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christian@orthogate.com






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What can you tell me about posterior element overuse syndrome? That's what our daughter has been told that she has.

With posterior element overuse syndrome, too much spinal extension and rotation cause damage to the area where the muscles and tendons connect in the low back. The ligaments, spinal joints, and joint capsules at the level of the repetitive trauma are damaged. The affected individual develops low back pain because the position of the low back is one of too much lordotic curve. The patient looks like there is a swayback position of the spine. X-rays and other more advanced imaging such as CT scans, MRIs, or bone scans may be needed to identify the specific vertebral level, location (right or left side), and severity of damage. Fractures, tumors, and infections are ruled out via X-rays. This condition is the second most common cause of back pain in adolescent athletes. The first symptom is pain when the child extends the spine and/or rotates or twists. The paraspinal muscles alongside the spine are usually tender to touch. Treatment begins with a cold modality such as ice packs or ice massage. Nonsteroidal antiinflammatory drugs help relieve pain and reduce inflammation. The affected individual (usually a child) is told not to lean back (hyperextend the spine). Core training to strengthen and coordinate the muscles of the trunk and abdomen is advised. The child is taught how to stand and move without hyperlordosis. Sometimes a brace called an antilordosis brace is prescribed. The brace is used until the spine is once again pain free, has full motion, and is stable. Athletes with posterior element overuse syndrome must retrain and rehab before returning to their full sports activity. Full pain free range-of-motion and strength are required. Sport-specific training under the supervision of a physical therapist is advised.

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