UNIVERSITY OF NEVADA ATHLETICS

LOWER BACK INJURIES

DEFINITIONS: frequently injured area of the Evaluation: • Spinal stenosis-narrowing of spine. • Thorough exam spinal canal • May require MRI • Spondylolysis-fracture of pars TYPES OF INJURIES: Treatment: interarticularis Muscular Pain • Conservative treatment ANATOMY • Spondylolisthesis-slippage of Results from overuse of lumbar with activity as tolerated, the vertebral body paraspinal muscles (strain) RICE, medication, physical • Disc Bulge/Herniation- Signs: therapy posterior movement of disc • Generalized pain lumbar • Epidural steroid blocks causing spinal nerve muscles with out radicular • Surgical repair if indicated compression injury symptoms • Radiofrequency ablation for • Sciatic Nerve-largest periph- • “Locking up and decreased smaller nerves eral nerve in body. Begins motion” .Fracture Types from nerve roots in the lumbar Evaluation: • Spinous process fracture spinal cord and extends • Thorough physical exam • Pars Interarticularis frac- through the buttock area to Treatment: ture send nerve endings down the • Reduce pain through RICE • Compression fracture BONES lower limb. See illustration (rest, ice, compression, eleva- • Facet joint fracture below. tion) and Ibuprofen OTC Signs: Cervical spine (C1-7) • Review biomechanics/posture • Acute injury with fall or BACKGROUND: • Physical therapy helps in up traumatic contact Thoracic spine (T1-12) • Bladder or bowl inconti- to 90% of cases • Hearing a pop in the back nence and progressive weak- • Core strengthening exercises • Pain with motion Lumbar spine (L1-5) ness in leg is true medical • Trigger point injections Evaluation: emergency! • Palpation and exam Sacrum • With any complaint of lower Nerve Entrapment • X-ray extremity pain, clinicians must Injury or compression of a Vertebral Body Treatment: rule out back injury or lumbar peripheral nerve as it exits • Brace immobilization 6-12 radiculopathy Signs: Spinous Process weeks for compression • Proper history and exam must • Pain shooting down to lower fracture be performed to rule out non- extremity Pars Interarticularis • Surgery for pars fracture trauma induced back pain • End point of radicular symp- • Physical therapy rehabilita- Facet Joints • Lumbar spine is more mobile toms confirms level of injury tion for spinous fracture and than the thoracic spine and • Limited motion facet fracture (may require NERVES also carries all the weight of surgery) the torso, making it the most Spinal Cord

Peripheral Nerves Return To Play and Prevention Guidelines

• Sciatic Nerve • Pain eliminated or mini- • Sport-specific activities to mized, and motion >80% of normal prevent future lower back MUSCLES pain and injuries • Strength testing >80% Erector Spinae compared to uninjured • Increase trunk and lower side extremity strength to reduce • Paraspinal muscles • Learn proper biomechan- stress on the lower back CONNECTIVE TISSUE ics of stretching , warm up and lifting techniques • Don’t sit cross-legged to de- Intervertebral Disc crease sciatic pressure • Strengthening program that emphasizes core • Body conforming mattress stabilization