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Diagnosis and Management of Spondylolysis in Teen-age Athletes
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Posted on: 04/26/2007
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Spondylolysis, generally thought to be caused by fatigue or stress fracture in the pars interarticularis of the neural arch, is the single most common cause of back pain among adolescent, or teen-age, athletes. The pars interarticularis is a small thin bone on the vertebra. Spondylolysis is particularly aggravated by sports requiring repetitive motion such as gymnastics, weight lifting, track and field, and soccer. This type of lower back pain, which gets worse with activity and improves with rest, can be acute or it can develop over time
Physicians don't agree on how best to diagnosis spondylolysis. Standing anteroposterior and lateral view X-rays are the most common choice of test, but this defect can be found in approximately 6% of the general population under 18 years old and between 8% and 15% of elite athletes under 18.
If, after using X-rays, spondylolysis is suspected, nuclear tests such as planar bone scans and single photon emission (SPECT), computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be performed. It's important to keep in mind that few studies have been done regarding how accurate these tests may be for diagnosing spondylolysis.
As with the actual diagnosis, there isn’t complete agreement on how best to treat spondylolysis. What is known is that a good many of the affected athletes do end up returning to their sport. Although there have been no controlled studies on patient management, the mainstay of all the treatment approaches is that of rest from the activities that contribute to the injury. This rest varies from bracing of the back to restriction from anything but movement needed for daily activities.
Bracing restricts the gross body motion, which is felt is what contributes to recover. A recent study didn't find signs of the fractures healing as a result of the brace. However, the authors do point out that the study was quite small.
It's suggested that the treatment be tailored to each athlete individually, taking in to consideration the teen's characteristics and personality, the spinal pathology, and the type of sport involved.
Rehabilitation is an important aspect of treatment in order to prevent re-injury. After sufficient rest, rehabilitation should begin with a focus of cardiovascular training (low-impact), early core stability and a broader kinetic chain assessment. As the teen progresses through the rehabilitation, work-outs can become more aggressive and sport-specific. The time frame for returning to the sports activity can be anywhere from five to seven months, based on a two to four month rehabilitation time line.
Unless the teen was quite young when the injury first occurred or had a spondylothisthesis, bilateral pars defects, or both, follow-up is generally not needed. The authors conclude that more research is needed in order to establish more stringent evidence-based guidelines for treatment of spondylolysis.
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References:
Christopher J. Standaert, MD and Stanley A. Herring, MD. Expert Opinion and Controversies in Sports and Musculoskeletal Medicine: The Diagnosis and Treatment of Spondylolysis in Adolescent Athletes. In Archives of Physical Medicine and Rehabilitation , April 2007. Vol. 88. Number 4. Pp 537-540.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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