Spine Injuries and Sports

How to Manage Pain and Heal Your Spine After a Sports Injury

Anatomy of the Spine

The spine, also known as the vertebral column or backbone, extends down the center of the body, from the base of the skull to the tailbone, or coccyx. A total of 33 uniquely shaped bones, called vertebrae, make up the spine. The majority of vertebrae are separated by intervertebral discs, which are made of tough fibrous collagen with a gel-like substance in the middle. In a way, vertebrae “float” on top of the intervertebral discs, which give them cushion and rotation.The intervertebral discs, along with the muscles of the neck and back, also keep the vertebrae in place. Each vertebrae form facet joints with their adjacent vertebrae, allowing the spinal column the flexibility to bend and extend, while limiting rotational motions. For this reason, the spine is capable of dynamic movement.

Standing upright is a battle against gravity, and in order to keep the weight evenly distributed along the entire vertebral column, the spine is curved forming an S shape. Looking at the human body from the side, it is clear that the neck, upper back, lower back and pelvic areas alternate in the orientation of their curves. Anatomically, the spine is divided into 5 regions, based on these curves: the cervical spine (neck), thoracic spine (mid to upper back), lumbar spine (lower back), sacrum and coccyx (tailbone). The cervical spine has 7 vertebrae, 12 are in the thoracic spine, the lumbar spine has 5 vertebrae, and the sacrum and coccyx have 9 bones total that are fused together in adults.

In addition to stability and movement, the spine also acts as a protective tunnel for the spinal cord, which is composed of nervous tissue and connects the medulla oblongata in the brain to the sacrum at the bottom of the pelvis. The spinal cord is the main highway of the Central Nervous System and the nerves of the Peripheral Nervous System branch off of the spinal cord into smaller avenues; it allows the brain to communicate with the rest of the body and vice versa. The exchange of information between the body and brain involves everything from sensory input, such as touch, to autonomic functions, such as breathing. Spine health is essential to the function of the entire body.

Cervical Spine (Neck) and Sports Injuries

The neck, or cervical spine area, begins at the base of the skull and reaches down 7 vertebrae to the top of the upper back. The spinal cord connects directly to the brain in this region. The natural C-curvature (lordosis) of the cervical spine is crucial to its ability to transfer any extra weight applied to the top of the head through the neck to the thoracic spine. If the neck is flexed forward or extended backwards to any degree, while there is a high-impact blow to the top of the head, the cervical vertebrae can compress, causing damage to the spinal cord and other structures in the area. This is called axial compression.

Of course, cervical spine injuries are not exclusively axial compressions; trauma can occur in a variety of ways. Statistics show that sports with the highest risk of cervical spine injuries are football, wrestling, diving, cheerleading, hockey, skiing and snowboarding. Cervical spine trauma can result in spinal cord injury (complete severing, contusion or loss of blood flow), spinal fractures, intervertebral disc herniation, and cervical radiculopathy. Injury to cervical area ligaments and tendons, as well as osteoarthritis can lead to bone spurs.

Spinal Care for Cervical Injury and Disorders

Spinal care specialists, including Orthopedic surgeons, utilize a variety of non-surgical and surgical treatment to assist patients with managing pain and returning to the highest level of function possible.

Cervical spine injury and disorders affect the spinal cord and the nerves surrounding it. Most often, the vertebrae, a herniated disc, inflamed ligaments and tendons, bone spurs, tumors or infection are putting pressure on the nerves. In more extreme cases, the nerves are lacking blood flow, are bruised, or have been severed completely. Extra pressure and damage to nerves in the cervical spine can be very painful, not only in the neck area, but also in the back, chest, shoulder, arms and hands, because all of these nerves branch off from the spinal cord. Nerve pain is typically relieved when the pressure on the nerve is decreased.

Managing the Pain

Epidural (Cortisone Steroid) Injections
During this in-office procedure, cortisone (a type of steroid) is injected in the epidural space directly surrounding the target nerve. Cortisone is a natural anti-inflammatory, and these injections help to decrease inflammation, and therefore, relieve the extra pressure on the nerve. Pain relief typically lasts around three months, and during this time, if needed, other measures can be taken to treat the cause of the inflammation.
Platelet-rich Plasma (PRP) Injections
Platelet-rich plasma (PRP) injections reduce pain and can help speed up the healing process using the patient’s own blood platelets.
Cervical Medial Branch Block
This method numbs the medial branch nerves that run from the spinal cord out through the facet joints, which are part of the vertebral column. Spinal care specialists use this technique to see if it is the medial branch nerves responsible for the patient’s pain. If anesthetizing these nerves results in pain relief, then it is clear the facet joints are an issue, and the specialist can prescribe appropriate treatment. For some patients, this technique is sufficient, but typically, the pain relief is short lived. Medial branch block is usually used as a diagnostic tool, and then followed up with longer term pain management.
Cervical Rhizotomy or Radiofrequency Ablation
Targeting the medial branch nerves in the facet joints, this technique essentially severs the communication between the nerves and brain, so that the pain signals are unable to reach the brain. An electrode, which has been heated by radio waves, or radiofrequency, is used to deaden the nerves determined to be the source of pain. For a number, rhizotomy is an effective means of pain relief which lasts for several months, or longer.

Repairing the Spine (Surgical Options)

Cervical Discectomy with Fusion and Corpectomy with Fusion
If the space within the spinal column has become too narrow due to a herniated disc (where the intervertebral disc fluid is bulging out, or has ruptured), degeneration, or trauma, it may be necessary to remove part of the damaged vertebrae and disc (discectomy), or remove the entire vertebrae and disc (corpectomy), and replace it with a spinal fusion. In both anterior cervical discectomy and cervical corpectomy, the incision and the procedure is conducted from the front of the neck. After removing the damaged material, the Orthopedic surgeons will use a bone graft to facilitate healthy spacing between vertebrae. For the bone graft, the surgeon will either transplant bone from another part of the body to the spine, utilize bone removed to decompress an area of the spine, or an artificial bone graft substitute.
Cervical Artificial Disc Replacement
Another treatment option for patients with a herniated disc, disc degeneration, or bone spurs is disc removal and replacement with an artificial disc. The disc replacement device is composed of metal and plastic and is held in place in the vertebral column by screws. The device will serve the same function as the original; allowing movement, and providing cushion and stability for the joint.

Lumbar Spine (Lower Back) and Sports Injuries

Lumbar spine injuries are common in athletes, although the nature of the injury is dependent on the sport. The lumbar spine consists of 5 vertebrae which help to stabilize and hold the weight of the upper body, control leg movements, and allow for twisting and bending motions in the trunk. Sport activities that require high-speed and high-impact movements such as jumping, kicking and twisting, can be hard on the lower back, and also put the back at risk of injury. A higher percentage of athletes in football, hockey, baseball, basketball, soccer, gymnastics, dance, skiing and snowboarding report lumbar spine issues than other sports. The thoracolumbar junction, the area of the mid back where the thoracic and lumbar spines meet, is especially susceptible to injury. Common injuries seen in the lumbar area are intervertebral disc herniation, minor fractures, bone spurs and degenerative disc disease.

Spinal Care for Cervical Injury and Disorders

Spinal care specialists, including Orthopedic surgeons, utilize a variety of non-surgical and surgical treatment to assist patients with managing pain and returning to the highest level of function possible.

As in cervical spine injury and disorders, lumbar spine issues affect the spinal cord and the nerves surrounding it. Most often, the vertebrae, a herniated disc, inflamed ligaments and tendons, bone spurs, tumors or infection are putting pressure on the nerves. In more extreme cases, the nerves are lacking blood flow, are bruised, or have been severed completely. Extra pressure and damage to nerves in the lumbar spine can be very painful, not only in the lower back area, but also throughout the lower body; hips, groin, legs, feet. Nerve pain is typically relieved when the pressure on the nerve is decreased.

Managing the Pain

Lumbar Epidural (Cortisone Steroid) Injections
During this in-office procedure, cortisone (a type of steroid) is injected in the epidural space directly surrounding the target nerve. Cortisone is a natural anti-inflammatory, and these injections help to decrease inflammation, and therefore, relieve the extra pressure on the nerve. Pain relief typically lasts around three months, and during this time, if needed, other measures can be taken to treat the cause of the inflammation.
Platelet-rich Plasma (PRP) Injections
Platelet-rich plasma (PRP) injections reduce pain and can help speed up the healing process using the patient’s own blood platelets.
Lumbar Medial Branch Block
This method numbs the medial branch nerves that run from the spinal cord out through the facet joints, which are part of the vertebral column. Spinal care specialists use this technique to see if it is the medial branch nerves responsible for the patient’s pain. If anesthetizing these nerves results in pain relief, then it is clear the facet joints are an issue, and the specialist can prescribe appropriate treatment. For some patients, this technique is sufficient, but typically, the pain relief is short lived. Medial branch block is usually used as a diagnostic tool, and then followed up with longer term pain management.
Lumbar Rhizotomy or Radiofrequency Ablation
Targeting the medial branch nerves in the facet joints, this technique essentially severs the communication between the nerves and brain, so that the pain signals are unable to reach the brain. An electrode, which has been heated by radio waves, or radiofrequency, is used to deaden the nerves determined to be the source of pain. For a number, rhizotomy is an effective means of pain relief which lasts for several months, or longer.

Repairing the Spine (Surgical Options)

Lumbar Discectomy and Laminectomy
If the space within the spinal column has become too narrow due to a herniated disc (where the intervertebral disc fluid is bulging out, or has ruptured), degeneration, or trauma, it may be necessary to remove part of the damaged vertebrae and disc (discectomy). In the case of extra bony growths (bone spurs) causing a narrowing of the spinal canal, the removal of bone, specifically the lamina of the vertebrae, is performed.
Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
This technique utilizes two small incisions on each side of the back, and special retractors provide access to the spine by gently moving away the muscle and other soft tissue, and eliminating risk of damage. If needed, small amounts of bone, disc, and/or ligament, causing pressure on the spinal canal, are removed. After removing the damaged material, the Orthopedic surgeons will use a bone graft to facilitate healthy spacing between vertebrae. For the bone graft, the surgeon will either transplant bone from another part of the body to the spine, utilize bone removed to decompress an area of the spine, or an artificial bone graft substitute.
Anterior Lumbar Interbody Fusion (ALIF)
This procedure is similar to TLIF, however it is done from the front (anterior) of the body, usually through a 3-5 inch incision in the lower abdominal area or on the side. This incision involves cutting through, and later repairing, the muscles in the lower abdomen, as well as moving aside organs and vasculature (arteries and veins). If needed, small amounts of bone, disc, and/or ligament, causing pressure on the spinal canal, are removed. After removing the damaged material, the Orthopedic surgeons will use a bone graft to facilitate healthy spacing between vertebrae. For the bone graft, the surgeon will either transplant bone from another part of the body to the spine, utilize bone removed to decompress an area of the spine, or an artificial bone graft substitute.
Comprehensive Spine Center Dallas specializes in pain management for sport-related injuries. Contact us today for a consultation.
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