Back Pain in Gaelic Games – why does it happen & what should be done?

Back Pain in Gaelic Games – why does it happen & what should be done? Blog

The Gaelic Athletic Association (GAA) organizes Gaelic games, the two most prominent games being Gaelic football and hurling. Back pain is not uncommon among the athletes, affecting approximately 2.5% to 15% of those who participate. These athletes are amateurs playing on a voluntary basis, and some research has shown that those who play sports similar to those played in the GAA are more likely to experience back pain if they work in jobs that require periods of physical inactivity.

In general, people who play sports are more likely to receive medical attention than their peers who aren’t involved in sports, short-term recovery is generally poorer than for the general public. For amateur athletes who could potentially lose income due to an injury that causes them to miss work, an effective short-term recovery is essential.

Causes of Back Pain

Back pain has many potential causes. Some of the most common causes include disc bulges, disc degeneration, and disc protrusions. Health care professionals more often see these changes in the lower levels of the spine in athletes than in the general population. In about 5-10% of cases, these changes are associated with significant nerve damage. When nerve damage results in symptoms such as numbness, weakness, or pain in the leg, the damage may be associated with a prolapsed disc.

In as many as 90% of back pain cases, the pain is difficult to locate in one particular area of the lumbar spine. These cases, referred to as non-specific low back pain, are often the result of soft tissue damage. Soft tissue damage can include overland, sprains, or strains of the muscles and/or joints that support the spine at the lower back.

Injuries in the Gaelic Games

GAA athletes who are at increased risk for injury fall into two categories. The first category includes those who must sit still for long periods of time. This includes students who have to sit for exams, for example. The second category includes those whose jobs cause them to place heavy loads on their spines, e.g. exercise professionals, those who work in trades, and members of defence forces. These categories of athletes must take special care to train so as to reduce the risk of injury leading to back pain.

What Can Be Done?

Conditioning to get the athlete into shape for competing in the Gaelic games is the key to preventing back pain. Health care providers can work with athletes to come up with a comprehensive training program that takes prevention into account. Using video analysis is a technique that may be useful in looking for movement tendencies that could increase the risk of spinal sprain or injury. Working together, the athlete and the health care team can created an individualised training plan that increases strength and movement control.

Adding to the difficulty of short-term recovery from back pain in the amateur athlete is mental stress. The anxiety of an upcoming sporting event or of being cut from one’s team due to injuries can have an effect on the player’s recovery process. These issues should be addressed by the health care staff as part of the player’s recovery when injuries do occur. Health care providers can direct injured players toward thought processes that aid in speeding recovery rather than hindering it.

Conclusion

Back pain is relatively common in athletes, but in many cases it can be treated successfully. For the most successful and efficient outcome in an athlete’s short-term recovery, the health care provider must accurately diagnose and treat the player’s symptoms. An individualised training plan that takes into account the player’s lifestyle, work load, movement patterns, and stress levels can help minimise the risk of injury as well as aid in recovery if injuries do occur.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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