Nutrition in Combat Sports

312 S.F. Martinez
17.8.5 Cervical Spine Injuries with Neurologic Deficit
These injuries rarely occur in Wushu competitions, although they can be caused
by blows to the head or neck, falls, sweeps, throws, and takedowns. Cervical
spine injuries may cause transient symptoms (e.g., cervical cord neuropraxia
with transient quadriplegia) or more definitive and permanent deficits. [13] The
athlete should be examined for unilateral or bilateral symptoms or signs.
Unilateral upper extremity symptoms may represent a brachial plexopathy or
nerve root traction injury. Pathology may include vertebral fracture with cord or
nerve root injury, cord compromise on a congenitally or developmentally smaller
vertebral canal, disc herniation, or nerve root injury. Physical examination is
similar to that for an athlete with a concussion, with a low threshold for transport
to a medical facility with spinal precautions. Imaging studies include basic
radiographs (anteroposterior, lateral, open mouth, flexion/extension); if possible,
the Torg spinal canal to vertebral body ratio should be determined. MRI and/
or CT scanning are mandatory. Treatment is dictated by the clinical presentation
and imaging studies.
17.8.6 Other Spinal Injuries
Spondylolysis is a stress fracture of the pars interarticularis caused predominantly
by hyperextension movements (e.g., butterfly maneuver in Wushu). Other sports
with a predisposition for spondylolysis include gymnastics, dancing, and figure
skating. The L4–5 level is most frequently affected, and fractures may be unilateral
or bilateral. Spondylolysis usually causes pain in the back, buttocks, and thigh that
is aggravated by lumbar extension and prone lower extremity extension; focal paraspinal
pain and spasm and tight hamstrings are frequent; neurologic symptoms or
signs are rare. Imaging studies should include basic radiographs (anteroposterior,
lateral, oblique, flexion/extension) and, occasionally, MRI and single photon emission
computerized tomography (SPECT) (Fig. 17.4 ); CT scanning allows evaluation
of spinal morphology and assessment of healing.
Treatment consists of the use of a flexion bias brace (e.g., Boston brace) for
2–8 months depending on symptoms and healing. A limited flexion bias rehabilitation
program is initiated early with limited strengthening and conditioning program.
A back stabilization program is begun with no axial pounding exercises allowed.
Gradual progression of activity is allowed as clinical and imaging findings indicate,
with extension activities prohibited for several months. Surgery rarely is
required.
Spondylolisthesis indicates translation of one vertebra over adjacent segment, and
usually is preceded by bilateral spondylolysis. Its severity is classified according to
the amount of slippage: grade 1, 0–25%; grade 2, 25–50%; grade 3, 50–75%; and
grade 4, 75–100%. The presentation is similar to that of spondylolysis, but neurologic