: How does Spine Injuries in Athletes differ from other books on the subject?
Dr. Hecht: Spine Injuries in Athletes is not about surgical techniques, it’s about decision making and evaluation of spine-injured athletes, whether they are a professional, Olympic, collegiate, amateur, or recreational athlete. The focus is on making decisions about treatment and determining when an athlete can return to play, which is often the most challenging aspect of caring for these patients. Spine Injuries in Athletes is intended for all the different types of specialists—orthopaedic sports medicine physicians, sports medicine internists, general orthopaedists, orthopaedic spine surgeons, neurosurgeons, athletic trainers, physiatrists, and physical therapists—who acutely care for spine-injured athletes.
AAOS Now: Have you noticed trends in the types of spine injuries you see in today’s athletes?
Dr. Hecht: Over the years, athletes have been better educated about the importance of avoiding high-risk behaviors. For example, heads-up tackling in football—where players are taught to keep their heads up and lead with their shoulders when tackling—has drastically reduced the number of devastating spine injuries that occur in the sport. In addition, workout routines and strength training regimens across all sports have become more sophisticated, with an increased emphasis on spine safety. The quality of protective gear, such as helmets, has also improved.
Despite these improvements, a significant number of spine injuries still occur in all contact and collision sports. Physicians see plenty of stingers, cervical cord neurapraxias, and disk herniations and fractures in the cervical spine. In addition, lumbar disk herniations and spondylolysis are still two of the most common conditions in young athletes. Overall, however, the number of devastating spine injuries has decreased.
AAOS Now: What is involved in managing athletes with these injuries?
Dr. Hecht: For athletes with a lumbar disk herniation, the first step is to get them pain free. Assuming the patient has a moderate-sized disk herniation with radicular pain and no neurologic deficit, conservative care may involve oral steroids, cortisone shots, or physical therapy. Once an athlete becomes asymptomatic, he or she begins rehabilitation. When athletes can tolerate physical therapy, are able to work with the athletic trainers, and can resume practice, they are often cleared to return to play. However, if an athlete has persistent symptoms, a different pathway will be followed, and this is covered in great detail in the book. Different pathways may also be required in athletes with cervical spine injuries, due to nuances that can occur in cervical spine pathology in athletes. These are also thoroughly addressed in the book.
Concussion is a significant issue in athletes. In Spine Injuries in Athletes, leading experts on concussion explain how to evaluate an athlete with a concussion both on and off the field. The section is edited by the co-chairs of the NFL Brain and Spine Committee. This section also discusses the long-term sequelae of concussion. The book includes information on all the different types of concussion questionnaires and state-of-the-art tools utilized by various sports programs, including the NFL.
AAOS Now: What should physicians keep in mind when treating athletes with spine injuries?
Dr. Hecht: When evaluating an athlete with a spine injury, it’s important to remember that many injuries can be mistaken for spine injuries. For instance, spondylolysis, pelvic stress fractures, trochanteric bursitis, and hamstring pulls, can often be hard to differentiate. Sometimes a shoulder condition can look like a cervical spine problem. When evaluating an athlete with a suspected spine injury, physicians need to ask themselves “What else could this be?” It’s important to approach the patient with the appropriate differential diagnosis.
AAOS Now: Can you explain more about the book—what are some of its features?
Dr. Hecht: Organized in a very practical way, Spine Injuries in Athletes emphasizes the evaluation of the spine-injured athlete, how to make the diagnosis, what the treatment options are, and importantly, when the athlete can return to play. The book includes numerous algorithms, protocols, and images. There are sections on rehabilitation, pharmacologic management, imaging, and differential diagnoses for the athlete with back and leg pain or with neck and arm pain.
The ebook includes videos that demonstrate how to make an on-field evaluation of athletes with a suspected spine injury or concussion. Additional videos show how to safely turn a player who is face-down and wearing a helmet; how to safely remove an athlete’s face mask, helmet, or shoulder pads; and how to safely turn—without slipping or sliding—a hockey player who is face-down on the ice. All of the videos are downloadable to mobile devices so they can be referenced on site.
AAOS Now: Do you have any final thoughts?
Dr. Hecht: It is important to note that all of the book’s contributors are experts in treating spine injuries in athletes. They include spine consultants for many of the NFL, National Basketball Association, Major League Baseball, National Hockey League, and collegiate teams. All of the section editors are experienced spine surgeons who are consultants for one or more professional sports or collegiate teams.
Getting an athlete back to play after a spine injury is truly a collaborative effort. I believe everyone involved in the process—from the physicians to the physical therapists and athletic trainers—will find that Spine Injuries in Athletes is a very valuable resource.
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Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at firstname.lastname@example.org