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Nonspondylolytic etiologies of lumbar pain in the young athlete

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Current Sports Medicine Reports

Abstract

Approximately 50% of adolescent athletes with persistent lumbar pain can be diagnosed with spondylolysis or spondylolisthesis. The remaining 50% will have suffered injury of the vertebral body, intervertebral disc, ring apophysis, pelvis, articular processes, spinous processes, interspinous ligament, or other soft tissues of the lumbar spine. The adolescent spine is prone to these injuries as a consequence of the growth spurt and skeletal immaturity. Accurate diagnosis is mandatory in order to achieve successful treatment. History, physical examination, imaging modalities, and precision spinal injections can be employed to accurately diagnose the source of the symptoms. Appropriate treatment measures can then be prescribed to optimally treat the adolescent spine injury.

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References and Recommended Reading

  1. Bono CM: Low back pain in athletes. J Bone Joint Surg Am 2004, 86:382–396.

    PubMed  Google Scholar 

  2. Kibler WB: Closed kinetic chain rehabilitation for sports injuries. Phys Med Rehabil Clin N Am 2000, 11:369–384. Thorough review of the functional restoration of musculoskeletal sports injuries by a leading authority addressing the kinetic chain as well as the injured structure.

    CAS  PubMed  Google Scholar 

  3. Delamarter RB, Sachs BL, Thompson GH, et al.: Primary neoplasm of the thoracic and lumbar spine: an analysis of 29 consecutive cases. Clin Orthop 1990, 256:87–100.

    PubMed  Google Scholar 

  4. Wenger DR, Bobechko WP, Gilday DL: The spectrum of intervertebral disc space infection in children. J Bone Joint Surg 1978, 60A:100–108.

    Google Scholar 

  5. d’Hemecourt PA, Gerbino PG, Micheli LJ: Pediatric and adolescent sports injuries. Back injuries in the young athlete. Clin Sports Med 2000, 19:663–679. A recent review discussing both a diagnostic imaging and bracing protocol for lumbar extension injuries formulated by a review of the literature.

    Article  PubMed  Google Scholar 

  6. Hickey GJ, Fricker PA, McDonal WA: Injuries to elite rowers over a 10 year period. Med Sci Sports Exer 1997, 29:1567–1572.

    Article  CAS  Google Scholar 

  7. Granhed H, Morelli B: Low back pain among retired wrestlers and heavy weight lifters. Am J Sports Med 1988, 16:530–533.

    Article  CAS  PubMed  Google Scholar 

  8. Videman T, Sarna S, Battie MC, et al.: The long term effects of physical loading and exercise lifestyles on back related symptoms, disability, and spinal pathology among men. Spine 1995, 20:699–709.

    Article  CAS  PubMed  Google Scholar 

  9. Hubbard DD: Injuries to the spine in children and adolescents. Clin Orthop 1974, 100:56–65.

    PubMed  Google Scholar 

  10. Micheli LJ, Wood R: Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 1995, 149:15–18.

    Article  CAS  PubMed  Google Scholar 

  11. Mundt DJ, Kelsey JL, Golden AL, et al.: Northeast Collaborative Group on low back pain. An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. Am J Sports Med 1993, 21:854–860.

    Article  CAS  PubMed  Google Scholar 

  12. Nachemson AL: Newest knowledge of low back pain. A critical look. Clin Orthop 1992, 279:8–20.

    PubMed  Google Scholar 

  13. Bogduk N: Clinical Anatomy of the Lumbar Spine and Sacrum. London: Elsevier Science Limited; 2002.

    Google Scholar 

  14. Brinckmann P, Frobin W, Hierholzer E, et al.: Deformation of the vertebral endplate under axial loading of the spine. Spine 1983, 8:851–856.

    Article  CAS  PubMed  Google Scholar 

  15. Hutton WC, Adams MA: Can the lumbar spine be crushed in heavy lifting? Spine 1982, 7:586–590.

    Article  CAS  PubMed  Google Scholar 

  16. Hansson TH, Keller TS, Spengler DM: Mechanical behaviour of the human lumbar spine. II. Fatigue strength during dynamic compressive loading. J Orthop Res 1987, 5:479–487.

    Article  CAS  PubMed  Google Scholar 

  17. Liu YK, Njus G, Buckwalter J, et al.: Fatigue response of lumbar intervertebral joints under axial cyclic loading. Spine 1983, 8:857–865.

    Article  CAS  PubMed  Google Scholar 

  18. Farfan HF, Cossette JW, Robertson GH, et al.: The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. J Bone Joint Surg 1970, 52A:468–497.

    Google Scholar 

  19. Pearcy MJ: Inferred strains on the intervertebral discs during physiologic movements. J Man Med 1990, 5:68–71.

    Google Scholar 

  20. Salter RB, Harris WR: Injuries involving the epiphyseal plate. J Bone Joint Surg 1963, 45A:587–622.

    Google Scholar 

  21. Micheli LJ: Low back pain in the adolescent: differential diagnosis. Am J Sports Med 1979, 7:362–364.

    Article  CAS  PubMed  Google Scholar 

  22. Hosea TM, Gatt CJ, McCarthy KE, et al.: Analytical computation of rapid dynamic loading of the lumbar spine. Trans Orthop Res Soc 1989, 14:358.

    Google Scholar 

  23. Hosea TM, Boland AL: Rowing injuries. Postgrad Adv Sports Med 1989, III:1–17.

    Google Scholar 

  24. Elliott B, Khangure M: Disk degeneration and fast bowling in cricket: an intervention study. Med Sci Sports Exerc 2002, 34:1714–1718.

    Article  PubMed  Google Scholar 

  25. Gatt CJ, Hosea TM, Palumbo RC, et al.: Impact loading of the lumbar spine during football blocking. Am J Sports med 1997, 25:317–321.

    Article  PubMed  Google Scholar 

  26. Yingling VR, McGill SM: Anterior shear of spinal motion segments: kinematics, kinetics and resulting injuries obser ved in a porcine model. Spine 1999, 24:1882–1889.

    Article  CAS  PubMed  Google Scholar 

  27. Standaert CJ, Herring SA, Halpern B, et al.: Spondylolysis. Phys Med Rehab Clin N Am 2000, 11:785–803.

    CAS  Google Scholar 

  28. Wiltse LL, Widell EH, Jackson DW: Fatigue fracture: the basic lesion in isthmic spondylolisthesis. J Bone Joint Surg 1975, 57A:17–22.

    Google Scholar 

  29. Chosa E, Totoribe K, Tajima N: A biomechanical study of lumbar spondylolysis based on a three-dimensional finite element method. J Orthop Res 2004, 22:158–163.

    Article  PubMed  Google Scholar 

  30. Hadley LA: Subluxation of the apophyseal articulations with bony impingement as a cause of back pain. Am J Roentgenol 1935, 33:209–213.

    Google Scholar 

  31. Baastrup CL: On the spinous processes of the lumbar vertebrae and the soft tissue between them and on the pathological changes in the region. Acta Radiol 1933, 14:52–54.

    Article  Google Scholar 

  32. Mayer O: Uber zewei neu entbeckte gelenke an der wirbelsaule des menschlichen. Zpers Z Physiol 1825, 2:29–35.

    Google Scholar 

  33. Lundin O, Ekstrom L, Hellstrom M, et al.: Injuries in the adolescent spine exposed to mechanical compression. Spine 1999, 23:2574–2579.

    Article  Google Scholar 

  34. Swaard L, Hellstrom M, Jacobsonn B: Acute injury to the vertebral ring apophysis and intervertebral disc in adolescent gymnasts. Spine 1990, 15:144–148.

    Article  Google Scholar 

  35. Saifuddin A, White J, Tucker S, et al.: Orientation of lumbar pars defects: implications for radiological and surgical management. J Bone Joint Surg Br 1998, 80:208–211.

    Article  CAS  PubMed  Google Scholar 

  36. Lane W: A remarkable example of the manner in which pressure changes in the skeleton may reveal the labourhistory of the individual. J Anat Physiol 1886, 12:385–406.

    Google Scholar 

  37. Keene JS: Low back pain in the athlete: from spondylogenic injury during recreation or competition. Postgrad Med 1983, 74:209–217.

    CAS  PubMed  Google Scholar 

  38. Mann DC, Keene JS, Drummond DS: Unusual causes of back pain in athletes. J Spinal Disord 1991, 4:337–343.

    Article  CAS  PubMed  Google Scholar 

  39. DePalma MJ, Slipman CW, Siegelman E, et al.: Interspinous bursitis in an athlete. J Bone Joint Surg Br 2004, 86-B:1062–1064.

    Article  Google Scholar 

  40. Connolly LP, Drubach LA, Connolly SA, et al.: Young athletes with low back pain: skeletal scintigraphy of conditions other than pars interarticularis stress. Clin Nucl Med 2004, 29:689–693. Interesting study establishing occurrence of nonspondylolytic etiologies in addition to or in substitution for spondylolysis as a source of low back pain detected by nuclear imaging studies in adolescents.

    Article  PubMed  Google Scholar 

  41. Baastrup CL: On the spinous processes of the lumbar vertebrae and the soft tissue between them and on the pathological changes in the region. Acta Radiol 1933, 14:52–54.

    Article  Google Scholar 

  42. Hazlett JW: Kissing spines. J Bone Joint Surg Am 1964, 46-A:1368–1369.

    Google Scholar 

  43. Beks JWF: Kissing spines: fact or fancy? Acta Neurochir 1989, 100:134–135.

    Article  CAS  PubMed  Google Scholar 

  44. O’Brien CP, Williams C, Duffy G: Lumbar spine stress fracture in a young athlete. Phys Sports Med 1997, 25:35–38.

    Article  Google Scholar 

  45. Shaffer WO, Taylor MR, Sundaram M: Lumbar facet fracture in an adolescent ice hockey player. Phys Sports Med 1999, 27:27–32.

    Article  Google Scholar 

  46. Kang JD, Stefanovic-Racic M, McIntyre LA, et al.: Toward a biochemical understanding of human intervertebral disc degeneration and herniation: contributions of nitric oxide, interleukins, prostaglandin e2, and matrix metalloproteinases. Spine 1997, 22:1065–1073.

    Article  CAS  PubMed  Google Scholar 

  47. Baker RJ, Patel D: Lower back pain in the athlete: common conditions and treatment. Prim Care Clin Office Pract 2005, 32:201–229.

    Article  Google Scholar 

  48. Sassmannshausen G, Smith BG: Back pain in the young athlete. Clin Sports Med 2002, 21:121–132.

    Article  PubMed  Google Scholar 

  49. Summers B, Malhan K, Cassar-Pullicino V: Low back pain on passive straight leg raising: the anterior theca as a source of pain. Spine 2005, 30:342–345.

    Article  PubMed  Google Scholar 

  50. Schwarzer AC, Aprill CN, Derby R, et al.: The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995, 20:1878–1883.

    Article  CAS  PubMed  Google Scholar 

  51. Boden SD, Davis DO, Dina TS, et al.: Abnormal magneticresonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg 1990, 72-A:403–408.

    Google Scholar 

  52. DiFazio FA, Barth RA, Frymoyer JW: Acute lumbar paraspinal compartment syndrome. A case report. J Bone Joint Surg (Am) 1991, 73-A:1101–1103.

    Google Scholar 

  53. Carr D, Gilbertso L, Frymoyer JW, et al.: Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies. Spine 1985, 10:816–820.

    Article  CAS  PubMed  Google Scholar 

  54. Hammer WI, Pfefer MT: Treatment of a case of subacute lumbar compartment syndrome using the Graston technique. J Manipulative Physiol Ther 2005, 28:199–204.

    Article  PubMed  Google Scholar 

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Correspondence to Michael J. DePalma MD.

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DePalma, M.J., Bhargava, A. Nonspondylolytic etiologies of lumbar pain in the young athlete. Curr Sports Med Rep 5, 44–49 (2006). https://doi.org/10.1007/s11932-006-0028-x

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