Media  Fall 02 - Fire Engine Room

In the industrialized world, 85 per cent of the population will experience back pain at some time in their life. It is the number one reason for limitation of activity in those under the age of 45. Most cases are mild, with 60 per cent of those injured recovering in one week and 90 per cent recovering in six weeks.

While there are not specific injury statistics for dragonboating, up to 50 per cent of athletes experience back injuries at some point during their sporting careers. And since paddling requires a high-energy, repetitive, asymmetrical torquing movement, the risk of back injury is significant.

Causes of injury

Poor alignment of the spine, muscles weakness and imbalance, and poor flexibility are all inherent factors that can cause back injuries. But training errors, incorrect technique and equipment, over training, and asymmetric use of the spinal muscles can be just as deadly. Poor weather conditions and overreaching beyond your level of conditioning may be other factors.

Injury Occurrence

Paddling involves major use of the back muscles, which generate the horsepower of the stroke. The recovery phase (the time your paddle is in the air) requires rotation of the spine towards your partner, which allows maximum forward reach and extension. This ensures an optimal stroke length. Straightening of the spine during the pull or compression phase, with the use of the large back, abdominal, and shoulder girdle muscles, helps to ensure maximum power creation and endurance.

As a result, injuries are most likely to occur during the phases of the race that require maximum explosive force generation. To nail the start, extreme power is required to move the approximate two tones of mass of a fully loaded boat, from the starting line to race speed, against water resistance and inertia. The finishing series requires 100 per cent effort as fatigue and waning technique often become a factor.

Types of Injury

The most common types of injuries are strains which involve the contracting muscle-tendon unit, and sprains, which involve the ligaments that stabilize the joints. These injuries result from sudden straightening of an overloaded or poorly conditioned spine, especially if rotation is involved. You will feel a sudden sharp pain in the low back, either in the mid-line, or localized to one side.

The pain is increased with movement, especially when bending forward, and reduced with rest. The pain can extend to the buttock or the back of the thigh, but numbness or weakness is usually not present.

The facet syndrome results when you injure the small joints in the back of the spinal column, which link the bony segments that make up the spine. You'll feel a sharp localized pain to one side of the spine, with pain spreading to the thigh or groin on that side. Spasm of the overlying muscles can lead to bending of the spine or scoliosis. Walking helps to reduce the pain, but straightening, twisting of compression of the spine can worsen the condition. Facet syndrome is important in that it can be very debilitating, and is often confused for more serious conditions such as a herniated disc.

Spondylolysis is a stress fracture of the vertebral ring that surrounds and protects the spinal cord. This results from repetitive straightening, bending, and twisting of the spine under a heavy load. You would bee chronic aching low back pain, which may or may not spread to the legs, and is increased by forward bending or straightening of the back. Muscle spasm will lead to loss of the normal curvature of the spine. Diagnosis is usually made by x-ray or bone scan. Spondylolithesis exists when the stress fractures occur on both sides of the vertebral ring, leading to separation of the bony fragments. Such slippage of one vertebra on another will result in instability of the spine.

The intervertebral discs serve as shock absorbers of the spine. Inside the disc is a gel-like material. When this gel-like material escapes the surrounding sac during a disc herniation, nerve root irritation can result. This leads to a sharp burning pain, numbness and muscle weakness in the back and the part of the leg supplied by the affected nerve. Forward bending and compression of the spine can cause further herniation of the disc gel.

TREATMENT AND PREVENTION
The Good

Acute sprains and strains usually heal within a few days or weeks. They respond well to decreased activity, ice, easy stretching, and treatment with pain-relieving medications, anti-inflammatories or muscle relaxants. Physiotherapy, manual therapies such as massage, and acupuncture may be extremely helpful in the initial relief of pain and muscle spasm. They block pain, reduce inflammation and swelling, improve blood flow, and initiate the healing response, interrupting the pain-spasm cycle.

Rehabilitation, after the acute pain ends, is very important as the risk of re-injury is high as long as the back muscles remain weak. This involves regaining flexibility, muscle conditioning and core stabilization. You can use core stabilization programs to develop strength and balance of the core muscle groups that support the spine, pelvis and hips, to re-create a powerful engine for your paddling stroke. Many athletes have recently started use of Swedish ball exercises, weights, or Pilates to help improve their performance and prolong their careers. (See The Ultimate Core exercise program, Dennis Lindsay, Dragon Boat World Summer 2002, pp. 9-11).

The Bad

The treatment of spondylolysis may involve more drastic action, including limitation of activity for 16 months or more and the possible external stabilization of the spine with a brace. Persistent pain and spinal instability may even require surgery.

The majority of disc herniations can be treated similarly to strains, although recovery may take up to six to nine months. Surgery may be indicated if weakness, numbness and pain persist despite treatment.

The Ugly

Disc herniations can result in a cauda equina syndrome, which can affect bowel and bladder function. Wetting your pants or being unable to control your bowels are dire warning signs of an impending disaster. Although rare, cauda equine syndrome is a true emergency requiring urgent surgery to prevent permanent bowel and bladder problems.

It is important to note that today's advanced microscopic surgical techniques are successful at relieving the pain of disc herniations, but they are unable to reverse the progression of spinal degeneration, or reduce the risk of re-herniation.

Prevention

Prevention is the key to an injury-free and successful dragonboating career. Excellent flexibility and conditioning allows you to maintain core stability and proper technique through starts, series, finishes and 15-minute high intensity pieces.

If an injury does not improve within a couple of days, or the injury continues to worsen, it is important to seek medical attention. Persistent pain may indicate a more serious injury. If the pain spreads beyond the injury site, or numbness and tingling develops, it may indicate nerve injury or irritation. Bladder or bowel dysfunction requires urgent medical evaluation.