Spine in Sports, Is Divided Into Three Sections

Mosby is an affiliate of Elsevier, Inc © 2005, Elsevier Inc.All rights reserved. First published 2005 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or other- wise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: [email protected] may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Support and contact” and then “Copyright and Permission”. ISBN 0 323 03574 4 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the editor assume any liability for any injury and/or damage to persons or property arising from this publication. The Publisher Printed in China Last digit is the print number : 987654321 iv We were saddened to hear of the death of Dr. Scott Nadler on December 26, 2004. Our heartfelt sympathy is extended to his family and friends. Scott was a prolific writer, astute clinician, excellent teacher, and most of all a family man who was admired by all. We will miss you Scott. TAL HMC Commissioning Editor: Dolores Meloni Project Development Managers: Andrea Alphonse and Henrietta Preston Project Manager: Anne Dickie Senior Designer: Stewart Larking Illustration Manager: Mick Ruddy Design Manager: Andy Chapman Illustrator: Mandy Miller Marketing Managers (UK/USA): Verity Kerkhoff and Laura Meiskey List of contributors Frederick Boop, MD James J Laskin, PT, PhD Associate Professor of Neurosurgery Director, New Directions Wellness Center and Pediatric Neurosurgeon and Professor of Physical Therapy Semmes Murphey Clinic Department of Physical Therapy Memphis, Tennessee The University of Montana Missoula, Montana Matthew Chalfin, MD University of Medicine and Dentistry of Julian Lin, MD New Jersey – Assistant Professor of Neurosurgery and New Jersey Medical School Pediatrics Newark, New Jersey Department of Neurosurgery University of Illinois College of Medicine at Robert Clendenin, MD Peoria Director of Physical Medicine Peoria, Illinois TN Ortho Alliance Nashville, Tennessee John Metzler, MD Instructor, Physical Medicine and Frank JE Falco, MD Rehabilitation Mid Atlantic Spine Department of Orthopaedic Surgery Newark, Delaware Washington University School of Medicine Thomas D Fulbright, MD St. Louis, Missouri Clinical Assistant Professor of Surgery Scott F Nadler, DO University of Tennessee School of Medicine Formerly Assistant Professor Chattanooga Unit Department of Physical Medicine and Chattanooga, Tennessee Rehabilitation Michael Furman, MD University of Medicine and Dentistry of Clinical Assistant Professor New Jersey – Department of Physical Medicine and New Jersey Medical School Rehabilitation Newark, New Jersey Temple University School of Medicine J Keith Nichols, MD Philadelphia, Pennsylvania Associate Director of Physical Medicine Laurie L Glasser, MD TN Ortho Alliance Associate Professor Nashville, Tennessee Orthopaedic Institute of Central New Jersey Ricardo Nieves, MD Sea Girt, New Jersey Medical Director of the Rehabilitation Medicine David C Karli, MD Unit Spinal Physical Medicine and Rehabilitation Spine Pain Sports Med PC Specialist Carlsbad, New Mexico Steadman-Hawkins Clinic Vail, Colorado Frank King, MD Huntington Beach California vii List of contributors Heidi Prather, DO Bryan Williamson, MS, PT, ATC Assistant Professor and Chief of Section Outpatient Physical Therapy Department Physical Medicine and Rehabilitation Skaggs Community Hospital Department of Orthopaedic Surgery Branson, Missouri Washington University School of Medicine St Louis, Missouri Robert E Windsor, MD Program Director, Emory/Georgia Pain Luke Rigolosi, MD Physicians Pain Management Training Department of Physical Medicine and Program Rehabilitation Georgia Pain Physicians PC University of Medicine and Dentistry of Marietta, Georgia New Jersey – New Jersey Medical School Lee R Wolfer, MD, MS Newark, New Jersey Chief, Division of Physical Medicine and Rehabilitation Stephen Roman, MD St. Luke’s Hospital Trenton Orthopedic Group San Francisco, California Mercerville, New Jersey Jeffrey L Woodward, MD, MS Ross Sugar, MD Private Physician Assistant Clinical Professor Springfield Neurological and Spine Institute Emory Department of Rehabilitation LLC and Associate Springfield, Missouri Georgia Pain Physicians PC Marietta, Georgia Peter Yonclas, MD Department of Physical Medicine and Samuel Thampi, MD Rehabilitation Attending Pain Management, Anesthesiology University of Medicine and Dentistry of North Shore Pain Service New Jersey – Valley Stream, New York New Jersey Medical School Newark, New Jersey Robert Tillman, PT, MOMT Professor of Orthopedic Manual Therapy Senior Instructor for the Ola Grimsby Institute and President of Orthopedic Rehabilitation and Specialty Centers Little Rock, Arkansas viii Preface The diagnosis and treatment of sports injuries has changed over the last decade. These changes have included surgical advances in minimally invasive techniques, multidisciplinary approaches to complex problems, improved imaging studies, and preventive strategies that encompass strength training, agility,and nutritional concepts.The sports medicine literature is abundant with the fundamentals of individual sports and their impact on peripheral joints and soft tissues. By comparison, this same information appears insufficient when relating individual sports to the spine.This text was developed, in part, to address this difference and to specifically evaluate individual sports and their effect on the spine. Our goal for this book, in part, was to evaluate spine biomechanics that are commonly seen by the physician, therapist, or trainer during individual sports. In most chapters, general spine movements unique to a particular sport are analyzed and the subtle and obvious impacts observed during these movements discussed. It is our belief that a solid understanding of these biomechanics helps the practitioner to make informed decisions when evaluating the spine disorder in the athlete. This text, Spine in Sports, is divided into three sections. The first section features a discussion about general spine health and biomechanics. The second section divides major categories of spinal injuries based on age group: mainly pediatric and senior adults. Spinal disorders unique to these populations and how they affect sports are discussed.The final section features individual sports – biking, running, tennis, volleyball, weightlifting, wheelchair activities, martial arts, basketball, football, and gymnastics. The predominant stresses placed on the spine were carefully evaluated for each of these sports. Common injury patterns, treatment options, and prevention techniques are discussed.We specifically sought out experts in their specialties, who have both personal experience and treatment expertise with each sport discussed, to author these chapters. In addition, various specialties and viewpoints are represented, including surgical and nonsurgical, academic and clinical, physician and therapist. We would like to thank each author for contributing their expertise to this text. Countless hours of research and writing are required by each of these contributors to produce such a volume. In addition, our thanks go out to the publisher, numerous transcriptionists, medical artists, mainly Suzanne Lennard, and our families who tolerated us during this project.We hope this text deepens your understanding of the spine in sports. Ted A Lennard, MD H Mark Crabtree, MD ix Dedications Ted Lennard – to my wife, Suzanne, and daughters, Selby, Claire, Julia and Maura Mark Crabtree – to my wife, Tammy, and sons, Nathan, Brandon and Ryan x SECTION ONE • General spine fitness and preparation for sports Principles of Spine Fitness 1 in the Athlete CHAPTER David C Karli Lee R Wolfer INTRODUCTION The spine is the core from which our movements originate. Athletic performance is dependent upon a stable spine with well-coordinated neuromuscular patterns of movement.A stable spine is maintained by three subsystems with passive, active, and neural components, as described by Panjabi1 (Fig. 1.1). The Control Subsystem Neural Passive Active Subsystem Subsystem Spinal Spinal Column Muscles Figure 1.1 The spinal stability system as outlined by Panjabi. (Adapted from Panjabi.1) 3 Principles of Spine Fitness in the Athlete passive subsystem includes intrinsic spinal anatomy comprising vertebrae, intervertebral discs, facet articu- lations, joints capsules, and extensive ligamentous attachments.The

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