EDITORIAL: Touching the Patient by Rob Nied, MD

At the 2014 Australian Open, Stan Wawrinka became the first man since 2009 to win a Grand Slam tennis tournament outside the Big Four of Federer, Djokovic, Murray and Nadal. In the championship match, he beat Nadal, who was suffering from a back injury. How much low back pain factored into the loss, only Rafa knows for sure. Certainly the 90% of us who have experienced this type of pain can imagine how limiting it might have been. In fact, low back pain is the number one cause of disability in the United States, with an estimated $100 billion annual cost for lost work and wages. For Nadal, the difference between the winner and first runner-up prize money was $1.3 million.

Does sports participation cause low back injuries? A recent study reviewing injury data from professional tennis players competing in the US Open from 1994 to 2009 did not find a significant increase in low back injuries, despite increases during those years in game intensity, higher rotational velocity serves, and longer playing seasons.¹ In fact, NCAA injury surveillance has found that only 2% of all sports-related injuries in college athletes are to the low back. Some of these are traumatic injuries, such as contusions and spondylolysis, but most often athletes suffer from the same common mechanical low back pain as the rest of us.

Degenerative disc disease may be quite common in athletes. In a study of asymptomatic late adolescent elite tennis players, none of whom had a history of low back pain, 28 of 33 athletes had significant findings on MRI, including pars interarticularis lesions, facet arthropathy and bulging discs.² Does this mean that sports are particularly hard on the spine or that a “bad back” on imaging does not necessarily correlate with symptoms or athletic limitation? Knowing how common abnormal MRI findings are in the general public, my interpretation is that athletes have the same backs as the rest of us but are better able to control their core forces and motion.

Athletes like a hands-on approach to low back pain. They are very aware of their bodies, and manual therapies tend to work well for them. Deep tissue work and massage have become a standard part of most training regimens. Beyond just “feeling good,” animal research suggests that manual therapy may actually help injured tissues recover faster. In a 2013 Consumer Reports survey, of the 14,000 subscribers who had experienced low back pain in the past year but did not have back surgery, 59% were highly satisfied by the care from their chiropractor, 55% with their physical therapist, and 53% with their acupuncturist.³ Only 34% of respondents were highly satisfied with the treatment offered by their primary care physician. Clearly our patients also appreciate the hands-on healing power of touch—it is better than prescribing a pill. . .

Dr. Nied, a family and sports medicine physician at Kaiser Permanente Santa Rosa, is the immediate past president of SCMA.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

VOM Is an Insider’s View of What Doctors are Thinking, Saying and Writing about