Over 90% of the population experiences spine symptoms at some point in their lifetime. The spine consists of 33 individual bones (vertebrae), including 7 cervical (neck) vertebrae, 12 thoracic vertebrae with corresponding ribs on each side (mid-back), 5 lumbar vertebrae (low back), 5 fused sacral vertebrae, and 4 fused coccyx vertebrae (tailbone). The normal curvature of the spine, combined with the joints between each segment, the discs, as well as the surrounding muscles, tendons and ligaments serve to absorb shock, maintain balance and promote movement all while protecting one of our most vital anatomical structures...the spinal cord, the link between the brain and the entire body.
While about 80 percent of the population suffers from a bout of low back pain at some point in their life, for obvious reasons, athletes are at greater risk of sustaining a spine injury due to physical activity. Whether the sport is skiing, basketball, football, ice skating, soccer, running, golf, or tennis, the spine undergoes a lot of stress, absorption of pressure, twisting, turning, and even bodily impact. Strenuous activity puts a strain on the back that can cause injury to even the most fit athletes. Many cases of low back pain in athletes can be traced to a specific event or trauma, while others are brought about by repetitive minor injuries that result in microtraumas. Although the athlete may be tempted to take some over-the-counter medication and tolerate the pain for the sake of the sport, avoiding treatment can lead to further and more serious injury and require additional time away from the sport.
The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injuries that produce pain and restrict motion. Sports such as soccer, football, skiing, weightlifting, and even running can result in neck strains and sprains, disc or nerve damage, and other neck injuries.
The shoulder is one of the most mobile joints in the body, but mobility has its price. The complexity of the joint predisposes it to a number of different injuries. Here are some common problems we see:
Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. Athletes involved in throwing, contact, or strength sports as well as swimmers are particularly susceptible. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.
Shoulder dislocation typically occurs with sudden injury and occurs primarily in contact sports (football or wrestling) or hard fall onto the outstretched arm (downhill skiing). The injury can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket. The ligaments and tendons around the shoulder can become loose or torn resulting in recurrent dislocations or instability with shoulder movement. This can increase the wear and tear on the shoulder joint.
A tendon attaches muscle to bone. Tendinitis is usually a result of the wearing down of the tendon that occurs slowly over time, but can also occur with repetitive motion activities. The tendons of the rotator cuff and biceps are the most frequently affected in the shoulder, typically associated with hitting, throwing or repetitive shoulder motion sports such as baseball, softball, tennis, swimming, or gymnastics. Tendinitis can become very painful, making it difficult to reaching up or across the body.
Rotator cuff tear
Tearing of the rotator cuff tendon can result from an acute injury during sports or sports involving repetitive motion of the shoulder. These tears can be partial or complete and can lead to weakness, pain or loss of motion in the shoulder.
The elbow is comprised of the joints between the three long bones of the arm. The bone of the upper arm (humerus) meets with the inner bone of the forearm (ulna) and the outer bone of the forearm (radius) to form a hinge joint. The radius and ulna also meet in the elbow to allow for rotation of the forearm. Here are some common problems that we see in athletes:
Lateral epicondylitis (tennis elbow)
The bony prominence on the outside of the elbow is called the lateral epicondyle. A large group of muscles that extend the wrist/hand attach to the epicondyle via a tendon, and inflammation in this attachment site is commonly referred to as lateral epicondylitis (tennis elbow).
Medial epicondylitis (golfer's elbow)
The bony prominence on the inside of the elbow is called the medial epicondyle. The muscles that flex the wrist and hand attach here and the inflammation of these tendons is called medial epicondylitis (golfer’s elbow).
A fluid filled sac (bursa) which serves to reduce friction pads the tip of the elbow. A hard impact at the tip of the elbow can irritate the bursa and this condition is known as olecranon bursitis.
Fracture (broken bone)
Common causes of elbow fractures include:
- Fall on the outstretched arm
- High impact trauma or athletic injury
Wrist & Hand
There are 27 bones in the human hand. The wrist is comprised of the numerous joints between the two long bones of the forearm (the radius and ulna) and the eight carpal bones. A complex design of tendons and ligaments allow the wrist and hand to perform intricate movements. Here are a few common injuries to the wrist or hand that we see in athletes.
Skier’s usually caused by trauma when the thumb is forced out, resulting in a tear or sprain of the ulnar collateral ligament at the bottom of the thumb. The classic example is a skier holding a ski pole and falling hard or planting the pole and pole pushes hard against the inside of the thumb. Sometimes a “pop” is felt during the injury followed by pain, bruising or swelling on the inside of the thumb.
Fractures of the wrist and hand are frequently sports related, particularly contact sports, or due to a fall on the outstretched hand. This injury may require casting or surgery. Physical Therapy can help restore range of motion and strength after the injury.
The hip joint, a ball and socket joint similar to the shoulder, provides an amazing combination of both mobility and stability in weight bearing. This is due to the configuration of the hip joint and the strength of the muscles, ligaments and tendon which support it. Damage to these structures can impact sports performance.
A bursa is a fluid filled sac which functions as a gliding surface to reduce friction. There are two primary bursae in the hip which can become inflamed (bursitis) and cause pain with movement, the trochanteric and iliopsoas bursae. Bursitis can occur for many reasons including tendinitis or muscular imbalances and in sports requiring repetitive hip motion.
Labral tear (acetabulum)
The acetabular labrum is the ring of cartilage along the rim of the socket of the hip joint. The labrum acts like a rubber seal or gasket to help both pad and hold and the ball at the top of the thighbone securely within the socket. A tear of the labrum can result in a locking, clicking or catching sensation in the hip, pain in the hip or groin, and stiffness or limited range of motion. Tears can occur in athletes that participate in such sports as soccer, golf, ballet, football and hockey.
The piriformis is one of the deep hip rotator muscles located in the buttock region, and the sciatic nerve exits out of the pelvis right next to this muscle. Piriformis syndrome occurs when the sciatic nerve is irritated by the piriformis causing pain, tingling and numbness in the buttocks and down into the back of the thigh.
Hamstring injuries, often referred to as “pulled hamstring”, occur frequently in running sports, particularly those requiring sprinting. The strain is felt as a sudden, often sharp pain or pulling in back of the thigh. Risk factors include muscle imbalance, muscle tightness, low back pain, fatigue, or a recent growth spurt in adolescent athletes.
Snapping hip syndrome, also known as dancer's hip, is a condition in which a snapping sound or sensation is felt in the hip when walking, running, getting up from a chair, or swinging the leg around. In most cases, snapping is caused by the movement of an inflamed muscle or tendon over a bony structure in the hip. For many people, the condition is little more than an annoyance but for dancers or athletes, snapping hip symptoms may also include pain and weakness that interfere with performance.
The knee is a hinge joint and one of the strongest in the human body, allowing the lower leg to move relative to the thigh while supporting the body’s weight. The knee joint is comprised of three bones, the femur (thigh), tibia (lower leg) and patella (kneecap) and movements at this joint are essential to many everyday activities, including walking, running, sitting and standing. Muscle imbalances or tightness in musculature around the knee, weakness in the hip, or problems in the foot can all increase an athlete’s likelihood to sustain an injury or have pain in the knee.
Patellofemoral syndrome (runner’s knee)
Patellofemoral pain syndrome (PFPS) is a term used to describe discomfort in the front of knee or around kneecap which is aggravated by activity or by sitting for extended time with knees bent. PFPS may be caused by overuse, injury, or a kneecap that is not properly aligned and occurs frequently in runners. The patella (kneecap) is supposed to track smoothly in a groove at the end of the femur (thighbone). Tightness in the lateral thigh muscles and tendons or weakness in the inner thigh can result in abnormal tracking of the patella, causing the patella to grate against the femur. Catching, popping, or grinding when walking, running or with knee movement is common.
Iliotibial band syndrome
Iliotibial band (IT band) syndrome is a common injury in runners characterized by inflammation of the thick tendon that connects the gluteus maximus and the tensor fascia latae (TFL) muscles, extends down the outside of the thigh, and attaches just below the knee joint. An excessively tight IT band, with repeated bending and straightening of the knee, can cause friction between the IT band and the surrounding structures. The IT band can also become irritated by improper form, un-level running surfaces, and overuse. The most common symptom is pain on the outer side of the knee but occasionally may radiate the entire length of the band.
The patellar tendon attaches the patella (kneecap) to the tibia (shinbone). Patellar tendinitis, commonly referred to as “jumper’s knee”, is an inflammation or irritation of this tendon due to overuse, repetitive movements particularly squatting and jumping, or sports such as basketball and volleyball which involve constant jumping, landing, and changing direction. Pain is usually felt directly over the patellar tendon, and the tendon can be tender, swollen, and at times is “crunchy” to the touch or with movement.
Articular cartilage, normally smooth and hard, protects bony surfaces where they come in contact with one another. This cartilage may become damaged due to injury, or the wear and tear with repetitive motion sports such as running. Chondromalacia is a softening, irritation or fragmentation of the articular cartilage under the patella (kneecap). It causes pain under the kneecap especially when walking up and down stairs and squatting. Other symptoms can include swelling, locking or catching under kneecap, noise during motion, pain with prolonged walking or stair climbing, buckling or giving way when full weight is placed on leg.
Meniscal tear is a tear of one of the two crescent-shaped cartilages (medial and lateral meniscus) that serve as a shock absorber in the knee joint. Meniscal tears most often occur in active young people involved in sports or the adult athlete. The tear most commonly occurs with a forceful twisting injury to the knee, possibly accompanied by a “pop” that is heard or felt in the knee. The most common symptoms of meniscal tear are pain, stiffness and swelling, catching or locking of the the knee, sensation of knee “giving way”, and inability to move knee through full range of motion.
Ligament injuries are tears or sprains of the ligaments that help to support the knee joint. The most frequently injured are the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL), but can occur in the posterior cruciate ligament (PCL) or lateral collateral ligament (LCL). Ligament injuries are most often a sports-related injury. However, despite the well-known association with contact sports such as football, over 80% of the sports-related ligament injuries are “noncontact” injuries, commonly occurring when simply pivoting or landing from a jump. Symptoms of a ligament injury include the knee “giving way”, and if torn, may have felt a “pop” at the time of injury followed by swelling and pain.
Foot & Ankle
Particularly critical in sports, a primary function of the foot and ankle, besides locomotion, is shock absorption. The foot is an amazing configuration of 26 bones, 2 distinct arches (front to back and side to side), and meets the two long bones of the lower leg, tibia and fibula, to form the ankle. Because of its critical role in shock absorption, when there is pain or dysfunction in the foot, excess mechanical stress may be distributed up the chain and affect the knee, hip and even low back.
The plantar fascia is a strong band of the connective tissue that runs from the heel to the toes and provides shock-absorption and support for the arch of the foot. Plantar Fasciitis is an inflammation of this tissue, often a result of walking or running for long periods of time particularly on hard surface for long periods of time. Additional factors include improper footwear, structural issues in the foot including high arches or flat feet, tight Achilles tendons or calf muscles. Plantar fasciitis may cause sharp pain in the heel and arch, especially with first steps in the morning or after sitting for extended period of time. Pain and stiffness may lessen as the tissue “warms up” but can increase as activity continues. If plantar fasciitis becomes severe and left untreated, heel spurs can develop.
Achilles tendinitis is an inflammation of the Achilles tendon at the back of the heel. Achilles tendinitis can result from overuse or repetitive motion during sports which involve repeated push-offs or a stop-and-go motion such as running, basketball, tennis or ballet dancing. In addition, it can occur with lack of conditioning or warm-up, improper footwear or incorrect running form. Symptoms may range from mild to severe pain in the back of the heel, particularly in morning, stiffness that subsides as the tendon “warms up”, swelling and tenderness, decreased strength with push-off or a feeling of sluggishness in the leg. If not resolved, the condition may progress to a degeneration or microscopic tearing within the tendon.
Shin splints, or medial tibial stress syndrome (MTSS), is an overload injury occurring when too much force is being placed on the tibia (shinbone) and connective tissues attaching the muscles to this bone. Shin splints are very common in runners. Risk factors include lower leg muscle weakness, inappropriate shoes, biomechanical issues and improper progression of training program. Shin splints cause pain or swelling along the tibia or just to the inside of the bone. In the early stages, pain is only felt with activity, but eventually, pain may become continuous.
A stress fracture is a tiny break in a bone. A stress fracture in the foot or leg is usually caused by repetitive stress from running or jumping. Stress fractures frequently occur with dance, running and track and field sports. They are also much more likely to develop in people who have just started a new sport or have suddenly increased workout intensity. When muscles aren’t well-conditioned, they tire easily and can’t help with support and shock absorption. The increased pressure is exerted directly on the bones, which can lead to a fracture. Pain is the most common complaint, although often not in the exact area of the fracture. Gradual swelling and bruising can occur around the site.
Metatarsalgia is a common overuse injury. The term describes pain and inflammation in the ball of the foot. It is often thought of as a symptom of other conditions, rather than as a specific disease.
Morton’s Neuroma describes a condition in which a nerve is inflamed or pinched in the forefoot (balls of feet). This can occur for a variety of reasons including having high arches, over-pronation of foot, wearing high heels or being involved in activities that require excess weight bearing through the forefoot, particularly dance. Symptoms include pain and numbness in the foot that radiates into the toes.
At times, the conditions listed above may require surgery and manual physical therapy is very beneficial for post-surgical recovery. Manual physical therapy, the advanced clinical skill which is Nesin’s speciality, helps relieve pain and restore the normal movement to the soft tissue (i.e. muscles, tendons, ligaments) and joints which is critical for optimal athletic performance. In addition, manual treatment helps improve the mobility of post-surgical scar tissue. Physical therapy helps the athlete recover strength in the muscles affected by the surgery and restore normal range of motion. The focus on restoring optimum biomechanics through hand-on skills allows the athlete to return to sport more safely and effectively.