What does LeBron's recent anti-inflammatory injection mean?

2015-10-22 11:42:52 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

lebrons-back

With LeBron's nagging back problems -- he sat out last January and will likely miss the rest of the preseason games this year -- many people are asking me if we should be concerned about his injury.

Recent reports stated he had an anti-inflammatory injection, or epidural injection, in his back last week. These are normally given to athletes with structural back issues, as opposed to something purely muscular.

It's a bit of a concern. He's played a lot of minutes and play-off minutes, but without seeing the MRIs it's difficult to answer. It's definitely something to keep an eye on.

Yesterday, I visited in studio and spoke with 1590 WAKR morning show host Ray Horner about this topic. Injections have become a useful tool in sports medicine and are used frequently not only in pro athletes, but in younger players as well.

Below is an audio file and transcript of our discussion.



HORNER: Joining us live right now is our good friend, Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital. Joe, good morning. Thanks for joining us again, my friend.

DR. CONGENI: Hey, Ray. How ya been?

HORNER: I'm doing pretty well. This LeBron thing, sitting out back, is it anything to be worried about?

DR. CONGENI: ... I mean, obviously, we wish as fans that it wasn't going on and that it obviously continues ... it is a chronic problem.

Dr. Joe Congeni

Um, he sat out around early January last year and before sitting, uh, out he had an injection in his back. And, the injection that he had last week as reported by just about everybody around, ESPN and other sources, said that he had an anti-inflammatory injection in the back. And um, typically these are what are called epidural injections, uh, I would assume.

There are 2 different kinds of injections, and we do use injections in athletes a lot at this point. One of them is when it's all purely muscular. There are people that have a lot of trigger points and a very simple injection are these trigger-point injections where steroids are injected into these knots in the muscle.

That's kind of a newer treatment, but it sounds like his was the deeper type of injection called an epidural injection. Athletes get these, not everybody is amenable to them.

So everybody with back pain, you don't just go in and say, "Hey, I want an injection now," steps like physical therapy and anti-inflammatory medicines and other things like that.

It's reserved for specific situations and usually there's an MRI or a CAT scan that shows something focal like a disk bulge, a disk herniation, uh, that's narrowing the place where the nerves come out and irritating that nerve.

Or, in the situation of David Wright (of the New York Mets) that you and I talked about a few months ago, I think of him seeing him play 3rd base last night, is, uh, his entire canal is narrowed. It's called stenosis, and he got injections mid-season and seems to be doing okay.

So, injections are something that are really helpful to us in younger athletes now. Most of the time for this specific, um, injection, Ray, they do it under fluoroscopy it's called. So, they do it in a suite where they can look at an X-ray to make sure that the needle's in the right place.

... If you're not in the right place, you can cause bleeding into the spine. You can cause an infection. Those are very, very rare. Or, you can actually go through the covering of the, uh, canal and the nerve and actually get into the nerve itself and that can be a complication or a problem with these injections.

HORNER: Well, Joe, you know, when I think of backs ... I immediately think, you know, Larry Bird, who had a very successful career. The back ended up taking out. He had so many steps in those legs going up and down the courts with all those play-off games that he endured.

When we talk about this situation with LeBron, is this preventative or is this the beginning stage of more serious back problems to come?

DR. CONGENI: ... I mean, of course, no way for me to know and for us to know exactly as to what those MRIs look like. Does he have the early part of some narrowing of the spine? Does he have some disk injury? Again, I think he must have something focal or they wouldn't be probably going down this road.

So, something structural going on in the back for them to be injecting. We don't just inject people with chronic muscular pain or mechanical pain, but this has become a tool in sports medicine that's used a lot more frequently. And even back into the Bird days of the '80s and '90s we didn't use that as much, and so that may not have been the situation.

But as to whether this is chronic and he's wearing out his back and heading down towards, you know, more longer-term problems, we don't know those kinds of things.

But it is a little bit of a concern, even though they said this is a maintenance injection of anti-inflammatory , that, you know, LeBron is still focusing on the back. He, too, has played a lot of minutes and a lot of play-off minutes and we're on the part of things now of, you know, we'd like to see him play another 6, 8, 10 years.

HORNER: But in general, Joe, what you're saying is this type of procedure is not necessarily used as a preventative measure.

DR. CONGENI: Yeah, not always. So, I tend to think he probably does have something going on when I heard this and uh, you know, I tend to think this was a good time a couple weeks off. That's the ideal time.

When you're going to have something like a steroid injection into almost any place, if you're gonna calm it down, you want a couple of weeks where you don't have to play and so, that works out pretty well for him at this time.

And so, I guess I understand it being planned, but just a little bit of something to keep an eye on and see whether he's going to need any days off during the season, and then most importantly, as this team gets its health back, heading into the months of April, May and June.

HORNER: Great information, Joe. Thanks for the time, always appreciate it, my friend.

DR. CONGENI: Okay, Ray. Have a great week. Thanks a lot.

HORNER: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital.

Originally aired on 1590 WAKR-AM on Oct. 21, 2015

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