Conservative Management of Spinal Pain in Sports

This session included presentations on: Prevention of back pain – the latest evidence; Imaging back pain and SPECT; Medical management of radicular pain and non-radicular pain in sports; A physiotherapy strategy for the management of spinal pain; Scoliosis and sport; and Brachial plexus issues in sports.

This session began with the reminder that although low back pain (LBP) and neck pain are very common and often well managed with exercise and CBT, all LBP of more than 3 weeks should be considered serious unless proven otherwise and to always exclude the red flag signs. Prevention and management of back pain follow a similar path and should be personalised to the athlete, and encompass adopting an appropriate workload strategy and optimal biomechanics. Work should be done on but not limited to core stability. Bone SPECT-CT is done using the isotope 99mTc-HDP (99mtechnetium hydroxydiphosphonate), which targets areas of osteoblast activity – bone remodelling as a result of injury or repair. SPECT and CT are used in conjunction, which allows the anatomic localisation of the SPECT ‘hot spot’. This technique is very useful for providing clarity, allowing visualisation of stress reactions, subtle fracture lines and for identifying different components in the case of multiple pathologies. Scoliosis is relatively common. Some children develop a ‘benign’ curve where no treatment is needed; others will develop an aggressive ‘malignant’ curve, which progress rapidly and requires surgery. There is no real conservative measure for treating scoliosis (evidence is sparse for the use of bracing). However, physiotherapy and strength are useful for preventing pain and injury for athletes with mild scoliosis (such as Usain Bolt). Surgical treatment depends more the balance of the spine, but also can involve the degree of curvature. Surgery involves biological fusion of the spine while trying to maintain function, which can be done more easily for treating thoracic curves rather than lumbar curves. Generally, elite sport is not possible after fusion surgery. For the management of brachial plexus issues, injury is usually due to an impact and the history and a knowledge of the force and vectors of the impact are crucial. For the first two levels of injury, removal of the pressure on the nerve will allow recovery. The third level of injury usually involves a severe injury (avulsion), which needs urgent treatment. Non-traumatic brachial plexus issues can arise from anatomical variation, such as having a long neck, or from having a very muscular neck and in these situations the first rib is not flat, which narrows the space through which the nerves pass.