Stress Fracture Of Lumbar Spine Sample †MyAssignmenthelp.com

Question: Discuss about the Stress Fracture Of Lumbar Spine. Answer: Introduction This report is based on football-associated stress fracture of the lumbar spine. Football is the worlds most loved game. Its history dates back to more than a century. It began in the year 1863 when Football Association of England was first formed. It was the first body formed to govern the sports (Walvin, 2014). The earliest form of the game dates back to the Han dynasty of China. Another variation of the game originated in the Far East as well and this was named the Kemari, which originated in Japan. Moreover, the Greeks and the Romans also had other variations to this game like the Episkryos and the Harpastum, respectively (Ryynnen, 2015). In 1882, the football related associations in England collaborated to create the International Football Association Board (IFAB). FIFA was established in the year 1904 in Paris and it became a part of IFAB in the year 1913. At that time, FIFA had only 7 countries as its members but now it consists of 208 members. This game involves the participa tion of 11 players from each team. The players need to maneuver the ball and hit it inside the oppositions goal post. This game involves the skillful use of ones legs and feet and as a result, it is associated with a number of injuries (Sorez, 2012). Knee injuries are the most common form of injuries associated with football. Knee injuries involve the anterior cruciate ligament and the medial collateral ligament injuries. Others include ankle sprains, torn meniscus, torn hamstrings, muscle contusions, shoulder dislocation and shoulder tendinitis (Whittaker et al., 2015). Stress fracture of the lumbar spine is another type of injury associated with football. This is medically known as Spondylolysis. It is caused due to overuse of ones lower back. It is the most common form of injury to the lower back associated with various games including football. It occurs in the lowermost lumbar vertebra named L5 (Kobayashi et al., 2013). The L5 is situated at the junction of the lumbar spine and the pelvis. This part remains highly stresses during various physical activities, which involves continuous moving and maneuvering. Heavy muscular forces can cause the micro fractures in the lumbar spine. It involves severe pain in the lower back. Thi s causes restrictions in the movement of the player (Murthy, 2012). This report describes the football-associated injury termed Spondylolysis or stress fracture of lumbar spine. Firstly, it provides a classification of stress fractures, diagnosis and the causes associated with this type of injury. Secondly, it provides treatment and rehabilitation programs. Lastly, it provides a prevention measures associated with the injury. Classification and Diagnosis Lumbar spine provides support and stability to the upper part of the body. An injury to this region changes the lumbar vertebral shape, thereby affecting the posture. Spondylolysis can be classified as (1) dysplastic, which is usually congenital, (2) degenerative, which is generally associated with old age, (3) isthmic, which is usually associated with sports, (4) traumatic, which occurs following previous fractures and (5) pathologic, which involves either a localized or generalized disease of the bone. Dysplastic spondylolysis occurs as a result of abnormalities present in the pper scarum or it involves the arch present in the L5. Isthmic Spondylolysis occurs because of lesion development, which can cause a lytic-fatige fracture of pars. Degenerative spondylolysis involves instability of the pars segments (Long Whang, 2015). X-Rays are not useful to detect early stages of stress fractures of the lumbar spine. X-rays can only detect them at the late stages when it is beyond treatment. A radiograph helps to identify compression fracture of the vertebra (Cicala et al., 2013). It also helps to determine the height loss of the vertebra, increase in distance between the pedicles, alignment of the vertebra, among others. However, various scanning techniques can be used to diagnose stress fractures. These are magnetic resonance imaging or MRI, Computed Tomography scan or CT-Scan or a simple bone scan. However, Single Photon Emission Computed Tomography or SPECT is superior to both CT and MRI in the detection of Spondylolysis (Patel et al., 2016). SPECT and CT reveals the presence of number of lesions detected in the pars interarticularis. Unilateral spondylolysis involves the presence of increased bone uptake and sclerosis in the contralateral part of the pars interarticularis as observed by SPECT and CT. Advanc ed stages result in the presence of sclerosis and pedicle, lamina overgrowth. MRI reveals the presence of bony edema, which helps to determine the age of the fracture. CT scan helps to determine the bone anatomy like height loss, canal compromise and fragment retropulsion (Elgazzar, 2017). High amount pressure on the lower vertebra can give rise to stress fractures. This results in the formation of tiny cracks in the lower vertebra, particularly the L5 or the fifth lumbar vertebra. This results in lower back pain as a result of rotation, extension and flexion movements. These movements affect the posterior portions of the spinal column, resulting in the formation of micro fractures in the bone (Gellhorn Katz Suri, 2013). It is particularly observed in young sports players. Overextending or overstretching of the lower back can give rise to can give rise to a lot of stress. These are common among weight lifters, gymnasts and footballers (Sasaji, 2016). Overuse of back muscles results in fatigue and results in its inability to absorb shocks. Repetitive shocks can give rise to tiny cracks in the vertebrae. Chronic pain in the lower back is the most common symptom. This may result from compressive or mechanical pain. Spondylolysis can also lead to Spondylolisthesis. This r esults in slippage of one vertebra over the other. The resulting slipped vertebra can put pressure on the spinal canal space, thereby constraining the nerves (Raastad et al., 2015). This pressure can also lead to back, leg and hip pain. It can also result in numbness of the feet. Other factors that can cause stress fractures are the genetic constitution of an individual and osteoporosis. Treatment and Rehabilitation An effective and acute treatment program is needed for players suffering from stress fractures of the lumbar spine. The treatment usually begins after diagnosis and involves advocating of complete rest to the athlete. The player is needed to stop the various routine exercises and any movements that may cause in pain development. If the pain continues after 3 weeks, it means that the player in getting insufficient rest or may need the support of a back brace. Back braces help to maintain the proper positioning of the back in order to speed up the healing process (Lee et al., 2012). Periodic X-Rays are needed to determine if the back is in proper position. If non-surgical treatment does not help to keep the back in proper position, a spinal fusion is recommended. In this procedure, screws and rods are used which helps to keep the vertebra in the proper position alongside the healing process. This in turn helps to stop the motion of a a vertebral segment, thereby reducing the pain (Wu e t al., 2012). However, there are risks involved with this procedure, which involves infection, bleeding, blood vessel injury and poor healing of wounds. Moreover, ibuprofen, which is an inhibitor of inflammation, can be used to heal the pain. Apart from the use of various nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants can also be used (Patrick, Emanski Knaub, 2016). Medications directed against narcotic pain and against neuropathic pain (like tricyclic antidepressants) can be used. Other techniques for treatment of pain involve analgesic patches, which are localized and intercostals nerve blocks or transcutaneous nerve stimulatory units (Wong McGirt, 2013). The rehabilitation program begins after the treatment phase. If the pain subsides and the player is able to perform daily activities, the athlete is allowed to progress to the rehabilitation program. The rehabilitation program begins in the second month after diagnosis, since the first month is associated with various surgical or non-surgical treatments. The rehabilitation program is characterized by physical therapy with the help of an experienced physiotherapist (Peterson Renstrom, 2016). Physical therapy involves various exercises like the lumbar and core exercises for stabilization, core exercises for generation of core stability, exercises that strengthen the legs and the hips. Other exercises involve postural taping, soft tissue massaging and Spinal Proprioceptive Extension Exercise Dynamic Program (SPEED) (Papa, 2012). Moreover, these exercises also help to make the muscles flexible to allow proper movement. Exercise programs can also be designed to enable the players to prac tice at home. Activities that provide lesser amounts of stress can be introduced. However, activities that put a lot of pressure on the spine like rotation or back arching is avoided. If the player is able to carry out the physical therapy and the low stress activities, then they are allowed to progress to the third phase of the rehabilitation program. The third phase involves continuation of the exercise programs both at home and at the rehabilitation center. Physical therapy exercises are also increased. The players are allowed to return to their sports, however, it is a gradual and progressive return, which involves a set of parameters and guidelines set out by the medical practitioner or physiotherapist (Garet et al., 2013). However, participation in the sport should not be carried out on consecutive days. On reoccurrence of pain, the activities and exercises are needed to be reduced. Prevention measures Stress fracture of the lumbar spine usually causes lower back pain that occurs on one side of the back rather than the center (Lotz, Fields Liebenberg, 2013). It occurs as a mild pain in the beginning and progresses to chronic pain following activities like jumping, running, kicking, among others. This is mostly common among young athletes like footballers. However, various preventative measures can be followed to avoid the development of stress fractures in the lumbar spine. These are: Maintenance of good physical condition during off seasons and not overexerting oneself during the peak seasons. Activities that require high impact like jumping, running, rotation and back arching should be increased in a gradual manner. It is necessary to take day-offs in order to give rest to the back muscles and the body as a whole. It is necessary to avoid participating in the sport throughout the year, as it puts a lot of pressure on the muscles and the vertebra. Maintenance of good flexibility of the hip and hamstring flexors, strength of the core, lumbar and abdominal muscles. Female athletes should be checked to determine their bone mass density (BMD), which helps to understand the quality of their bone health (Chen, Tenforde Fredericson, 2013). Calcium and Vitamin D supplementation can also help to prevent stress fracture. Orthotic devices can prevent lower back stress fractures by shock absorptions. Insoles that absorb shocks are very effective in preventing stress fractures (Kendall, Bird Azari, 2014). Other injuries like those in the ankle can be prevented by the use of balance boards and proprioceptive training. Strengthening programs help to reduce hamstring, knee and groin sprains. Conclusion Lumbar spine generally provides support to the entire upper part of the body. However, continuous strains on the lower vertebra, particularly L5 can give rise to the generation of small fractures. Continuous pressure through various exercises and continuous tournaments lead to the development of a large number of these micro fractures, which eventually results in inability of the vertebrae to absorb shocks causing pain of the lower back. Initially mild pain ensues, which then progresses to severe and chronic pain. The player is unable to carry out normal movements and carry on with their game. With the appearance of mild pain, it is essential for the player to consult a medical practitioner for proper diagnosis. Diagnosis generally involves X-rays, radiographs, MRI, CT scan, SPECT, among others. Such stress fractures of the lumbar spine are generally observed among the athletes who perform gymnastics, weight lifting, footballers, and cricketers, among others. Such athletes require ro tation and arching of their backs continuously. Various treatments that are available involve proper rest and consumption of NSAIDs, in order to relieve the pain. However, back braces can also be used. Surgical treatments involve the spinal fusion technique, which employs screws and rods to keep the vertebra in proper position, preventing it from slipping. Following treatment, the athlete is advised to participate in a rehabilitation program, which involves physical therapy under the guidance of an experienced physiotherapist. Moreover, it involves various exercises that help to stabilize and strengthen the core, lumbar, legs and hip muscles. Other techniques are postural taping, soft tissue massage and SPEED programs. However, it is necessary for the athletes to prevent such occurrence of stress fractures in the future. The athlete needs to provide sufficient rest to his/her body in order to prevent stress. Nutritional supplementations like calcium and vitamin D helps to prevent st ress fractures of the lumbar spine. Moreover, orthotic devices are also known to prevent development of stress fractures in the future. Thus, from the above discussions it can be concluded that stress fractures if severe and not diagnosed properly can give rise to serious consequences and affect the ability of the athlete to participate in the game in the future. References Chen, Y. T., Tenforde, A. S., Fredericson, M. (2013). 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