Causes and patterns of back pain in young athletes - includes editor's note - adapted from the Archi

Author: Marc Rivo
Date: May 15, 1995

Sports injuries are becoming a greater source of morbidity in children and adolescents who are active in competitive sports. Low back pain is often seen in children participating in sports that require repetitive flexion, extension or rotation of the spine. Adolescents who present with low back pain are generally given a diagnosis of nonspecific lumbar strain and treated with rest and analgesics. This conservative approach is, in part, based on epidemiologic studies in adults presenting with acute back pain. However, recent studies suggest that a significant percentage of young gymnasts presenting with acute back pain may have a significant spinal derangement. Micheli and Wood compared the pathogenesis of acute low back pain in young athletes and adults.

A total of 100 athletes attending an adolescent sports medicine clinic with a chief complaint of low back pain and 100 adults attending an orthopedic hospital clinic with acute low back pain were included in the study The age range in the adolescent group was 12 to 18 years, and the age range in the adult group was 21 to 77 years.

The most common cause of low back pain in this cohort of adolescents was a spondylolysis stress fracture of the pars interarticularis (47 percent of cases), confirmed by imaging techniques. Only 5 percent of patients in the adult group had a diagnosis of spondylolysis. Discogenic back pain, including herniated and degenerated lumbar disc, was the most common diagnosis in the adult group (48 percent). Only 11 percent of the adolescents had back pain attributable to disc abnormalities. The frequency of lumbosacral strain differed significantly between the two groups, with 27 percent of adults and 6 percent of adolescents experiencing this acute injury. Ten percent of adults had a diagnosis of spinal stenosis or osteoarthritis, while no adolescents exhibited these conditions.

The authors conclude that the major causes of low back pain differ significantly between young athletes and adults. They recommend that careful examination be performed and accurate diagnosis made to ensure prompt and correct interventions. (Archives of Pediatrics and Adolescent Medicine, January 1995, vol. 149, p. 15.)

EDITOR'S NOTE: These findings, particularly the high incidence of spondylolysis in this cohort of adolescents, should be interpreted with caution. It is important to recognize that the study population is drawn from specialty clinics (an adolescent sports medicine clinic and an adult orthopedic hospital clinic), which may not be representative of cohorts seen in a primary care practice. However, the data underscore the fact that primary care providers should carefully inquire about the nature of acute back injury in adolescents and recognize that the pathogenesis is different than in adults. Family physicians should be suspicious if the injury appears to be significant on the basis of the history or the physical examination or if the symptoms do not promptly. resolve with conservative management.

COPYRIGHT 1995 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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