Andrew J. Cole

Spine injuries in runners: A functional approach.

Interest and participation in running has increased over the past several decades. There has also been a substantial increase in the incidence and prevalence of injuries associated with running. The etiology of running injuries is multifactorial. Of all the musculoskeletal injuries associated with running, lumbar spine injuries are among the least common - yet can be the most debilitating. The impact load generated during heelstrike travels up the lower extremity kinetic chain and converges on the lumbar spine. This impact load is minimized through a series of normal biomechanical actions of the joints and the soft tissues that support them. Dysfunction at any link in the lower extremity kinetic chain can set off a cascading series of mechanical adaptations throughout the spinal axis. Similarly, spinal pain and dysfunction can create peripheral joint adaptations. These mechanical adaptations may become painful or may create a painful dysfunction at a more distant site. There are a variety of structures in the lumbar spine that can cause pain. Mechanical, vascular, biochemical, and neurochemical factors may also be involved in the production of low back pain and radiculopathy. Running stresses the normal biomechanics of the lumbar spine. Changes in normal tissue function including strength, strength balance, flexibility, and proprioception may be caused by these stresses or be the cause of them. New adaptive functional running patterns occur. A thorough rehabilitation plan that addresses all aspects of the injury requires an accurate and complete diagnosis that is made as soon as possible. The rehabilitation program is divided into acute and subacute phases. Education, physical modalities, medication, manual therapy, traction and therapeutic exercise are used to help meet the goals of the acute phase of rehabilitation. The goals of the subacute phase are met by optimizing strength, endurance, and coordination of the neuromuscular system as it affects the lumbar spine and preventing any further injury or recurrences. Running specific rehabilitation may start early in the subacute phase and then progress as the runners spine stabilization skills improve.

Zygapophysial (facet) Joint Injections

Fluoroscopically guided analgesic zygapophysial joint (z-joint) injections are a safe and scientific method of documenting z-joint pain. Lumbar z-joint injections provide significant diagnostic data and may facilitate a more focused treatment program. Because of the possibility of placebo response to a single block, however, diagnosis of definitive z-joint-mediated pain requires a physiologic response to two separate injections with different local anesthetics. The therapeutic effects of intra-articular corticosteroids remain more controversial, with only open studies supporting their use. Further research is needed to address whether injections followed by a more aggressive conservative program of exercise and manual therapy during the period of relative analgesia increase long-term benefit.

Introduction to the Second Edition

Generally ‘youth’ tends to be seen as a problem: young people are beset by predominantly negative images, are seen as either a source of trouble or in trouble. In bringing together this collection one of our main goals has been to challenge this ‘problematising’ perspective on youth. We also want to promote critical reflection on the position of young people in the UK today and in so doing we have sought to capture and analyse the changing images and experiences of young people as well as the complexity of the transitions they go through. We perceive a need to rethink youth in terms of acknowledging and respecting the many positive contributions young people can and do make to their communities and how adults can provide young people with both effective support and positive criticism. We believe that adults and young people alike can learn and benefit from such a refashioned public dialogue. Thus this reader, along with its companion anthology Changing Experiences of Youth (Garratt, Roche and Tucker, 1997), is presented as a positive contribution towards promoting the rights, and acknowledging the responsibilities, of young people in contemporary society. Yet a great deal has changed since this reader was first published in terms of young people’s everyday lives: the policies directed towards them and the practice issues affecting those that work with them. In this new introduction we will provide an overview of some of the main changes that have taken place, and comment on the new material included in this second edition.