Online Health Chat with Kim Gladden, MD, and Kush K. Goyal, MD

September 16, 2014

Description

Neck and back pain can have many causes such as muscle sprain, ligament strain, muscle spasm, numerous types of spine fractures and disc herniation, shoulder impingement, bursitis and hip/pelvic fractures. Patients might also suffer from facet-mediated pain and sacroiliac joint pain.

  • There are other possible causes of neck and back pain; be sure to seek medical help if you experience:
  • Clumsiness/tripping and falling
  • Hip or knee pain for more than a few weeks or months
  • Bowel or bladder incontinence
  • Severe neck or back pain at night

Also, seek help if you develop a fever, chills or sweats.

Spinal injuries can occur in many sports. If you are an athlete who has suffered neck or back pain, get your questions answered by two of our sports and exercise medicine and spine health experts, Kim Gladden, MD, and Kush Goyal, MD, who will discuss possible causes for pain, diagnosis and treatment options.

About the Speakers

Kush K. Goyal, MD, is a Physical Medicine and Rehabilitation-trained physician specializing primarily in spine health (diagnosis, evaluation and management of neck and back pain). He focuses on interventional spine procedures and sports medicine. Dr. Goyal graduated medical school from the Medical College of Ohio (currently University of Toledo Health Science Center) and completed his residency in Physical Medicine and Rehabilitation at Oakwood Hospital/Wayne State University. He later completed his fellowship at Cleveland Clinic in the Center for Spine Health.

Kim Gladden, MD, is a Sports and Exercise Medicine physician in the Center for Sports Health. Her specialty interests include sports and athletic injuries in adolescents and adults, musculoskeletal injuries and performing arts medicine. Dr. Gladden went to medical school at George Washington University School of Medicine in Washington, DC. She then went on to complete a residency in Physical Medicine and Rehabilitation at Northwestern University Affiliated Hospitals in Chicago and a fellowship in Primary Sports Medicine at Cleveland Clinic.


Let’s Chat About What You Need to Know about Spinal Sports Injuries

Moderator: Welcome to our chat today with Cleveland Clinic specialists Dr. Kim Gladden and Dr. Kush Goyal. We are thrilled to have you both available to share your knowledge and expertise about sports-related spinal injuries.

Moderator: Let’s begin with the questions.


CONDITION SPECIFIC

kacyleu: I have been suffering with what my doctor says is a thoracic back sprain/strain. I am only 35 years of age and my occupation is a waitress. I'm also a single mom of five children. I have tried physical therapy, which was horrid; and after two sessions, I started experiencing random numb spots on my body off and on, and it is scaring me. I have made my doctor aware of all pain and other issues with numbness that I'm experiencing. He took me off of work. It has been at least six weeks. My doctor gave me Flexeril®, naproxen and 10/325 Norco® (hydrocodone bitartrate and acetaminophen). I have been begging for a referral (due to my insurance) for an MRI. He finally gave me one written on a prescription paper, and I explained to him that I wanted to stop taking all this medicine and figure out what is wrong with me. He said he agreed because I am so young, and he said he would fill my meds until October, I'm assuming in case I have to wait to get into the orthopaedic doctor I was referred to. I called yesterday and the orthopaedic doctor said my doctor would need to fax my referral along with my demo and notes. The nurse did nothing.

Kush_K._Goyal,_MD: Thoracic back pain is more difficult to treat than neck and back pain. Remember that not all therapy is equal. I have had tremendous success with spine-trained therapists. Rarely does an MRI of the thoracic spine show problems that are related to symptoms.

Chase: When my son was in middle school, we were told he had a very mild curvature of the spine. Our pediatrician watched it for many years and, thankfully, said it didn’t get worse. He just started his freshman year away at college and told me he’s joined a rugby team. How nervous should I be?

Kush_K._Goyal,_MD: Scoliosis typically progresses during puberty. If he has finished puberty, it is unlikely to progress. If he has back pain, he may want to see a spine specialist

Moderator: You may be interested in joining the Scoliosis chat next week. For more information please see:
http://chat.clevelandclinic.org/chatpage.aspx?chatid=1638

Anj42: My 13-year-old daughter is a competitive gymnast. We were recently told she has scoliosis. Can she still compete? Do we need to be worried? Please help!

Kim_Gladden,_MD: It would depend on the degree of scoliosis. If it is of minor degree and was noted incidentally, there is likely no contraindication to her doing gymnastics. If you are concerned over the degree of the scoliosis, or if she has back pain related to this, I would recommend further evaluation.

Devon_81: My younger sister has been suffering from chronic back pain. It started out as manageable, but got worse and worse. Now she cannot bend back or twist to the sides without sharp pain. She is a ballet dancer, and this has really limited her movements. She has had x-rays and an MRI, but no fracture or other cause has been detected. Are there exercises that might help? Should we take her to a specialist for another opinion?

Kim_Gladden,_MD: I think that ongoing pain, especially in a younger athlete, would warrant further evaluation. While we are always looking for structural injury, we also consider "systemic" issues that may lead to joint pain. That being said, I would be happy to see her in my dance injury clinic to see if I can determine what may be going on. The clinic meets on the second and fourth Tuesday of the month from 4 to 6 p.m. at the Sports Health Center in Garfield Heights. You can schedule by calling 216.518.3475. We also have dance physical therapists to determine appropriate exercise for specific injuries.


SPINE STRESS FRACTURES

mrscmzie: My daughter is a figure skating and was having pain in her back. The doctor says she has a stress fracture in her lower spine. What causes this and how long will it take to heal?

Kim_Gladden,_MD: First of all, I would want to know the exact diagnosis. There are several different fractures this could be. The two most common are fracture that occur in a structure called the pars interarticularis. These can occur in athletes who perform extension frequently. Resolution depends on the extent of the fracture, the pain level and the desired activity.

mrscmzie: She (my figure skating-daughter) is very anxious to continue training for an upcoming competition. What can she do to prevent further damage to her spine? Will these stress fractures reoccur?

Kim_Gladden,_MD: I would recommend having her see a sports medicine physician to be evaluated, and then start treatment (likely physical therapy for core strengthening) or get proper restrictions to activity. That way, she will be monitored and followed through the course of treatment with the goal of a safe and successful return to full activity.

mrscmzie: Sorry for all the questions, but I am concerned about my daughter’s spine. Do you think the moves that require a lot of flexibility (Biellmann spins - spinning with her leg above her head) contributed to her condition? In the future, should she limit these moves?

Kim_Gladden,_MD: If it is the type of fracture I mentioned, there is thought that some individuals may have an element of weakness in the pars that predisposes them to injury. We tend to see pars fractures in athletes who have a lot of extension activities in their sport. As to limiting future participation, again this will depend on the extent of the fracture and the demands of the sport. One consideration is whether or not any neurological changes have/are taking place (weakness in the legs, sensory changes), as this would require further evaluation and limit participation.

mrscmzie: OK, one more question. Is there any equipment that my daughter can utilize
that will minimize problems in her back?

Kim_Gladden,_MD: The basis of back health is good core strength, which I think can be achieved with dedicated physical therapy assessment and treatment. Although we sometimes brace these injuries, this has not been shown to alter the injury course, and seems to be primarily helpful in reminding the athlete not to use their back in a way that is painful while they are healing.

mrscmzie: If my child is having spine issues in her teens should she expect to have more later in life?

Kush_K._Goyal,_MD: If she has scoliosis, this problem typically does not worsen after puberty. In my opinion, she may be more at risk for back pain in the future with prior injury, but that does not mean she will have another problem. Ninety percent of people get back pain at some point in their lives.

mrscmzie: Sorry, I should have been more specific. If my teenage child has a stress fracture, is she more likely to have other fractures in the future.

Kim_Gladden,_MD: If we are referring to the pars fracture (spondylolysis), I am not sure of the exact recurrence rate. Risk of re-injury can be reduced by allowing adequate time for healing, good core conditioning and making sure that bone health is optimized. Many patients with these fractures go on to participate in sports without ongoing problems.

IDHS.coach: One of the kids I coach had back pain for a few weeks and I hear from the mother that doctors think it could be a stress fracture. Is that even possible in the back? What do I need to know about it?

Kush_K._Goyal,_MD: Yes, there are fractures that can be considered stress fractures (pars fractures). Certain sports have an increased risk for fracture, especially in females. Pain is typically worse with extension in stress fractures in the low spine. If you are concerned, you may want to consider seeing a sports medicine or spine specialist.


CAUSES & PREVENTION

Devon_81: I've read that "neck strengthening" can help prevent spinal injuries, specifically in high-impact sports such as football. Is this true? What are some ways that young athletes can work to strengthen their neck muscles?

Kush_K._Goyal,_MD: Yes, neck strengthening is important. We believe that this may have a role in concussions. Shoulder stabilizers and neck muscles should be worked on together.

alliecat: Do you see certain sports with more back or neck injuries than others? Do you feel there are other sports that are less likely to be related to spine injuries?

Kush_K._Goyal,_MD: That is a great question. Contact sports, high-impact sports, sports with jumping and from heights are higher risk. These include football, rugby, skiing, gymnastics, weightlifting, tennis, diving, wrestling and cheerleading.

theKidd: Are sports spine injuries related more to tight muscles/ligaments or to actual bone issues?

Kush_K._Goyal,_MD: They can be related to either, but 90 percent to 95 percent of back injuries are related to muscle strains. They can be related to weak bones; at especially high risk are females and patients with osteoporosis. Most bone fractures are from an acute trauma event with high impact.

mrscmzie: Are back braces helpful for preventing stress fractures?

Kush_K._Goyal,_MD: No. I rarely recommend braces, unless they have had a fracture and the spine is unstable.

John: Are there any recommendations for protecting your spine and preventing sports injuries?

Kim_Gladden,_MD: First and foremost, being prepared to participate will help to protect your spine. This includes understanding the demands of the activity and making sure that you are properly conditioned in the realms of aerobic capacity, strength and flexibility. Things to consider are: maximizing core strength, which can affect how the back is being used and make it less susceptible to injury; making sure that you are properly warmed up; being properly hydrated; and getting adequate sleep and good nutrition. Other factors include sun exposure, impact activity such as running or walking, smoking history, being female/male and family history, all of which can impact bone health.


SYMPTOMS & DIAGNOSIS

Devon_81: How do you know when back pain is a strain or something serious that requires more than rest?

Kush_K._Goyal,_MD: Ninety percent to 95 percent of back pain in sports is related to back sprains. Pain that radiates down leg, bowel or bladder changes and weakness are indicators to see a spine specialist.

Holister: I’m 70 years old and I’m taking up golf! Sometimes, after we’ve been to the driving range, my back is sore, sometimes for days. Does that mean I have to give it up?

Kush_K._Goyal, MD: Golf is a great activity and usually safe. Anti-inflammatories such as Aleve are typically safe if you do not have history of stomach ulcers or kidney failure. You can take this before and after golf. If symptoms persist, you may want to see a spine specialist

Nico: I played tennis in high school and have just started up again. The lower part of my back is really bothering me. I’ve really enjoyed playing. Do I need to stop altogether?

Kush_K._Goyal,_MD: No. You can play tennis as tolerated. Consider seeing a therapist to strengthen your core. You may want to take Aleve before and after playing. If symptoms continue, I recommend seeing a sports medicine or spine medicine specialist.

Markie58: My daughter has always been a good swimmer and this year joined the swim team. She’s actually very good! After one meet where she swam a 400 IM and 200 fly, her back started hurting her and I don’t think it’s ever really gone away. Any suggestions?

Kush_K._Goyal,_MD: If your daughter is local, we have some therapists in Beachwood who are great at back pain and swimming. Otherwise, she can be evaluated by a sports medicine or spine medicine specialist.

Devon_81: I run between 3 and 6 miles a few times a week. The longest distance I have run is a half marathon about four years ago. I have recently noticed a dull, but nagging pain in my lower back during my longer runs, which usually subsides after stretching and sometimes a couple of Aleve. I have incorporated more core strengthening exercises into my fitness routine, but are there other things I can do to help eliminate/reduce the pain? Could it be posture related? It doesn't seem to happen on shorter distance runs. Thanks so much!

Kim_Gladden,_MD: Pain in the back can be related to flexibility issues, so it is possible that this is posture related or related to flexibility in the hips and exacerbated by running. I take it from your question that you do not have any "red flag" symptoms of low back pain, such as loss of strength in the legs, abnormal sensations, loss of bowel or bladder, or sudden intractable pain. If it is focused in the low back and alleviated with stretching, consider having a reputable fitness specialist evaluate your running gait as well as your hip and back flexibility and core strength. As always, be seen by a sports medicine physician if there is concern of injury or illness.


GENERAL INFORMATION

pur932: What is facet-mediated pain and sacroiliac joint pain, and what is the relationship to sports spine injury?

Kush_K._Goyal,_MD: Both are common in sports. Sacroiliac joint pain is typically more related to trauma or high impact and occurs in the low back and buttocks, whereas facet-mediated pain is related to repetitive extension of the back and is usually above the belt line. I try to differentiate these two common problems with a good physical exam. You may want to see a spine specialist to differentiate your problem.

surfsUp: Sometimes I have back pain. I’d like to take up yoga or Pilates. Is one better than the other for people with back pain?

Kim_Gladden,_MD: If you have what I would term "mechanical low back pain" or muscle strain, both can be good exercise modalities, but it completely depends on the instructor, as not all are created equal. If you are considering one of these classes, you may want to first see your physician to make sure that there is not an injury to the back that might be worsened with these activities.

If you are cleared to participate, do your homework on the class to understand the level of the class. It may be a good idea to observe prior to taking a class so that you have an idea of what poses and exercises are being done. You can also see how much individual attention the instructor is able to give. I like to take a class with an instructor who is walking around the room watching and correcting the participants, not with one who sees it as their time to work out for an hour.

Sal: We have a family history of back problems on both sides of the family. Most of us have needed an operation at some point. Now our son wants to play football. Is that advisable?

Kush_K._Goyal,_MD: Ninety percent of people have back pain and rarely need surgery. If he doesn't have back pain, I think he can play football. Improving core strength is very important. If you have more questions, you may want to see a spine medicine or sports medicine specialist.

Moderator: I’m afraid that’s all the time we have today for questions. Thank you again, Dr. Goyal and Dr. Gladden, for your time this afternoon and for all of the great information you provided about spinal sports injuries.


For Appointments

To make an appointment with Kim Gladden, MD, or any of the other specialists in our Center for Sports Health at Cleveland Clinic, please call 877.440.TEAM. You can also visit us online at sports-health.org.

To make an appointment with Kush Goyal, MD, or another medical spine specialist, please call 866.588.2264. You can also visit us online at the Center for Spine Health.

For More Information

On Cleveland Clinic

The Center for Sports Health at Cleveland Clinic is a unique center within the Department of Orthopaedic Surgery. It brings together top orthopaedic surgeons, sports and exercise medicine physicians, physician assistants, physical therapists, athletic trainers, registered dietitians, radiologists and exercise physiologists to keep athletes in the game.

We believe all athletes deserve the very best sports-related care and treatment that’s one-on-one and state-of-the-art. At Cleveland Clinic Center for Sports Health, this involves conditioning to become stronger and faster, maximizing abilities, treating injuries if they do occur and improving future performance.

Our experts treat athletes in all sports, all ages and skill levels. As a patient, you have access to the same specialists who treat Cleveland’s professional sports teams and the orthopaedic program ranked #3 in the nation by U.S. News & World Report.

Each year, the experts at the Center for Spine Health at Cleveland Clinic help thousands of patients with conditions of the back and neck, ranging from the most common to the most complex. Whether your goal is to get back to sports, work, hobbies or just enjoying life, the specialists at the Center for Spine Health can help.

Our specialists are nationally recognized in orthopaedic surgery, neurosurgery and medical spine, and provide patients with the latest, most innovative, most effective medical and surgical treatments available for back and neck conditions.

Cleveland Clinic’s Center for Spine Health services run the gamut of spine care, including:

  • Acupuncture
  • Interventional spine therapies
  • Mature spine care
  • Medical spine evaluation and treatment
  • Pediatric and adolescent spine care
  • Rehabilitation and physical therapy
  • Spinal and pelvic manipulation
  • Spine injury prevention
  • Spine surgery
  • Spine wellness
On Spinal Sports Injuries

Learn more about symptoms, causes, diagnostic tests and treatments for spinal injuries at:

Back Strains & Sprains
http://my.clevelandclinic.org/disorders/Back_Pain/hic_Back_Strains_and_Sprains.aspx

The Spinal Cord and Injury
http://my.clevelandclinic.org/disorders/Spinal_Cord_Injury/hic_The_Spinal_Cord_and_Injury.aspx

For additional health information, visit clevelandclinic.org/health.

Cleveland Clinic Treatment Guide
Please use this guide as a resource to learn about the causes of back pain and your treatment options. As a patient, you have the right to ask questions and seek a second opinion http://pages.clevelandclinic.org/back-pain-index.html.

Clinical Trials
For additional information about clinical trials, see https://clinicaltrials.gov/.

On Your Health
MyChart®: Your Personal Health Connection is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 8+\66.915.3383 or send an email to: mychartsupport@ccf.org.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.

Contact Information

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