Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
Middle aged adults who do even a small amount of regular strength training exercise may be lowering their risk of so-called metabolic syndrome – itself a risk factor for both heart disease and diabetes, a recent study suggests.
People with at least three unfavorable health stats from a list that includes large waist size, high blood pressure or triglycerides, high blood sugar or low “good” cholesterol are said to have metabolic syndrome, and are at increased risk of going on to develop diabetes, heart disease or both.
But researchers found that when generally healthy people did strength-building exercise for less than an hour a week they had 29 percent lower odds of developing metabolic syndrome than their peers who did no resistance exercise.
“You already get health benefits with even a low amount of resistance exercise per week, which is good news for people with a very busy lifestyle,” said lead author Esmee Bakker of Radboud University Medical Center in Nijmegen, The Netherlands.
An estimated one-third of U.S. adults have metabolic syndrome, the authors write in Mayo Clinic Proceedings. Although previous studies have reported how aerobic exercise, such as running, walking and swimming, reduce metabolic syndrome, few studies have looked at resistance exercise alone.
The U.S. government’s Physical Activity Guidelines for Americans suggest that adults should do “muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week” and aerobic exercise 150 or more minutes each week.
“A modest amount of resistance exercise, such as two 30-minute sessions per week, has beneficial effects,” Bakker told Reuters Health by email. “We think that resistance exercise, in addition to aerobic exercise, should be included in standard medical recommendations to prevent metabolic syndrome.”
Bakker and colleagues analyzed data on more than 7,400 people who participated in medical examinations at the Cooper Clinic in Dallas, Texas, between 1987 and 2006. They ranged in age from mid-30s to mid-50s at the time of their examinations.
The research team found that 1,147 participants, or 15 percent, had developed metabolic syndrome during the follow-up period. Meeting the resistance exercise guideline of two or more days per week reduced risk of metabolic syndrome by 17 percent overall, compared to doing no resistance exercise. Those who met both aerobic and resistance training guidelines had a 25 percent lower risk of developing metabolic syndrome.
“This result was independent of other healthy behaviors, such as not smoking,” Bakker said. “It also made little difference if people did resistance exercise only on weekends or spread throughout the week.”
Bakker and colleagues plan to study the effect of resistance training on other health outcomes, such as the heart health benefits of a one-year resistance exercise training program. They also want to examine the long-term effects of different types and intensities of strength training on metabolic syndrome.
“The real next step is to see how we can get people to exercise,” said Paul Thompson of the University of Connecticut in Hartford, who wasn’t involved with the study.
“We can talk about the right dose and intensity, but it’s clear that in most studies, doing something is better than nothing,” he told Reuters Health by phone. “Most people do nothing, and the key is to get them to do anything.”
One limitation of the study is that it relies on self-reported survey data, which could bias the results. Thompson also cautions that some patients of the Dallas clinic are relatively more affluent than the rest of the country, so the results might not apply more generally.
“The increasing American girth has increased metabolic syndrome, which leads to insulin resistance and makes it harder for insulin to work,” he noted.
Thompson is studying how exercise affects people who have a tendency toward metabolic syndrome and ways they can work against a genetic disposition toward diabetes and hypertension, for example.
“Everybody should have some exercise,” he said. “Play with the dog or grandkids, do yard work or go for a walk. Just do something for 30 minutes every day.”
People who complain that they only have to smell food to gain weight may be right. Researchers at the University of California, Berkeley, found that obese mice who lost their sense of smell also lost weight. That part of the study was no surprise. But the strange part of the study found that mice that retained their sense of smell ballooned to twice their normal weight by eating the same amount of fatty food as the mice with no sense of smell.
Stranger still is that mice with a superior sense of smell gained even more weight on the same high-fat diet than the mice with a normal sense of smell.
The findings, which were published in the journal Cell Metabolism, suggest that the odor of what we eat may play an important role in how the body deals with calories. If you can’t smell your food, you may burn it rather than store it. But simply being able to smell your food may pack on the pounds.
Scientists know that humans who lose their sense of smell due to age, strokes, or diseases such as Parkinson’s, often become anorexic. They theorized that the loss of pleasure in eating can lead to depression, which can cause loss of appetite. But the new study suggests that the loss of smell itself plays a role in how the body uses energy.
For the study, researchers used gene therapy to destroy olfactory neurons in the noses of adult mice. They spared stem cells, however, so that the loss of smell was only temporary and lasted for about three weeks before the olfactory neurons re-grew.
The smell-deficient mice rapidly burned calories by reregulating their sympathetic nervous system, which is known to increase fat burning. The mice turned their beige fat cells, the subcutaneous fat storage cells that accumulate around our thighs and midriffs, into brown fat cells, which burn fatty acids to produce heat.
Some mice turned almost all of their beige fat into brown fat, becoming lean, mean fat-burning machines.
In these mice, white fat cells — the storage cells that cluster around our internal organs and are associated with many health problems — also shrank in size.
Although it would be a drastic step to eliminate smell in humans wanting to lose weight, Andrew Dillin, senior author of the study, said it might be a viable alternative for the morbidly obese contemplating stomach stapling or bariatric surgery.
“For that small group of people, you could wipe out their smell for maybe six months and then let the olfactory neurons grow back, after they’ve got their metabolic program rewired,” he said.
One problem is that the loss of smell was accompanied by a large increase in levels of the hormone noradrenaline, which is a stress response tied to the sympathetic nervous system. In humans, such a prolonged rise in this hormone could cause a heart attack.
But stomach stapling and bariatric surgery are also associated with problems. A study published in Surgery for Obesity and Related Diseases found that one in five patients who undergo bariatric surgery for weight loss is likely to develop problems with alcohol.
It’s high season for grilling and backyard barbecues, with July 4 celebrations planned across the country. But experts say it’s important to be aware that the popular summer pastime is riddled with minefields when it comes to health and food safety.
“Grilling is generally a healthy way to cook food if you take certain precautions,” says registered dietitian Joan Salge Blake, an associate professor at Boston University’s Sargent College of Health and Rehabilitation Sciences.
Here are some tips from Blake and other experts:
Avoid food contamination: Mixing cooked food with juices from raw meat is a big no-no. “When it comes to food safety, we have to be careful about cross-contamination,” Blake tells Newsmax Health. “People bring the raw meat out on a platter, grill it and then put it back on the same platter without washing it. That’s how you can transfer pathogens that can cause a range of food-borne illnesses.”
Use a thermometer: You can’t trust your eyes to tell you whether or not meat is cooked enough. “One in four hamburgers turn brown prematurely, before they are at a safe internal temperature to be consumed,” says Blake. “Rather than trust our vision to determine if food is safe to eat, use a meat thermometer and make sure the internal heat is at least 165 degrees Fahrenheit.”
Keep the flame down: Cooking with high heat from an open fire creates carcinogenic compounds in beef, pork, poultry, and seafood. So while that flame-licked steak or salmon may have a great grilled flavor, it also contains heterocyclic amines (HCAs) from the charred part and polycyclic aromatic hydrocarbons (PAHs) from the fire’s smoke. Lab studies suggest that they can cause mutations in DNA that may boost the risk of cancer.
Pre-cook meat: One way to reduce HCAs and PAHs is to partially cook meat — by boiling or microwave — before grilling it. That will reduce the time it is exposed to the high heat and smoke that creates these dangerous compounds.
Flip frequently: “You want to keep turning the meat to keep it from getting charred, because that’s where the [biggest] problem is,” says Blake. “If it does get charred, don’t eat that part.” Aim to flip grilled foods at least once a minute.
Foil flare-ups: One thing that can make the flame flare up is when fat from the meat drips down to the heating source. Blake suggests putting some foil down on the grill, which will keep the melted fat from hitting the flame.
Use marinade: Studies show that marinades can significantly reduce the HCAs and PAHs in grilled meat. Researchers believe it works by helping to keep the meat moist, and it can also improve flavor. One study showed that using the herb rosemary lowered HCA levels by 90 percent. Other things that can cut down on the bad compounds are garlic, onion and honey.
Watch your sauce: Blake warns not to use the leftover marinade for a sauce on the grilled meat, unless you cook it as well, because it could contain bacteria and other pathogens from the raw meat.
Grill veggies: “One of the best things you can do for overall health is to grill more vegetables than protein sources,” says Blake. “They don’t produce HCAs and PAHs, and they have a wide range of health benefits.”
Be fire smart: The most obvious health threat of grilling is the fire itself. According to the National Fire Prevention Association, about 9,000 blazes are sparked by grills every year, causing an average of 10 deaths, 160 injuries and more than $100 million in property damage.
Using common sense can reduce fire risks. The NFPA cites the main fire causes as placing the grill too close to anything that can burn, not cleaning it regularly, and leaving it unattended. If you’re using a propane grill, don’t turn the gas on for too long before lighting it. You should also check lines and connections for leaks.
UK research has revealed that many middle-aged office workers are as sedentary as elderly pensioners.
Carried out by the University of Edinburgh’s Physical Activity for Health Research Centre, the team gathered data on 14,367 people in Scotland taken from the 2012-14 Scottish Health Survey, to look at how age and sex affected weekday and weekend sedentary time.
Defined as time spent in any waking activity done while sitting or reclined, sedentary time includes working, eating, reading, watching TV, or spending time on a computer.
Many recent studies have looked at the effects of sedentary time on health, with some experts warning that more than seven hours of inactivity a day can increase the risk of cardiovascular disease, type 2 diabetes, some cancers, and an early death, even if people are physically active at other times of the day.
The results of the new research found that men aged 45 to 54 spend on average 7.8 hours per weekday sitting down, compared with 7.4 hours for the over-75s.
Time spent sitting at work is the main reason for their sedentary time.
The team also found that only the youngest group of men — 16 to 24-year-olds — are significantly less sedentary than the over-75s on weekdays.
Most of the time spent sedentary in this age group is spent in front of a TV or screen.
At the weekend, those aged 25 to 54 were the least sedentary, sitting for between 5.2 and 5.7 hours a day, and in contrast the over 75s were the most sedentary, at 7.3 to 7.4 hours a day.
In addition, the researchers also found that men spend less time in front of a screen as they get older, with women peaking in middle-age.
The results now replace previous findings that older adults are the most sedentary age group in the UK and highlights the potential health risks of excessive sitting at work.
“Large parts of the population are dangerously sedentary, something we have underestimated. We need to tackle high levels of sedentary time in early and middle age, when patterns may develop. Our findings suggest that changing habits in the workplace could be an appropriate place to start, given how much time we spend sitting there every day,” commented one of the study’s authors Tessa Strain.
The findings were published in the Journal of Sports Sciences.
In the first part of this 2-part series, chiropractor, Dr. Alexander Jimenez looked at the likely signs and symptoms of disc Herniation, in addition to the selection standards for micro-discectomy surgery in athletes. In this report he discusses the lengthy rehab period following a micro-discectomy procedure, and provides a plethora of strength based exercises.
Surgeries to ease disc herniation, with or without nerve root compromise, comprise traditional open discectomy, micro-discectomy, percutaneous laser discectomy, percutaneous discectomy and micro- endoscopic discectomy (MED). Other surgical conditions are employed in The literature like herniotomy that’s interchangeable with fragmentectomy or sequestrectomy. The saying ‘herniotomy’ is defined as removal of the herniated disc fragment just, and the ‘standard discectomy’ as elimination of the herniated disc along with its degenerative nucleus in the intervertebral disc space.
When surgery is required, minimizing tissue disruption and strict adherence to an aggressive rehabilitation regimen may expedite an athlete’s return to perform(1), that explains why micro discectomy is a favored surgical procedure for athletes. Micro discectomy procedures entails Removing a small part of the vertebral bone over a nerve, or removing the fragmented disc stuff from under the compressed nerve root.
The surgeon can then enter the spine by removing the ligamentum flavum that insures the nerve roots. The nerve roots can be visualized with functioning eyeglasses or with an operating microscope. The surgeon will then move the nerve to your side and to subsequently remove the disc material from beneath the nerve root.
It’s also sometimes required to eliminate A small portion of the related facet joint to permit access into the nerve root, and additionally to relieve pressure on the nerve root resulting in the facet joint. This procedure is minimally invasive since the joints, muscles and ligaments are left intact, and the process doesn’t interfere with the mechanical construction of the spinal column.
Endoscopic Lumbar Discectomy
Local Doctor performs lumbar discectomy using minimally invasive techniques.�From the El Paso, TX. Spine Center.
Surgical Outcomes
In general, athletes with lumbar disc Herniation have a favorable prognosis with traditional therapy; more than 90 percent of athletes using a disc herniation improve with non-operative treatment. Many demonstrate a response to conservative treatment with increased pain and sciatica within 6 weeks of the initial onset(2). This implies that the requirement to function immediately could be considered hasty.
However, in case of failed Conservative therapy, or together with the pressure of a significant upcoming competition, surgery might be needed in some instances. Even though it involves surgical therapy, micro-discectomy has been reported to have a high success rate — over 90 percent in some studies(3,4). Patients generally have hardly any pain, are able to return to preinjury activity levels, and therefore are subjectively happy with their results.
The achievement rate of micro-discectomy is The following studies have been summarised to underline the success rate of micro-discectomy procedures:
1. In a survey on 342 professional athletes Diagnosed with lumbar disc herniation in sports like hockey, football, basketball and baseball, it was discovered that powerful return to perform occurred 82% of this time, and 81 percent of surgically treated athletes returned for an additional average of 3.3 years(5).
2. From a limb paresis which might be associated with a disc herniation following surgical treatment. If the preoperative paresis was mild then they could anticipate an 84% likelihood of full recovery. Patients with more severe paresis have less chance of recovery (55%)(6).
3. Wang et al (1999) in a study on 14 athletes demanding discectomy processes found that in single degree disc procedures, the return to game was 90%. However when the procedure involved 2 levels enjoyed considerably less favorable results(7).
4. In a study of 137 National Football League players with lumbar disc herniation, surgical treatment of lumbar disc herniation led to a significantly more career and greater return to play rate than those treated non-operatively(8).
5. Schroeder et al (2013) reported 85% RTP rates in 87 hockey players, with no substantial difference in outcomes or rates between the surgical and nonsurgical cohorts(9).
6. A study by Watkins et al (2003) coping with professional and Olympic athletes revealed the acceptable outcomes of micro-discectomy concerning return to play, since elite athletes in general were highly encouraged to return to perform(10). Also, athletes who had single-level micro- discectomy were more likely to come back to their original heights of sports activities than were people who’d two-level micro- discectomies.
7. A study by Anakwenze et al (2010) investigating open discectomy at National Basketball Association participants demonstrated that 75% of patients returned to perform again compared with 88 percent in control subjects who did not undergo the operation(11).
8. A recent review found that conservative therapy, or micro-discectomy, in athletes using lumbar disc herniation seemed to be satisfactory concerning returning the injured athletes into their initial levels of sports activities(12).
These studies conclude that though a Analysis of lumbar disc herniation has career-ending potential, most gamers have the ability to return to play and generate excellent performance-based outcomes, even if surgery is required.
What is also apparent from research Studies is the level of this disc herniation can also determine prognosis after surgery. Athletes shower a greater difference in progress between surgical and non-operative treatment for upper amount herniations (L2-L3 and L3-L4) compared to herniations at the L4-L5 and L5-S1 levels. Patients using the upper level herniations needed less progress with non-operative treatment and marginally better operative outcomes than those with lower degree herniations(13).
There are several possible explanations A range of studies have revealed that low spinal canal cross-sectional area is associated with an increased likelihood of symptomatic disc herniation, and increased intensity of herniation symptoms. The spinal cross-sectional region is the smallest (thus contains a larger possibility of nerve compromise) at the most upper posterior section and the cross-sectional region increases further down to the lower lumbar spine(14).
The location of the disc herniation�(foraminal, posterolateral or central) may also contribute to differences.�In this study, upper lumbar herniations were more likely to happen in the much lateral and foraminal positions than were people in the lower two intervertebral degrees(13).
Post-Surgical Rehab
After micro-discectomy surgery, the Small incision and restricted soft tissue injury makes it possible for the patient to be ambulatory reasonably fast, and they’re usually encouraged to start rehabilitation sooner or later during the 2-6 weeks after surgery.
In a review on the efficacy of busy Rehabilitation in patients following lumbar spine discectomy, it may be reasoned that individuals can safely take part in high or low-intensity supervised or home-based exercises initiated at 4 to 6 weeks following first-time lumbar discectomy(15).
Herbert et al (2010) discovered that with Effective post-surgical rehabilitation plans, there was a key accent on lumbar stabilisation exercises(16). Second, positive trials tended to initiate rehabilitation earlier in the postoperative interval compared to negative trials (about 4 vs 7 weeks).
Outcome Measures
The most widely used result Measure following back injury and/or disc surgery is the Oswestry Disability Questionnaire(17). This questionnaire is reported to have good levels of test-retest reliability, responsiveness, and also a minimum clinically important difference estimated as 6 percent(18) Furthermore, treatment success has been defined as a 50 percent decrease in the Modified Oswestry Disability Questionnaire score(19).
Concerning physical performance measures following back disc or pain operation, a commonly used clinical examination is that the Beiring-Sorensen Back Extension examination (see Figure 1)(20). This test is performed in a prone/horizontal body position with the spine and lower extremity joints at neutral position, arms crossed at the chest, lower extremities and pelvis supported with the top back unsupported against gravity.
Rehabilitation Program
Presented below is a five-stage rehabilitation program. The stages involved in rehabilitation are:
1. Optimize tissue healing — protection and regeneration
2. Early loading and foundation
3. Progressive loading
4. Load buildup
5. Maximum load
This program has been designed to get a field hockey player with had a L5/S1 lumbar spine discectomy. Even though the progressions from one point to the next are driven by the exit standards related to that stage, it might be anticipated that the athlete could progress in post-surgery to ‘fit to compete’ in about 12-13 weeks.
In this phase it’s anticipated that the athlete will remain relatively quiet for 2-3 weeks post surgery. This allows for full tissue recovery to happen, including scar tissue maturation. The athlete is allowed to completely mobilize in full weight-bearing; however care needs to be taken using any flexion and rotation motions and no lifting will be allowed.
The athlete can begin with the physiotherapist with the objective to manage any gluteal and lumbar muscle trigger points and start�nerve mobilization techniques that show how to engage the TrA and LM muscles (see Figures 2a and 2b).�If the physiotherapist has access to your muscle stimulator (Compex), then this can be utilized in atrophy manner on the lumbar spine multifidus and erector spinae. The key criteria to exit this early phase are curable walking as well as also an Oswestry Disability Score of 41-60%.
Early Loading & Foundation
The primary feature of this phase is that the athlete can start early and low-load strength exercises focusing on muscle activation in a neutral spine position, along with a progressive selection of motion program to improve lumbar spine flexion, extension and rotation. In this stage that the physiotherapist will guide the athlete through safe and gentle stretches to your hip quadrant muscles like the hip flexors, gluteals, hamstrings and adductors. The athlete also lasts gentle neuro-mobilization exercises to advance the freedom of the sciatic nerve — an issue in this condition as neurological tethering is a chance as a result of scar tissue formation caused by the surgical procedure.
The athlete can also be encouraged to start hydrotherapy in the form of walking in water (waist high) along with swimming fitnesscenter. In addition, he/she must start a string of low degree muscle activation drills in this stage (see Figure 3) that can be performed every day. This exercise teaches the athlete to hip flex (fashionable hinge) whilst maintaining a neutral spine. The neutral spine is maintained by using a light broomstick aligned with the back with the touch points being the occiput, the 6th thoracic vertebrae (T6) and the posterior sacrum.
Progressive Loading
In this phase the athlete continues with a variety of movement progression along with the physiotherapist progresses manual therapy to the pelvis and lumbar spine. Neuro-mobilization techniques can also be progressed. The significant change in this phase is that the progression of load on many of the strength and muscle control exercises.�Two exercises here are the �standing twisties� and the �crook lying pelvic rotation� exercise (Figures 4 and 5).�These movements are the introductory spinning based movements. The primary progression about fitness drills is the athlete can begin pool running drills.
Load Accumulation
This is the stage where the athlete begins to advance the load in strength-based exercises. Resistance is used in the form of barbell load and band resistance. Three exceptional exercises performed here are the ‘kneeling hip thruster’, ‘deadbug antirotation press’ and also the ‘quadruped walkout’ (Figures 6-8 — explained in detail in the online database of exercises).
The athlete also begins running drills at this phase and it might be expected that as well as building running Amount, the athlete should progress over four weeks to close to full sprint speeds. This is also the stage whereby they would initiate mild to moderate sports special skills drills. Another characteristic of this stage is that the athlete starts the ‘Sorensen test’ exercise (Figure 9) and it will be expected that they can maintain the position for no less than 90 seconds before advancing to the next phase.
Maximum Load
In this final stage, the athlete spreads all core and strength exercises to maximum loads, and they work with the fitness trainer on coming to squat and functional fitness center lift movements. Skill progression can also be advanced alongside sprint and agility drills. The last exit standards prior to advancing to endless strength and training work is they have to keep the ‘Sorensen test’ for 180 seconds and their self documented Oswestry scale ought to be someplace between 0-20%.
Obesity is not only an epidemic for the human race. One third of dogs and cats also suffer from it, according to a new American study. A lack of exercise, overfeeding and genetics are all contributory factors.
According to this American study published recently by Banfield Pet Hospital, the number of overweight and obese cats rose by 169% in the US over the past 10 years. For dogs, the increase was 158%. And the numbers are still trending upwards.
The survey analyzed data gathered on 2,521,832 dogs and 505,389 cats based on visits and checks made at veterinary clinics across the country. Almost 30% of the dogs and 33% of the cats seen during these visits were overweight or obese.
The main causes are a lack of exercise and too much food. A genetic predisposition can also be a factor, as some breeds of dogs and cats are more likely to become obese. Pets that have been sterilized also have an increased risk of gaining weight, as hormonal changes can boost their appetite and make them less inclined to play and take a walk.
Obesity has consequences for animal health. It raises the risk of type 2 diabetes, arthritis and heart disease.
Banfield Pet Hospital says that up to the age of 4 months, a kitten should be fed 4 times a day, and then 3 times daily when it is aged between 4 and 6 months. After that, feeding should be no more than twice a day. For dogs, it varies according to the animal’s size, age, physical condition and how active it is.
The study warns against the common attitude of giving treats to a dog or filling its bowl out of love or guilt for leaving it home alone. Portion size is also a problem, as it is often too generous.
Banfield Pet Hospital advises that the ideal weight for a dog or cat is when you can feel the animal’s ribs without being able to see them. If the animal is 10% above its correct weight, its ribs are no longer visible and cannot be felt, and if it is 20% above, no waist can be seen. Anywhere above the 20% mark is considered to be obese.
Only sport and a diet should be used to lower a pet’s weight.
Obesity also affects other types of pets. A British study in 2014 undertaken by the Pet Food Manufacturing Association revealed that 28% of pet rodents were obese and 15% of indoor birds.
And awareness can be an issue. In France, a 2010 survey by BVA/Gamm Vert revealed that only 13% of pet owners thought that their dog had a weight problem.
Chiropractor, Dr. Alex Jimenez looks at lumbar spine disc herniation. What are the Likely signs and symptoms associated with disc herniation, and what would be the selection criteria for micro-discectomy operation in athletes? Complaint in the young college age athlete and professional athlete, and it’s been estimated that over 30% of athletes complain of back pain at least once in the profession(1).
Lumbar spinal disc herniation is one kind Of lumbar injury that can’t just cause painful low back pain, but can also compress nerve roots and create radicular referral of pain into the lower leg with related sensation changes and muscle contraction. This injury will not only influence the short-term opponent ability of the athlete, but might also reoccur and eventually become persistent possibly causing a career ending injury.
Managing disc herniation from the athlete Usually begins with conservative therapy and if this fails, surgical solutions are considered. But often elite athletes will request a quicker resolution to their symptoms to minimize time away from competitors. Therefore, providing the criteria for lumbar spine surgery are suggested, the conservative period will often be compressed, and surgery will be sought earlier. The favored surgical process for the athlete with a disc herniation is that the lumbar disc micro-discectomy.
Anatomy & Biomechanics
A significant biomechanical role in the spine, allowing for motion between the spinal segments while spreading compressive, shear, and torsional forces(2). These discs include a thick outer ring of fibrous cartilage termed the annulus fibrosis (akin to the onion rings enclosing the center of the onion), which encompasses a more gelatinous core called the nucleus pulposus, which is included within the cartilage end plates inferiorly and superiorly.
The intervertebral disc consists of Cells and substances such as collagen, proteoglycans, and thin fibrochondrocytic tissues, which enable transmission and absorption of forces arising from body weight and muscle activity. To do so, the disc depends mainly on the structural condition of the nucleus pulposus, annulus fibrosis and the vertebra lend plate. If the disc is normal and is functioning optimally, then forces are spread across the disc evenly(3).
But disc degeneration (mobile Degradation, lack of hydration( disc failure) may decrease the capacity of the disc to withstand extrinsic forces, as forces are no longer distributed and spread evenly. Tears and fissures from the annulus can lead, and with adequate external forces, the disc material may herniate. Alternatively, a sizable biomechanical force set on a healthy, ordinary disc may cause extrusion of disc material as a result of crushing failure of this annular fibers — illustrations include a hefty compression type mechanism because of a fall on the tailbone, or strong muscle contraction such as heavy weight lifting(4).
Herniations represent protrusions of Disc material beyond the confines of this annular lining and in the spinal canal (see Figure 1)(5). If the protrusion does not invade the canal or undermine nerve roots then back pain may be the only symptom.
Endoscopic Discectomy 3D Simulation
The pain associated with lumbar Radiculopathy happens due to a mix of nerve root ischemia (due to compression) and inflammation (because of neurochemical inflammatory mediators released from the disc). Throughout a herniation, the nucleus pulposus puts pressure on weakened regions of the annulus, and proceeds through the diminished websites in the annulus in which it ultimately forms a herniation(6 ft). It follows from this that some kind of disc degeneration may exist prior to the disc may really herniated(7).
In contrast to other respiratory Tissues, discs have a inclination to degenerate earlier in life, with some studies demonstrating adolescents presenting signs of degeneration between the ages of 11 to 16(8). With increasing age, there’s further degeneration of the intervertebral discs.
While the disc might be in danger of harm in All fundamental planes of motion, it’s particularly susceptible during repetitive flexion, or hyper-flexion, combined with lateral bending or rotation(10). Traumatic events such as excessive axial compression may also damage the inner structure of the disc. This can occur as a result of a fall or powerful muscular forces developed during tasks such as heavy lifting.
Athletes are generally exposed to high loading conditions. Examples of this include:
1. World-class power lifters, in which the calculated compressive loads on the backbone are involving 18800 Newtons (N) and also 36400N acting in the L3-4 motion segment(11).
2. Elite level football linesmen who have Been proven to present time-related hypertrophy of this disc and changes in vertebrae endplate in response to this repetitive high loading and axial pressure(12).
3. Long distance runners have been Shown to undergo significant strain into the intervertebral disc, indicated by a reduction in disc height(13).
Herniations could be classified depending on Ultimately, herniations are also identified based on level, with most herniations happening at the L4/5 and L5/S1 intervertebral disc level; these can then in turn affect the L5 and S1 nerve roots resulting in clinical sciatica(15). Upper level herniations are less common, and when they do occur with radiculopathy, they will affect the femoral nerve. Finally, the prevalence of disc injury rises increasingly caudally, with the best numbers at the L5/S1 degrees(16).
Herniation In Athletes
The offending movements implicated in The 20-35 age group are the most common group to herniate a disc, most likely because of the fluid nature of the nucleus pulposis and due to behavior(18). This age group are more likely to participate in sports which need high lots of flexion and spinning or are reckless with their positions and positions during loading.
The sports most at risk of disc herniation are:
Hockey
Wrestling
Soccer
Swimming
Basketball
Golf
Tennis
Weightlifting
Rowing
Throwing events
These are the sports that involve either significant Furthermore, those who take part in more and more severe training regimes seem to be at higher risk of spinal pathologies, as do people involved in sports.
Signs & Symptoms Indicating Discectomy
The efficacy of management programs for lumbar spine disc herniation — in terms of the decision to operate or treat conservatively — will be discussed in greater depth in part 2 of this series. However, the decision to operate within an athlete is generally driven by the motivation and approaching goals the athlete has put themselves. They may in fact favor a comparatively simple micro-discectomy instead of waiting for symptoms to abate through an extended period of rehabilitation.
This conservative period of Management may involve medicine therapy, epidural injections, relative back and back muscle recovery, acupuncture, osteo/chiropractic interventions. On the other hand, the normal presenting symptoms and signs that suggest a substantial disc herniation that will require surgical intervention in the athlete comprise:
Low back pain with pain radiating down one or both legs
Positive straight leg raise test
Radicular pain and neurological signs consistent with the nerve root level affected
Mild weakness of distal muscles such as extensor hallucis longus, peroneals, tibialis anterior and soleus. These would fit with the myotome relevant for the disc level
MRI confirming a disc herniation
Possible bladder and bowel symptoms
Failed conservative rehabilitation
Time span in which to enable conservative rehabilitation to be effective. In the overall population, medical practitioners will most likely prescribe a minimal 6-week traditional period of treatment with an overview at 6 weeks as to whether to expand the rehabilitation a further 6 weeks or to seek a specialist opinion. The expert may then attempt more medically orientated interventions such as epidural injections.
The athlete nevertheless will have these They might be more inclined to experience an epidural very early in the conservative period to assess the effectiveness of this procedure. If no signs of progress are evident in a couple of weeks then they may choose to get an immediate lumbar spine micro- discectomy.
Endoscopic Lumbar Discectomy
Local Doctor performs lumbar discectomy using minimally invasive techniques. From the El Paso, TX. Spine Center.
Imaging
MRI remains the favored system of Identifying lumbar spine disc herniation, since it’s also very sensitive to detecting nerve root impingements(23). However, abnormal MRI scans can occur in otherwise asymptomatic patients(25); hence, clinical correlation is always essential before any surgical thought. What’s more, patients can present with clinical signs and symptoms which suggest the diagnosis of acute herniated disc, and yet lack evidence of sufficient pathology on MRI to warrant operation.
Therefore it has been proposed that a Volumetric analysis of a herniated disc on MRI may be potentially beneficial in checking the suitability for operation. Several writers have previously mentioned the possible value of volumetric evaluation of herniated disc on MRI as part of their selection criteria for lumbar surgery(26).
In a survey conducted in Michigan State University, it was found that the size and positioning of the herniated disc determined that the likelihood for operation with what researchers called ‘types 2-B’ and ‘types 2-AB’ being the most likely candidates for surgery(27).
The MRI protocol to your lumbar spine consists of (see Figure 2)
1.Sagittal plane echo T1- weighted sequence
2. Sagittal fast spin echo proton density sequence
3. Sagittal fast spin echo inversion recovery sequence
4.Axial spin echo T1- weighted sequence
Summary
Disc herniations are not a common Complaint in athletes, but they do happen in sports which involve high loads or repetitive flexion and rotation movements. Sufferers of a disc herniation will normally feel focused low-back pain, maybe with referral in the lower limb with associated neurological symptoms if the nerve root was compressed.
Managing a disc herniation within an General population as frequently the risk of a Protracted failed rehabilitation period is Bypassed for the protected and low risk Micro-discectomy procedure. In the Discuss the exact surgical alternatives involved Observing a lumbar spine micro-discectomy.
References
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In this phase it’s anticipated that the athlete will remain relatively quiet for 2-3 weeks post surgery. This allows for full tissue recovery to happen, including scar tissue maturation. The athlete is allowed to completely mobilize in full weight-bearing; however care needs to be taken using any flexion and rotation motions and no lifting will be allowed.
Early Loading & Foundation
The primary feature of this phase is that the athlete can start early and low-load strength exercises focusing on muscle activation in a neutral spine position, along with a progressive selection of motion program to improve lumbar spine flexion, extension and rotation. In this stage that the physiotherapist will guide the athlete through safe and gentle stretches to your hip quadrant muscles like the hip flexors, gluteals, hamstrings and adductors. The athlete also lasts gentle neuro-mobilization exercises to advance the freedom of the sciatic nerve — an issue in this condition as neurological tethering is a chance as a result of scar tissue formation caused by the surgical procedure.
Progressive Loading
In this phase the athlete continues with a variety of movement progression along with the physiotherapist progresses manual therapy to the pelvis and lumbar spine. Neuro-mobilization techniques can also be progressed. The significant change in this phase is that the progression of load on many of the strength and muscle control exercises.�
Load Accumulation
This is the stage where the athlete begins to advance the load in strength-based exercises. Resistance is used in the form of barbell load and band resistance. Three exceptional exercises performed here are the ‘kneeling hip thruster’, ‘deadbug antirotation press’ and also the ‘quadruped walkout’ (Figures 6-8 — explained in detail in the online database of exercises).
The athlete also begins running drills at this phase and it might be expected that as well as building running Amount, the athlete should progress over four weeks to close to full sprint speeds. This is also the stage whereby they would initiate mild to moderate sports special skills drills. Another characteristic of this stage is that the athlete starts the ‘Sorensen test’ exercise (Figure 9) and it will be expected that they can maintain the position for no less than 90 seconds before advancing to the next phase.
