Spine injections in athletes

Abstract

A major proportion of athletes have intermittent acute low back pain at some stage of their sport life. Some athletes develop chronic low back pain, which may be a major source of failing in sports. Facet, epidural and intradiscal steroid injections for specific pain generators in the spine show different short- and long-term results. They can improve low back pain for specific pain generators experienced by back pain patients and might be able to help some of these athletes to avoid open surgery and shorten the time until return to sports (RTS). Facet and intradiscal steroid injections provide only short-term effects in axial low back pain and should therefore be considered with caution, whereas the different forms of epidural steroid injections for sciatica caused by radicular compression seem to be a well-proven adjuvant treatment option within a conservative therapeutic regimen. An overview of the literature related to the use of different steroids has shown that non-particulate steroids provide better results regarding safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off-label and patients have to provide their informed consent prior to injection. In summary, careful use of spinal injections within a conservative physiotherapeutic regimen seems to improve chronic back pain and, in turn, reduce the time of RTS.