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Most athletic hand and wrist injuries can be treated with a standard rehabilitation protocol emphasizing splinting, edema control, range of motion, and strengthening. Patient factors and the injury itself influence the timing and intensity of these protocols. A subset of injuries may require specific rehabilitation programs.



Lumbar Spine

Robert G. Watkins

In This Chapter

Low back pain Diagnosis

Spondylolysis and spondylolisthesis Intervertebral disk injury Nonoperative treatment and rehabilitation Operative indications Individual sports

Low back pain has been a significant factor in many different types of athletic activity. The severity and extent of back pain often determines the actual ability to compete and is a worry to all concerned from the athlete, the family, coaches and trainers to those responsible for paying the bills. Essentially, treatment of the athlete with a lumbar spine injury involves an understanding of basic anatomy and biomechanical function of the spine, the diagnosis of conditions affecting the lumbar spine, proper use of diagnostic studies, and a systematized all-inclusive history and physical examination. We must understand some factors that are important in predisposing the athlete to lumbar spine problems as well as training and therapeutic techniques to prevent lumbar spine problems in athletes. Among the predisposing factors to back pain in athletes are increased trunk length and stiff lower extremities.1 Occulta spina bifida is found in a higher incidence of patients developing lower lumbar spondy-

lotic defects.2 The exact relationship of exercise and back pain in athletes, when compared to the average population, does not demonstrate an increased incidence in back pain in athletes participating in organized sports as opposed to regular students. Fairbank et al1 found that back pain was more common in students who avoided sports than those who participated. Fisk et al,3 in 1984, found that prolonged sitting was the most important factor in the pathogenesis of Scheuermann's disease as opposed to athletes lifting weights, undergoing compressive stresses, or doing heavy lifting and part-time work. This study showed that 56% of males and 30% of females had some radiographic evidence of changes similar to Scheuermann's disease in one review of 500 students 17 and 18 years old.3

In an interesting review of back injuries, Keene et al4 found that 80% of back injuries occurred during practice, 6% during competition, and 14% during preseason conditioning. The incidence was 8% in men and 6% in women, which was of no statistical significance. The nature of the injury was usually acute (59%) or overuse (12%), while aggravation of a pre-existing condition occurred in 29%.

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Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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