Lower Back Pain with Dr. Jason Tarno

In Southern Nevada many people are active in athletic activities. Sometimes they injure their low back. Which activities tend to generate most of the low back injuries?

Injuries to the low back can happen with just about any sports related activity. Some sports, however, tend to subject the low back to stresses that can lead to injury more than other sports. Weight lifting, football, baseball, softball, and golf are examples of some sports where we tend to see low back injuries most often.

What symptoms are common to people with low back pain?

The symptoms of low back pain range from muscle stiffness and soreness, to actual spine pain, to discogenic pain. When a nerve is compressed, symptoms can involve pain or weakness in the lower extremities.

How common is low back pain?

Quite common. It is actually the number one occupational (work related) injury, and is the second leading cause of missed days of work. As we age, the back tends to be more susceptible to injury. Not all back problems cause back pain. Some disorders like herniated discs can cause pain in the legs.

How can you determine where the problem lies?

A good tool for the physician is a complete patient interview and medical history along with a thorough physical examination. However, diagnostic studies are also helpful in determining the athlete’s problem.

What type of diagnostic tests?

Diagnostic tests to find the cause of low back pain include x-rays, MRI, CT scan, nerve conduction studies, and bone scans.

Will an x-ray show nerve or disc disorders?

No, an x-ray will not show the nerves or the actual disc. X-rays do show the entire spine, however, and give the physician a sense of the integrity of the disc based on the amount of space between the discs. They are also helpful in determining any slippage of one spine on another (instability) and looking for arthritic changes. Therefore, x-rays are usually the first diagnostic tests utilized when evaluating back pain complaints.

How does an MRI differ from a plain x-ray?

An MRI gives the physician a better idea of what is going on with the actual discs, spinal canal, and nerves. It does not replace the need for plain x-rays because the MRI takes image slices of the back, whereas the x-ray gives the entire “lay of the land.”

Is there any radiation exposure to the athlete with an MRI?

No, MRI stands for Magnetic Resonance Imaging. With this modality of imaging, magnetic waves are used to create computerized pictures of the body part in question by taking cross sectional views. Therefore, there is no exposure to radiation.

What is your feeling regarding manipulation of the spine?

The word manipulate stems from the latin words manus and pulus. Manus translates to “hand’ in English, and pulus translates “to the skillful use of.” Manipulate then means by definition: the skillfull use of hands. Using that definition there are many areas that would qualify in some way as manipulation. Massage therapists, physical therapists, chiropractic physicians, and osteopathic physicians all perform different levels of manipulation. In that regard, I am a big believer in manipulation of the spine.

What is the difference between chiropractic and osteopathic manipulation?

A chiropractic physician (D.C. – doctor of chiropractic) is skilled in the use of chiropractic manipulation. An osteopathic physician (DO – doctor of osteopathy) is trained in the use of osteopathic manipulation. A D.C. does not perform surgery, admit to hospitals, or prescribe medications. An osteopathic physician is trained in the use of manipulation, but also is able to perform surgery, admit to hospitals, and prescribe medications.

So would it be beneficial to an individual with low back pain to seek manipulation when they have low back pain?

Manipulation or adjustments of the spine can be helpful in some athletes. But there is no one form of therapy or treatment that works for everyone. That is why medicine is an art and not an exact science. What works for one athlete may not necessarily work for the next. The goal of the medical professional is to use any acceptable modalities that they possess in order to get the athlete back to a functional level as quickly and as safely as possible.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com

Common Golf Injuries with Dr. Jason Tarno

Many people in Southern Nevada participate in golf. Is golf considered a sport and do people actually get injured playing this game?

Webster defines the word “sport” as:

1. an athletic activity requiring skill or physical prowess and often of a competitive nature

2. diversion, recreation.

Therefore, by definition, golf is a sport, and people occasionally do get hurt playing this game. Studies have shown that golf is actually one activity that ranks high on the list for head injuries, depressed skull fractures being the number one type. Unfortunately this happens when someone swings a club and accidentally strikes a bystander in the head. These types of injuries are rare and purely accidental. More commonly, the injuries from playing the game tend to affect the wrist, elbow, shoulder, and low back. These injuries tend to be either acute or chronic.

How do acute injuries differ from chronic injuries?

Acute injuries tend to occur from missing the ball, taking a fall, slipping, etc. The injuries that are chronic in nature are most commonly due to overuse, and are often caused by having poor swing mechanics. In some instances golfers can injure themselves to the point of requiring surgery to return to the links.

How does someone injure their wrist playing golf?

The wrist is usually injured if there is significant or consistent impact of the club head with the ground. When this type of impact occurs, it is the left wrist (in a right-handed golfer) that takes most of the load, and becomes injured. Likewise, a tendonitis can occur in the thumb region of the left hand secondary the impact of the club with the ground. This is termed DeQuervain’s disease.

Rarely, a fracture of a small bone in the wrist called the hamate bone can occur during the actual golf swing. This injury occurs in the hand grasping the end of the club (the left hand of a right-handed golfer).

What types of elbow injuries are most common in golfers?

The most common problem for golfers at the elbow is pain to the medial (or inside) aspect of the elbow. This has been termed over the years “golfers elbow” because of the frequency of this complaint in golfers. The muscles that allow flexion in the hand and at the wrist have tendons that originate at the medial aspect of the humerus (the arm bone) termed the medial epicondyle. With overuse, or improper swing mechanics, these tendons can become inflamed, and very painful. Golfers elbow most commonly occurs in the back elbow (right elbow of a right-handed golfer). A golfer using his or her arms to generate acceleration of the club head through the swing instead of their legs and shoulders are at risk for developing this syndrome.

A rare complication can also occur along with golfers elbow called ulnar neuritis. The ulnar nerve lives in the same area of the elbow as the flexor tendon attachments. When the arms are used to accelerate the club head through the swing this nerve can be stretched, causing irritation of the nerve, and numbness down to the pinky finger.

What types of shoulder injuries are most common?

Rotator cuff injuries are the most common. Rotator cuff tendonitis, and even rotator cuff tears can occur in either shoulder. For the most part, cuff tendonitis tends to occur in the younger age golfers, while cuff tears tend to occur in the older age golfers. Again, the most common mechanism for these injuries is improper swing mechanics.

What types of back injuries are most common?

While it certainly is possible to injure a disc while golfing, the most common back injury is lumbar sprain or strain.

What is the difference between a sprain and strain?

A sprain generally refers to injury to ligaments (connectors of bone). Strains are injuries to the muscle itself. The lumbar area of the back is the lower section of the back made up of five lumbar vertebrae. During the golf swing, the lumbar vertebrae and the surrounding muscles are under a tremendous load. If a golfer suffers from improper swing mechanics it is possible to over-rotate this area increasing the load, resulting in a very painful injury.

It is obvious that mechanics play a vital role in the evolution of injury patterns in golfers. What advice do you have for someone that has played golf for many years versus someone that is just beginning to play golf?

Poor swing mechanics are the number one cause of injury to golfers. The key for any golfer, whether they are just beginning to golf or have been golfing for a number of years is to get proper instruction regarding hand placement, and proper swing mechanics. For someone who has golfed many years, if they begin to develop an overuse type of injury, they may be having a breakdown in their mechanics. Having a golf pro evaluate their swing would help to find any breakdowns in mechanics, and help to prevent injury.

Additionally, it is very important for any golfer to have a conditioning program that includes strengthening of the abdominal muscles, low back, upper and lower extremities and shoulders. Their conditioning program should also focus on flexibility of these same areas.

Is a warm up time important?

A time to “warm up” the muscles, tendons, and ligaments before each game of golf is vitally important. Start slowly with some gentle stretching, and easy walking, and then rotate the shoulders and back with a club for assistance. Eventually work up to hitting the ball. In doing so, you will increase blood flow into the muscles that will be used during the game. This will also aid in decreasing the risk of injury to those same areas.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com