Sports

Introduction and Literature	337	Sporting Activities that are Good and Bad for the
Sports and the Cervical Spine	337	Intervertebral Disks	338
Sports and the Lumbar Spine	338

Introduction and Literature

Sports play a mixed role in disk disease. On the one hand, suitable types of sporting activity help prevent degenerative changes in the intervertebral disks, according to the motto, “The disk lives by moving.” On the other hand, certain harmful types of movement and excessive participation in sports can harm the disks and can, in particular, provoke disk protrusions and prolapses. A review of the relevant literature discloses only a small number of randomized controlled trials on this topic. Most of the available scientific studies on spinal injuries and overuse phenomena in sports are retrospective analyses, theoretical biomechanical papers, and summaries of the authors’ personal experience (MacAuley and Best 2002, Schmitt 2004, Göbel et al. 2005, Krämer, Wilcke and Krämer 2005, Lennart and Crabtree 2005).

Just as it has been found difficult to attribute occupation-related spinal changes to a particular pattern of abnormal mechanical stress (Dupuis 1999, Hartmann 1999; see Chapter 17), it has also not been possible to delineate the characteristic features of spinal injury due to any particular sport. There is no “weightlifter’s spine,” “rower’s spine,” or “golfer’s spine.” The literature only contains reports on the frequency and severity of back pain in individual types of sport without indicating any modality-specific patterns of injury (Krämer 1997, Nadler 1998, Day and Giovanni 2001). Fifteen percent of all sporting injuries affect the spine (Day and Giovanni 2001). Female athletes more commonly have low back pain than male athletes (Nadler 1998). Wrestlers (Granhed and Morelli 1988); triple jumpers, javelin throwers, and gymnasts (Görtzen 1998); power athletes, and weightlifters (Schmitt 2004) have a high lifetime incidence of back pain. Long-distance and marathon runners tend to have less back pain, over the course of their lives, than others. Radiological studies of former high-performance athletes reveal the greatest degree of degenerative change among shot-putters, discus-throwers, and high-jumpers (Schmitt 2004). Despite their marked degenerative changes, however, these former high-performance athletes had fewer symptoms than a control group of individuals who did not have their degree of physical training.

The degree of severity of radiological changes such as spondylosis and osteochondrosis in current or former athletes is much less important than the clinical findings, both with respect to diagnosis and with respect to the medicolegal assessment of any such problems as occupational injuries to the spine. The current state of knowledge on the resilience of the spine to the stresses of sport allows us to make the following statements:

Trained athletes with well-developed back muscles complain of less back pain than untrained individuals.

Powerful muscles and taut ligaments are better able to cope with the many mechanical stresses of everyday life than weak muscles and slack ligaments.

When taken ill, athletes have a strong desire to get well and demonstrate excellent compliance in their aftercare: they are ideal patients.

Sports and the Cervical Spine

The special biomechanical properties of the cervical spine owing to the relative heaviness of the head were discussed in Chapter 9. The cervical motion segments are stabilized by the muscles of the shoulder and the nuchal and anterior cervical muscles. If the physical examination is unremarkable, i.e., in patients without any history of complaints related to the cervical spine and with well-toned shoulder, nuchal, and anterior muscles, there is no reason to advise against any of the usual types of sport. The high acceleration found in motor sports necessitates the use of a cervical support behind the neck. Contact sports such as football, rugby, and wrestling are more likely than other types of sport to cause cervical spine injuries (Watkins and Williams 2004). Whenever a cervical spine injury is suspected, even if it is considered to be unlikely, guidelines for the proper transport of the athlete from the field should be followed. Neck supports extending down to, and resting on, the shoulders should be worn whenever permitted by the rules of the sport.

Individuals with pre-existing spinal injuries and recurrent pain in the shoulder and neck, with or without radiation into the arm, should be especially cautious about combat sports such as judo, karate, and wrestling. They should also be wary of playing soccer (heading the ball) and handball (collision with opponents). Competitive cycling is also problematic because the head is thrust backward during sprinting. In noncompetitive (recreational) cycling, the handlebars can be elevated to bring the upper body into an erect position and avoid the unfavorable configuration of the head and neck. Individuals currently suffering from shoulder and neck pain should not ride a bicycle out of doors, because even mild shocks can exacerbate the pain; in such cases, we recommend a stationary bicycle.

Individuals suffering from chronic, recurrent shoulder and neck pain who nevertheless want to continue participating in a type of sport that is unfavorable for their cervical spine can benefit from compensatory training of the nuchal and shoulder musculature. This should be done with special apparatus under the direction of a physical therapist. Once individuals have become familiar with the apparatus and the exercise program, they can continue the exercises unaided.

Sports and the Lumbar Spine

The positive and negative effects of sporting activity on the spine are mainly centered on the lumbar region. Fifteen percent of all sporting injuries affect the spine, and most of these affect the lumbar spine (Day and Giovanni 2001). The most common injuries involve lumbago and sciatica arising either in training or during competition.

The benefit of sport to the lumbar spine is mainly due to the physical exercise associated with most types of sport. Rhythmic loading and unloading of the lumbar spine improves fluid exchange into and out of the intervertebral disks.

Sports involving exercise improve metabolic exchange in the disks and help prevent disk disease.