| Low Back Pain in the Adolescent Athlete Please see your doctor if you have back pain wellbody |
pain sometime in their life. We will only cover LOW back pain here. Back pain may be from: Activity Most common problem Overuse (too many exercises) Muscle sprain/strain Trauma (an unplanned exercise/fall) Bone, disc, ligament More work than planned (too heavy of an exercise) Muscle sprain/strain, disc Congenital (born with it) Bone (spondylolysis, scoliosis) |
First, a good exam is essential. Then consideration for diagnostic tests may assist the clinician in pinpointing an exact diagnosis. Xray- a good starting point, can see bone problems such as fracture (difficult to see stress fracture), tumors (unusual but there are several kinds of benign tumors in children), and malalignments such as scoliosis, spondylolisthesis. There is a small amount of radiation exposure during an xray. CT- a great way to see the bone integrity, not good for disc and nerve problems. The "Gold Standard" to pick up stress fractures, better visualize bone abnormality. The risk includes an increased amount of radiation (and cost) compared to xray. MRI- a great way to see the nerve and disc. Not as good for looking at bone. While there is no radiation, MRIs are expensive. Bone Scan- this is a great way to find stress fractures and abnormal activity in the bone. And the doctor does not have to be specific on location since the bone scan can detect this activity anywhere in the body. There is some radiation involved and an IV is necessary to give contrast before the pictures can be taken. |
Non-steroidals like ibuprofen and naprosyn A good start to control pain and inflammation. Long term use can be dangerous because of they can cause stomach problems such as ulcers. Ice and Heat- Like most injuries, 72 hours of ice (in 20 minute treatments 3-4 times per day), followed by heat (after the 72 hours) makes sense for muscle injuries Muscle Relaxants- a few days for a muscle sprain/strain may be tried, with limited success, and for athletes at least 12 years old. Narcotics- rarely needed, but used sometimes for severe pain Chiropractor- worth a try for many problems, a good diagnosis should be understood to insure that this treatment will be successful Physical Therapy- worth a try, once again, a good diagnosis should be understood to insure that the PT knows exercises that will help Surgery- rarely necessary in young patients Magnets, TENS units, Oral supplements/herbs/vitamins, biofeedback, acupuncture- each of these have patients who give testimonials of successful outcomes. There are limited studies to prove they will be helpful for more than the patient who is in the advertisement! (Acupuncture is probably the most studied of the list above) Possibly worth a try, but be careful with financial and emotional costs! |
Occuring in both males in females, scoliosis (a curvature of the spine) is usually picked up in early adolescence- sometimes during a school physical. It rarely causes pain, and rarely progresses to the point that treatment is necessary- but it should be closely monitored- growth spurts can cause sudden increases in the curvature. Less than 20 degrees- no treatment, no pain associated with this (most adolescents with mild scoliosis fall between 10 and 20 degrees)... so if the patient has pain, something other than the scoliosis is causing it! Between 20 degrees and 40 degrees- more careful follow up, still no pain associated with it, think about bracing around 40 degrees (bracing stops the progression but does not "fix" the scoliosis) Above 40 degrees- careful follow up should occur, an orthopedic surgeon whose expertise is in scoliosis should become involved, bracing often necessary, surgery sometimes necessary, pain can (but doesn't always) occur with scoliosis that has a large angle (typically above 50 degrees) In all cases, follow up is most important. Kyphosis- an increased "hump" in the thoracic spine, "Schuerrmans syndrome" is also seen in adolescence- and monitored closely during growth spurts for worsening angles. |
the lumbar (low) spine. It is most common in athletes where the sport requires hyper-extension at the low back- but can occur in anyone Sports most at risk: -gymnasts -diving -linemen in football -dancing
gymnasts have this problem in their back! Not all athletes have symptoms bad enough to go to the doctor. What is it from?
with the stress fracture- congenital- and then their activity exacerbates the area and causes pain... other experts believe the activity itself causes the fracture- traumatic. Either way, the fracture is painful- especially with extension activity and typically is diagnosed after months (or years) of symptoms. Diagnosis:
most cases a CT or bone scan is necessary). MRI sometimes detects it- although MRI is not the best technique for picking up this problem Treatment:
months. Although the actual fracture may not completely heal, the rest and brace typically results in no pain and the athlete can return to their sport Pain-Free! Outcomes:
sport pain free. Some athletes are never diagnosed and are thought to have "back pain for no reason". Some of these patients have even had xrays and an MRI (but the MRI did not detect the fracture) And sometimes (in bilateral spondylolysis) the back "shifts" forward or backward- this is termed spondylolisthesis- this situation uncommonly requires surgery (fusion) if the shift advances or is unstable. |
Below is an example of an xray
Below is an example of a CT scan
Below is an example of a bone scan
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| Here is some more information: http://www.eorthopod.com/public/patient_education/6572/lumbar_ spondylolysis.html |
| Discuss with your doctor if you have back pain. This information is to complement... never replace a good history and exam by a medical provider. |