of challenges. The athletes are expecting their bodies to perform high-level activities, and if that won't be possible, they must have the appropriate expectations and understand the implications of continuing at a high level. "I like to educate my athletes on the lifelong implications of chronic injuries," says Dr. Armstrong. "I understand that they are sacrificing a lot for the game. Many have had chronic head injuries, which have implications long after they stop playing the game."
Additionally, as professional athletes are deciding the best mode of treatment, they are being influenced by family, friends, agents and their teams. Surgeons should understand how these influences are impacting the athletes as they work with them throughout the recovery process.
5. Most injuries can be treated without surgery. Surgery is often the last resort for treating patients, including professional athletes. Most athletes are treated for acute injuries with a combination of ice, a contrast between application of heat and ice, chiropractic care and physical therapy. The chiropractor and physical therapist can also incorporate deep tissue or soft tissue work into the routine for professional athletes. "They are more muscular and their muscles spasm, which means that the soft tissue pain that goes along with the injury can be helped with soft tissue work," he says.
Other treatment options for athletes include prescribing anti-inflammatory medication, pain medication or steroids to manage the pain. "If there is leg pain associated with the back injury, one might consider oral steroids for a short period of time, or an epidural steroid may be used earlier in the treatment path for professional athlete than for other patients," says Dr. Armstrong.
6. If you perform surgery, minimally invasive procedures are best. Performing minimally invasive spine surgery for athletes who have a massive disc herniation can help them return to play quicker because the procedure minimizes tissue damage and allows the athlete to begin rehabilitation quicker. Minimally invasive procedures are often also associated with less blood loss and fewer complications and infections because the incision is so small.
7. Put athletes through a conditioning programs during recovery. During the rehabilitation process for back injuries, athletes should undergo conditioning programs to make sure they keep their bodies in peak physical condition for returning to play. Even though the athletes should avoid pain-provoking activities, they can do other exercises to strengthen unaffected muscles. "Studies have shown that elite athletes have clinically measurable evidence of de-conditioning within 7-10 days of not working out," says Dr. Armstrong.
Good work-outs for athletes with back injuries include recumbent bicycles and treadmills that allow for un-weighted walks and jogs. Water therapy can also help keeping up cardiovascular strength. "Knowing the anatomy allows you to work around the injury with safety, and athletic trainers can be more aggressive with professional athletes when they know where the trauma is," says Dr. Armstrong.
8. Strengthen the spine for athletes with chronic injuries. Spine surgeons are often working with professional athletes to help them perform through as many years of their contracts as possible. If an athlete has chronic back pain, strengthening the muscles around the spine, such as the abdominal and oblique muscles, becomes important. Mild training can help the average patient protect the injured area, but athletes expect 120 percent out of their spine and they must engage in rigorous strengthening activities.
"If you have a knee injury, the athlete knows they have to strengthen the muscles around the knee to protect it," says Dr. Armstrong. "It's more challenging for us as physicians to get patients, especially athletes, to understand that the spine is much the same way. Even if the athlete as has a six-pack, if they've got back pain, I recommend strengthening the abdominal muscles and back muscles to protect and support the spine."
Learn more about Dr. Ian Armstrong.
Read Articles Related to Treating Professional Athletes:
8 Biggest Challenges Facing Team Physicians for Professional Athletes
12 Spine Surgeons for Professional Athletes
8 Points to Consider Before Becoming a Team Physician for Professional Athletes