PKiA8jrefs.MYD4F<7NAmari, R. Sakai, T. Katoh, S. Sairyo, K. Higashino, K. Tachibana, K. Yasui, N.2008pFresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature reviewArch Orthop Trauma SurgJul 8Stress fracture in the pars interarticularis is a common cause of low back pain in young athletes. Pedicle stress fractures have also been reported in adolescent sport players, and most of them were associated with contralateral spondylolysis. Only a few cases with bilateral pedicle stress fractures have been reported. We report a 14-year-old ballet dancer with fresh bilateral pedicle fractures treated conservatively, together with a review of the literature.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18607611 Journal article0936-8051 (Print)*Archives of orthopaedic and trauma surgery18607611Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.Engu<7Baker, R. J. Patel, D.2005?Lower back pain in the athlete: common conditions and treatment201-29 Prim Care321Athletic Injuries/*diagnosis/physiopathology/*therapy Diagnosis, Differential Humans Low Back Pain/*diagnosis/physiopathology/*therapy Physical Examination Primary Health Care Risk Factors Spinal Injuries/*diagnosis/physiopathology/*therapyMarAthletes younger than 12 years of age commonly have pathology related to the lower back pain. Spondylolysis is the most common condition in these athletes. Other conditions, including lumbar Scheuermann's disease,scoliosis, disc herniation, fractures, and muscular stains, can occur. Most of the mature general population experiences low back at some time in life.Athletes may be at increased risk, but outcomes are good. The majority of low back pain in mature athletes is mechanical in nature. Herniated discs,spinal stenosis, sacoilitis, and sacral stress fractures can also cause low back pain in these athletes. Low back conditions mentioned above may be treated with rest, specific exercise programs, and medication. Surgery is indicated for severe spinal stenosis, pain with evidence of neurological compromise,and some painful deformities. Newer treatments for back pain are emerging,but few controlled clinical trials are available.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15831319 $Journal Article Review United States0095-4543 (Print) Primary care15831319zWMU Bronco Athletics, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA. baker@kcms.msu.edueng <7'Bennett, D. L. Nassar, L. DeLano, M. C.2006ELumbar spine MRI in the elite-level female gymnast with low back pain503-9Skeletal Radiol3570Adolescent Adult Athletic Injuries/complications/*diagnosis Child Female Gymnastics/*injuries Humans Low Back Pain/*etiology Lumbar Vertebrae/*injuries/pathology Magnetic Resonance Imaging Predictive Value of Tests Prospective Studies Spinal Diseases/*diagnosis/etiology Spondylolysis/*diagnosis/etiologyJulLOBJECTIVE: Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. DESIGN: Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. PATIENTS: Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. RESULTS: Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. CONCLUSIONS: Our initial hypothesis was not confirmed, in that there were findings that were confined to the symptomatic group of elite-level female gymnasts.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16520993 &Clinical Trial Journal Article Germany0364-2348 (Print)Skeletal radiology16520993University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Radiology, 200 Hawkins Drive, Iowa City, IA 52242, USA. lee-bennett@uiowa.edueng <7 Bono, C. M.2004Low-back pain in athletes382-96J Bone Joint Surg Am86-A26Athletic Injuries/*complications/epidemiology/therapy Fractures, Stress/complications Humans Low Back Pain/epidemiology/*etiology/therapy Risk Factors Sacrum/injuries Spinal Diseases/*complications/epidemiology/therapy Spinal Injuries/complications Spondylolysis/complications Sprains and Strains/complicationsFebWhile most occurrences of low-back pain in athletes are self-limited sprains or strains, persistent, chronic, or recurrent symptoms are frequently associated with degenerative lumbar disc disease or spondylolytic stress lesions. The prevalence of radiographic evidence of disc degeneration is higher in athletes than it is in nonathletes; however, it remains unclear whether this correlates with a higher rate of back pain. Although there is little peer-reviewed clinical information on the subject, it is possible that chronic pain from degenerative disc disease that is recalcitrant after intensive and continuous nonoperative care can be successfully treated with interbody fusion in selected athletes. In general, the prevalence of spondylolysis is not higher in athletes than it is in nonathletes, although participation in sports involving repetitive hyperextension maneuvers, such as gymnastics, wrestling, and diving, appears to be associated with disproportionately higher rates of spondylolysis. Nonoperative treatment of spondylolysis results in successful pain relief in approximately 80% of athletes, independent of radiographic evidence of defect healing. In recalcitrant cases, direct surgical repair of the pars interarticularis with internal fixation and bone-grafting can yield high rates of pain relief in competitive athletes and allow a high percentage to return to play. Sacral stress fractures occur almost exclusively in individuals participating in high-level running sports, such as track or marathon. Treatment includes a brief period of limited weight-bearing followed by progressive mobilization, physical therapy, and return to sports in one to two months, when the pain has resolved.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14960688 $Journal Article Review United States0021-9355 (Print)%The Journal of bone and joint surgery14960688Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, Dowling 2 North, Boston, MA 02118, USA. bonocm@prodigy.neteng<7%Congeni, J. McCulloch, J. Swanson, K.1997@Lumbar spondylolysis. A study of natural progression in athletes248-53Am J Sports Med252Adolescent Adult Child Disease Progression Female Humans *Lumbar Vertebrae/radiography/radionuclide imaging Male *Spondylolysis/radiography/radionuclide imaging *Sports Tomography, Emission-Computed, Single-Photon Tomography, X-Ray ComputedMar-AprWe examined the natural course of athletically active young people with back pain and a diagnosis of spondylolysis (stress fracture of the pars interarticularis of the facet joint of the lumbar spine). We limited the study to those with "subtle" fractures (normal radiographs and positive bone scans) and used computed tomography scanning to further characterize this lesion and to determine whether we could demonstrate healing in this population. The study group included 40 patients with low back pain and a diagnosis of spondylolysis by nuclear medicine study. Computed tomography scans were performed with both traditional cuts and reverse-gantry angled cuts to help determine long-term treatment and prognosis. Forty-five percent of patients (18) demonstrated chronic nonhealing fractures, 40% (16) demonstrated acute fractures in various stages of healing, and 15% (6) demonstrated no obvious fractures. With the diagnosis of spondylolysis being fairly common in young athletes with low back pain, primary care physicians need to have a high index of suspicion in making the diagnosis. Computed tomography scans can play a very important role in diagnosis, assessment of the defect, short-term and long-term management decisions, and in determining prognosis.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9079183 Journal Article United states0363-5465 (Print)'The American journal of sports medicine9079183MSports Medicine Center, Children's Hospital Medical Center, Akron, Ohio, USA.eng K|7^Connolly, L. P. d'Hemecourt, P. A. Connolly, S. A. Drubach, L. A. Micheli, L. J. Treves, S. T.2003bSkeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra909-14 J Nucl Med446Adolescent Adult Child Female Humans Low Back Pain/diagnosis/*etiology/radionuclide imaging Lumbar Vertebrae/*abnormalities/anatomy & histology/radiography/*radionuclide imaging Lumbosacral Region/abnormalities/anatomy & histology/radiography/radionuclide imaging Male Radiopharmaceuticals/diagnostic use Sacrum/*abnormalities/anatomy & histology/radiography/*radionuclide imaging Technetium Tc 99m Medronate/diagnostic useJun-Lumbosacral transitional vertebrae can alter the biomechanics of weight transfer at the affected spinal segment. Low-back pain may result. This study assessed what skeletal scintigraphy reveals about stress associated with a lumbosacral transitional vertebra in young patients with low-back pain. METHODS: The study population included 48 patients (30 male, 18 female; age range, 6-19 y; mean age, 15.7 y) with low-back pain and a lumbosacral transitional vertebra. Skeletal scintigraphy was correlated with plain radiographs in all, CT in 12, and MRI in 11. RESULTS: High uptake was shown at the articulation between the transverse process of a lumbosacral transitional vertebra and the sacrum in 39 (81%) of the patients. In 23 (59%) of the 39 patients with high uptake, this finding was shown only by SPECT. In 13 (81%) of the 16 for which the high uptake was shown by planar imaging, the anterior projection was more valuable than the posterior projection. In 9 (23%) of the 39 patients with high uptake at the transverse-sacral articulation, the lumbosacral transitional vertebra had not been noted in a radiographic report before skeletal scintigraphy but was identified through reevaluation or repetition of radiographs after skeletal scintigraphy. Radiographs showed sclerosis along the transverse-sacral articulation in only 8 (21%) of the 39 patients with high uptake. Findings indicating stress or motion at the joint were shown by CT in 6 (55%) of 11 and by MRI in 5 (63%) of 8 patients with high uptake at the transverse-sacral articulation who underwent these examinations. CONCLUSION: Skeletal scintigraphy often indicates stress at the transverse-sacral articulation of young patients with low-back pain and a lumbosacral transitional vertebra. Showing evidence of stress is best accomplished using SPECT. Changes are usually not radiographically evident, but there is a trend for MRI and CT to show findings that imply stress or motion at the articulation. The unique ability of skeletal scintigraphy to provide this physiologic information supports its use in these patients.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12791818 ^Clinical Trial Journal Article United States official publication, Society of Nuclear Medicine0161-5505 (Print)12791818Division of Nuclear Medicine, Department of Radiology, Children's Hospital, Boston, Massachusetts, USA. connolly_l@TCH.Harvard.edueng<75d'Hemecourt, P. A. Gerbino, P. G., 2nd Micheli, L. J.2000"Back injuries in the young athlete663-79Clin Sports Med194Acute Disease Adolescent Athletic Injuries/diagnosis/physiopathology/*therapy Back Injuries/diagnosis/physiopathology/*therapy Biomechanics Braces Child Cumulative Trauma Disorders/diagnosis/physiopathology/therapy Humans Risk FactorsOctThe diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11019734 $Journal Article Review United states0278-5919 (Print)Clinics in sports medicine11019734SDepartment of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts, USA.eng<7=d'Hemecourt, P. A. Zurakowski, D. Kriemler, S. Micheli, L. J.2002QSpondylolysis: returning the athlete to sports participation with brace treatment653-7 Orthopedics256Adolescent Adult Age Factors Athletic Injuries/*complications/physiopathology/*therapy *Braces Child Female Humans Low Back Pain/*etiology/physiopathology/*therapy Lumbosacral Region/*injuries/*physiopathology Male Outcome Assessment (Health Care) Pain Measurement Physical Therapy Modalities Recovery of Function/*physiology Spondylolisthesis/*etiology/physiopathology/*therapy Spondylolysis/*etiology/physiopathology/*therapy Time Factors Trauma Severity IndicesJunBetween 1988 and 1995, 73 adolescent athletes treated with the Boston Overlap Brace for spondylolysis were reviewed to evaluate improvement in pain score and activity level. A favorable clinical outcome was achieved in 80%. Girls and boys who participated in high-risk sports were five times more likely to have an unfavorable clinical outcome than those who participated in low-risk sports (odds ratio = 5, 95% confidence interval = 2.4-7.5, P = .003). In addition, acute onset of pain and hamstring tightness were associated with a worse outcome. Athletes with symptomatic spondylolysis treated with an antilordotic brace can expect improvement in their clinical course and return to sports participation in 4-6 weeks.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12083575 Journal Article United States0147-7447 (Print) Orthopedics12083575gDepartment of Orthopedic Surgery, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.eng<7 DeMann, L. E., Jr.19974Sacroiliac dysfunction in dancers with low back pain2-10Man Ther21FebLSUMMARY. Low back pain is a common occurrence in dancers. Studies have shown its prevalence to be around 12% of all dance type of injuries. It is commonly thought by health professionals who specialize in dance medicine that sacroiliac (SI) dysfunction is one of the more common causes of low back pain in dancers. The aetiology of SI dysfunction in dancers is related to both the biomechanics of the SI joint and the physiological demands placed on the SI joint from the dynamics of dance. Injury to the SI joint can be due to a combination of a single traumatic incident, from overuse factors involving repetitive microtrauma or from emotional stress. Clinical manifestations could be pain in the back, buttock, hip and leg, and limitation of movement specific to dance. Diagnosis is based upon the deviation from normal of both the static and kinetic functions of the low back and pelvis in its relationship to the biomechanics of dance. Treatment is aimed at relieving pain, restoring the function of the SI joint and returning the dancer to full function. Copyright 1997 Harcourt Publishers Ltd.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11440519 Journal article Journal article1532-2769 (Electronic)Manual therapy11440519 New York, USAEng8<7 Featherstone, T.1999EMagnetic resonance imaging in the diagnosis of sacral stress fracture276-7Br J Sports Med334Adult Athletic Injuries/*diagnosis Female Fractures, Stress/*diagnosis Humans Low Back Pain/diagnosis *Magnetic Resonance Imaging Physical Education and Training Sacrum/*injuries Spinal Fractures/*diagnosisAugLow back and buttock pain in athletes can be a source of frustration for the athlete and a diagnostic dilemma for the doctor. Sacral stress fractures have been increasingly recognised as a potential cause of these symptoms. As plain radiographs are often normal and the radiation load of an isotope bone scan is substantial, the alternative use of magnetic resonance imaging in the diagnosis of a sacral stress fracture is highlighted in this case report.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10450485 $Case Reports Journal Article England0306-3674 (Print)"British journal of sports medicine10450485*Sunderland Royal Hospital, United Kingdom.eng<7 #Fehlandt, A. F., Jr. Micheli, L. J.1993/Lumbar facet stress fracture in a ballet dancer2537-9Spine1816Adult Dancing/*injuries Female Fractures, Stress/diagnosis/*etiology/therapy Humans Lumbar Vertebrae/*injuries Spinal Fractures/diagnosis/*etiology/therapyDecA frequent cause of back pain in athletes and dancers is stress injury to the posterior vertebral elements. Stress fractures affect the pars interarticularis and, rarely, other vertebral regions. The authors present their experience with the diagnosis and treatment of a fourth lumbar inferior articular facet stress fracture in a ballerina in this brief report and discuss the literature concerning posterior element stress fractures.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8303462 *Case Reports Journal Article United states0362-2436 (Print)Spine8303462GDivision of Sports Medicine, Boston Children's Hospital, Massachusetts.eng<7 .Guillodo, Y. Botton, E. Saraux, A. Le Goff, P.2000hContralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report2541-3Spine2519Child Female Gymnastics/*injuries Humans Low Back Pain/diagnosis/etiology Lumbar Vertebrae/*injuries/pathology/radiography Magnetic Resonance Imaging Spinal Fractures/diagnosis/*etiology/physiopathology Spinal Osteophytosis/diagnosis/*etiology/physiopathology Tomography, X-Ray ComputedOct 1STUDY DESIGN: The case of an elite female gymnast whose pathology started in her 12th year and whose evolution has been exceptional is reported. OBJECTIVE: To present a fracture of the right lumbar pedicle showing complete spontaneous consolidation despite gymnastic practice 15 hours a week. SUMMARY OF BACKGROUND DATA: Lumbar pain, which has an incidence of approximately 75% among young athletes, often results from diseases of the posterior arch of vertebrae in gymnasts, including spondylolysis. The association between unilateral spondylolysis and fracture of the contralateral lumbar pedicle in young athletes is poorly described. METHODS: An elite young female gymnast underwent clinical examination and lumbar radiographs (as systematically required by the French Federation for high-level gymnasts) from 1994 to 1997 to join a sports program in gymnastics. RESULTS: Clinical examination and lumbar radiographs systematically required of an asymptomatic female gymnast allowed the condensation of the right pedicle to be observed before lysis of the left isthmus of L5 in 1994, unilateral lysis of the left isthmus of L5 in 1995, a right pedicular fracture of L5 in 1996, and healing of the pedicular fracture in 1997. CONCLUSION: Inconsistency between radiographs and clinical observations can be noted, and spontaneous consolidation of pedicular fractures can occur despite the practice of the gymnastics 15 hours a week.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11013509 *Case Reports Journal Article United states0362-2436 (Print)Spine11013509GUnit of Rheumatology, Brest University Medical School Hospital, France.eng<7 Hall, S. J.1986DMechanical contribution to lumbar stress injuries in female gymnasts599-602Med Sci Sports Exerc186Athletic Injuries/*physiopathology Biomechanics Female *Gymnastics Humans Lumbar Vertebrae/anatomy & histology/*injuries/physiopathology Stress, MechanicalDecBecause female gymnasts as a group display higher than average incidences of stress-related pathologies of the lumbar spine, it was of interest to evaluate mechanical factors which are potential contributors. Lumbar hyperextension and impact forces were quantified for performances of five commonly executed gymnastics skills by four competitive collegiate women gymnasts. The skills performed were the front walkover, the back walkover, and the front handspring, the back handspring, and the handspring vault. Wielke's (1983) radius method was used to quantify lumbar curvatures from film data during normal relaxed standing postures and during subject performances of the five selected skills. A force platform was used to monitor vertical and lateral ground reaction forces at the terminations of the respective skill performances. Of the skills examined, the handspring vault produced the highest vertical and lateral impact forces, and the back handspring and back walkover required the greatest amounts of lumbar hyperextension. During the front and back walkovers and during the back handspring, maximum lumbar hyperextension occurred very close to the time that impact force was sustained by either the hands or the feet.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3784872 Journal Article United states0195-9131 (Print)+Medicine and science in sports and exercise3784872eng ~<7Hutchinson, M. R.1999(Low back pain in elite rhythmic gymnasts1686-8Med Sci Sports Exerc31114Adolescent Cumulative Trauma Disorders/etiology Female Follow-Up Studies Gymnastics/education/*injuries Humans Low Back Pain/*etiology Motor Skills/physiology Prospective Studies Retrospective Studies Risk Factors Scoliosis/complications Spondylolysis/etiology Sprains and Strains/etiology Stress, MechanicalNovBACKGROUND: Rhythmic gymnastics is a sport that blends the athleticism of a gymnast with the grace of a ballerina. The sport demands both the coordination of handling various apparatus and the flexibility to attain positions not seen in any other sport. To attain perfection and reproducibility of their routines, the athletes must practice and repeat the basic elements of their routines thousands of times. In so doing, the athlete places herself at risk of a myriad of overuse injuries, the most common being low back pain. METHODS: To document the presence and severity of low back pain in elite rhythmic gymnasts, a prospective study of seven national team members was undertaken that documented injuries and complaints with daily medical reports over a 7-wk period. These findings were correlated with a retrospective review of 11 elite level gymnasts followed over a 10-month period whose complaints ultimately required evaluation by a physician. RESULTS: Eighty-six percent of the gymnasts in the prospective study complained of back pain at some point over the course of the study. The only injury recorded that required a time loss from sport was a low back injury. The most common complaint requiring a physician's evaluation was low back pain with the diagnoses varying from muscle strains to bony stress reaction or complete fracture of the pars inter-articularis (spondylolysis). No athlete had a spondylolisthesis or ruptured disk. Two had mild scolioses which did not appear to be associated with their low back pain. CONCLUSIONS: It would appear that rhythmic gymnasts are at relative increased risk of suffering low back complaints secondary to their sport.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10589874 Journal Article United states0195-9131 (Print)+Medicine and science in sports and exercise10589874YDepartment of Orthopaedics, University of Illinois at Chicago, 60612, USA. mhutch@uic.eduengP<7:Johnson, A. W. Weiss, C. B., Jr. Stento, K. Wheeler, D. L.2001XStress fractures of the sacrum. An atypical cause of low back pain in the female athlete498-508Am J Sports Med294Adult Athletic Injuries/*complications/*diagnosis/therapy Basketball/injuries Bone Density Diet/adverse effects Energy Intake Female Fractures, Stress/*complications/*diagnosis/therapy Humans Low Back Pain/*etiology Menstrual Cycle Middle Aged Recovery of Function Risk Factors Running/injuries Sacroiliac Joint/radiography/radionuclide imaging Sacrum/*injuries/radiography/radionuclide imaging Soccer/injuriesJul-AugLow back pain is a common finding in an athletically active premenopausal female population. We describe an unusual cause of persistent low back/sacroiliac pain: a fatigue-type sacral stress fracture. Plain radiographs, bone scans, computed tomography, and magnetic resonance imaging studies were obtained in the female athletes to determine the nature of the pathologic abnormality. The most significant risk factor for fatigue-type sacral stress fractures was an increase in impact activity due to a more vigorous exercise program. Potential risk factors such as abnormal menstrual history, dietary deficiencies, and low bone mineral density were examined. The clinical course was protracted, with an average 6.6 months of prolonged low back pain before resolution of symptoms. Sacral fatigue-type stress fractures did not preclude the athletes from returning to their previous level of participation once healing had occurred.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11476393 *Case Reports Journal Article United States0363-5465 (Print)'The American journal of sports medicine11476393NLafayette College, Bailey Health Center, Easton, Pennsylvania 18042-1768, USA.eng<7J5Kujala, U. M. Oksanen, A. Taimela, S. Salminen, J. J.1997JTraining does not increase maximal lumbar extension in healthy adolescents181-184 Clin Biomech 123OBJECTIVE: To investigate if there is training reserve in the maximal lumbar extension. DESIGN: Three-year longitudinal study. BACKGROUND: Among adults there is variation in the normal range of sagittal motion of the lumbar spine, but reduced spinal flexibility does not predict future occupational back pain. In various sports and in ballet, maximal extension of lumbar spine is a common manoeuvre, and low-back pain is also common. It is not known whether training increases maximal extension of healthy back. Forceful training of maximal extension may injure the anatomical structures limiting the extension range. METHODS: We compared lumbar sagittal flexibility to hip flexor and hamstring flexibility in a 3-year longitudinal study on female ballet dancers (n = 18), athletes (n = 31), and controls (n = 17) before and after their adolescent growth spurt. RESULTS: Ballet dancers had more flexible hamstrings and hip flexors than controls, but there were no group differences regarding the maximal lumbar flexion or extension. These results persisted throughout follow-up. CONCLUSIONS: The maximal physiological extension of the lumbar spine cannot be increased by training in healthy adolescents. RELEVANCE: An attempt to exceed the physiological maximum extension may only cause overly hard strain on specific anatomical structures of the lumbar spine. This knowledge should be considered when the rules of sports and choreography of dance performances are considered.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11415691 Journal article0268-0033 (Print)%Clinical biomechanics (Bristol, Avon)11415691kUnit for Sports and Exercise Medicine, Institute of Biomedicine, University of Helsinki, Helsinki, Finland.Eng <7EKurd, M. F. Patel, D. Norton, R. Picetti, G. Friel, B. Vaccaro, A. R.20073Nonoperative treatment of symptomatic spondylolysis560-4J Spinal Disord Tech208Adolescent Adult Child Female Fractures, Stress/complications Humans Low Back Pain/etiology *Lumbar Vertebrae Male Orthotic Devices Physical Therapy Modalities Range of Motion, Articular Retrospective Studies Spondylolysis/etiology/*therapy *Thoracic Vertebrae Time FactorsDecSUMMARY OF BACKGROUND DATA: Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases. OBJECTIVE: To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program. STUDY DESIGN: Retrospective case series. PATIENT SAMPLE: Four hundred thirty-six juvenile and adolescent patients with spondylolysis. OUTCOME MEASURES: Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities. METHODS: Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination. RESULTS: Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery. CONCLUSIONS: Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18046167 Journal Article United States1536-0652 (Print)(Journal of spinal disorders & techniques18046167Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. markkurd@yahoo.comeng<<7Lin, J. T. Lane, J. M.2003Sacral stress fractures879-88J Womens Health (Larchmt)129Female Fractures, Stress/*diagnosis/etiology/*therapy Humans Osteoporosis/complications/diagnosis Risk Factors Sacrum/*injuriesNovStress fractures result from skeletal failure resulting from submaximal repetitive forces over time. Sacral stress fractures may represent an underdiagnosed cause of low back and buttock pain. They occur primarily in two populations, young active persons and elderly osteoporotic women, usually corresponding to fatigue and insufficiency-type fractures, respectively. The clinical presentation of these fractures is similar, but the medical and rehabilitation management of these patient populations differs and is tailored to the specific underlying etiology. In both types of fractures, appropriate conservative measures generally result in good functional outcomes. This paper provides an overview of the anatomical considerations, risk factors, clinical presentations, diagnostic imaging findings, appropriate laboratory studies, medical management, and rehabilitation management of patients with sacral stress fractures.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14670167 $Journal Article Review United States1540-9996 (Print) Journal of women's health (2002)14670167Physiatry Department, Hospital for Special Surgery and Department of Rehabilitation Medicine, Weill Medical College of Cornell University, 353 East 70th Street, New York, NY 10021, USA. linj@hss.edueng <7BMasci, L. Pike, J. Malara, F. Phillips, B. Bennell, K. Brukner, P.2006qUse of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis940-6; discussion 946Br J Sports Med4011Adolescent Adult Child Cohort Studies Humans Low Back Pain/*etiology *Magnetic Resonance Imaging Prospective Studies Sensitivity and Specificity Spondylolysis/complications/*diagnosis *Tomography, Emission-Computed, Single-PhotonNov BACKGROUND: Active spondylolysis is an acquired lesion in the pars interarticularis and is a common cause of low back pain in the young athlete. OBJECTIVES: To evaluate whether the one-legged hyperextension test can assist in the clinical detection of active spondylolysis and to determine whether magnetic resonance imaging (MRI) is equivalent to the clinical gold standard of bone scintigraphy and computed tomography in the radiological diagnosis of this condition. METHODS: A prospective cohort design was used. Young active subjects with low back pain were recruited. Outcome measures included clinical assessment (one-legged hyperextension test) and radiological investigations including bone scintigraphy (with single photon emission computed tomography (SPECT)) and MRI. Computed tomography was performed if bone scintigraphy was positive. RESULTS: Seventy one subjects were recruited. Fifty pars interarticulares in 39 subjects (55%) had evidence of active spondylolysis as defined by bone scintigraphy (with SPECT). Of these, 19 pars interarticulares in 14 subjects showed a fracture on computed tomography. The one-legged hyperextension test was neither sensitive nor specific for the detection of active spondylolysis. MRI revealed bone stress in 40 of the 50 pars interarticulares in which it was detected by bone scintigraphy (with SPECT), indicating reduced sensitivity in detecting bone stress compared with bone scintigraphy (p = 0.001). Conversely, MRI revealed 18 of the 19 pars interarticularis fractures detected by computed tomography, indicating concordance between imaging modalities (p = 0.345). There was a significant difference between MRI and the combination of bone scintigraphy (with SPECT)/computed tomography in the radiological visualisation of active spondylolysis (p = 0.002). CONCLUSIONS: These results suggest that there is a high rate of active spondylolysis in active athletes with low back pain. The one-legged hyperextension test is not useful in detecting active spondylolysis and should not be relied on to exclude the diagnosis. MRI is inferior to bone scintigraphy (with SPECT)/computed tomography. Bone scintigraphy (with SPECT) should remain the first-line investigation of active athletes with low back pain followed by limited computed tomography if bone scintigraphy is positive.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16980534 <Comparative Study Evaluation Studies Journal Article England1473-0480 (Electronic)"British journal of sports medicine16980534Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia. masci@hotmail.comeng<7McCormack, R. G. Athwal, G.1999VIsolated fracture of the vertebral articular facet in a gymnast. A spondylolysis mimic104-6Am J Sports Med271Child Diagnosis, Differential Female Fractures, Stress/diagnosis/*pathology Gymnastics/*injuries Humans Low Back Pain/*etiology Lumbosacral Region Spinal Fractures/diagnosis/*pathology Tomography, X-Ray ComputedJan-Febehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9934428 *Case Reports Journal Article United states0363-5465 (Print)'The American journal of sports medicine9934428nDepartment of Orthopaedics, Royal Columbian Hospital, University of British Columbia, New Westminster, Canada.eng%<7McTimoney, C. A. Micheli, L. J.2003HCurrent evaluation and management of spondylolysis and spondylolisthesis41-6Curr Sports Med Rep21Adult Braces Child Disease Progression Female Humans Low Back Pain/etiology Lumbar Vertebrae/radiography/radionuclide imaging Magnetic Resonance Imaging Male Reproducibility of Results Risk Factors Spondylolisthesis/classification/complications/*diagnosis/*therapy Spondylolysis/classification/complications/diagnosis/therapy Tomography, Emission-Computed, Single-Photon Tomography, X-Ray Computed Treatment OutcomeFebSpondylolysis occurs with a prevalence of 4% to 6% in the general population. Although the etiology of this lesion is still unclear, it has been shown to have both hereditary and acquired risk factors, with an increased prevalence in men and athletes participating in certain high-risk sports. Spondylolisthesis occurs in a significant proportion of individuals with bilateral spondylolysis. Predicting risk factors for progression of the slip in spondylolisthesis has proven difficult. Multiple imaging techniques are helpful in the diagnosis of spondylolysis and spondylolisthesis, with recent research addressing the utility of magnetic resonance imaging in the diagnosis and management of pars lesions. The management guidelines have remained largely unchanged since early recommendations. Recently, the addition of a bone growth stimulator to the management of difficult cases has shown promise.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12831675 $Journal Article Review United States1537-890X (Print)Current sports medicine reports12831675xDivision of Sports Medicine, Children's Hospital Boston, 319 Longwood Avenue, Boston, MA 02115, USA. michelilyle@aol.comeng<7Micheli, L. J. Curtis, C.2006(Stress fractures in the spine and sacrum 75-88, ixClin Sports Med251Adolescent Adult Athletic Injuries/complications/*diagnosis/physiopathology/*therapy Biomechanics Diagnosis, Differential Female Fractures, Stress/complications/*diagnosis/physiopathology/*therapy Humans Low Back Pain/etiology Lumbar Vertebrae/injuries Male Nutrition Physiology Risk Factors Sacrum/injuries Spinal Injuries/complications/*diagnosis/physiopathology/*therapy Spondylolysis/complications/diagnosis/therapy Sports Medicine/methodsJan4Stress fractures of the pars, pedicle, and sacrum are important considerations in the differential diagnosis of lower back pain in the child or adolescent athlete. A thorough history and physical examination as well as a high index of suspicion are essential when assessing a patient with lower back pain. Diagnostic imaging, including radiographs, bone scans, CT scans, and other imaging modalities are important for further narrowing the diagnosis. The early identification and proper management of stress fractures of the pars, pedicle, and sacrum are integral in the prevention of stress fractures in the adolescent athlete population. This article reviews current concepts in the assessment and management of stress fractures of the lumbosacral spine, particularly of the pars (spondylolysis), pedicles, and sacrum.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16324975 $Journal Article Review United States1556-228X (Electronic)Clinics in sports medicine16324975~Division of Sports Medicine, Department of Orthopedics, Children's Hospital Boston, Boston, MA 02115, USA. michelilyle@aol.comeng X<7Micheli, L. J. Wood, R.1995WBack pain in young athletes. Significant differences from adults in causes and patterns15-8Arch Pediatr Adolesc Med1491yAdolescent Adult Aged Case-Control Studies Child Humans Low Back Pain/*etiology Middle Aged Retrospective Studies *SportsJanOBJECTIVES: To determine whether there are significant differences in the causes of back pain in young athletes compared with the general adult population and to review the diagnosis and assessment of young athletic adolescent patients who present with this complaint. DESIGN: Retrospective randomized case comparison study with two cohorts segregated by age and type of activity. SETTING: The adolescent sports medicine clinic of a children's hospital compared with the acute low back pain clinic of an orthopedic hospital. PATIENTS: One hundred adolescent athletes (aged 12 to 18 years; mean age, 15.8 years) with a chief complaint of low back pain were compared with 100 adults (aged 21 to 77 years; mean age, 31.9 years) with acute low back pain. INTERVENTIONS: None. MAIN OUTCOME MEASURES/RESULTS: Sixty-two percent of the adolescents had derangements of their posterior elements associated with the onset of back pain. Forty-seven percent of the 100 adolescents were ultimately shown to have a spondylolysis stress fracture of the pars interarticularis. By contrast, 5% of adult subjects were found to have spondylolysis associated with low back pain. Similarly, discogenic back pain was the final diagnosis in 48 of the 100 subjects in the adult group, while 11 of the 100 in the adolescent group had back pain attributable to disc abnormalities. Muscle-tendon strain accounted for back pain in 27% of the adults, while only 6% of the adolescents were diagnosed as having muscle-tendon strain. These differences were significant. Spinal stenosis and osteoarthritis as causes of back pain were encountered in 10% of the adults, while these conditions were not encountered in the children. CONCLUSIONS: There is a significant differences in the major causes of low back pain in young athletes compared with causes of low back pain in the general adult population. Physicians diagnosing back pain in young athletes must have a specific understanding of these differences to avoid incorrect diagnosis and harmful delays in proper treatment.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7827653 Journal Article United states1072-4710 (Print),Archives of pediatrics & adolescent medicine7827653HDepartment of Orthopaedic Surgery, Harvard Medical School, Boston, Mass.eng <7dSairyo, K. Katoh, S. Sasa, T. Yasui, N. Goel, V. K. Vadapalli, S. Masuda, A. Biyani, A. Ebraheim, N.2005Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study583-90Am J Sports Med334Adolescent Adult Athletic Injuries/*etiology/radiography Biomechanics Child Disease Progression Female Finite Element Analysis Fractures, Stress/*etiology/radiography Humans Lumbar Vertebrae/*injuries/radiography Male Spondylolysis/*complications/radiographyApr&BACKGROUND: Unilateral spondylolysis is common in youths; its clinical and biomechanical features, especially effects on the contralateral side, are not fully understood. HYPOTHESIS: Unilateral spondylolysis predisposes the contralateral side to stress fracture, especially in athletes actively engaged in sporting activities involving torsion of the trunk. STUDY DESIGN: Case series and descriptive laboratory study. METHODS: Thirteen athletes younger than age 20 with unilateral spondylolysis were included. The contralateral pedicle and pars of spondylolytic vertebrae were examined using computed tomography and magnetic resonance imaging. Using a finite element model of the intact ligamentous L3-S1 segment, stress distributions were analyzed in response to 400-N axial compression and 10.6-N.m moment in flexion, extension, lateral bending, and axial rotation. Unilateral spondylolysis was created in the model at L5. The stress results from the unilateral defect model were compared to the intact model predictions and correlated to the contralateral defects seen in patients. RESULTS: Among 13 patients, there were 6 early-, 2 progressive-, and 5 terminal-stage defects. Three (23.1%) showed contralateral stress fracture. Among them, 2 belonged to the progressive-stage and 1 to the terminal-stage spondylolysis group. The remaining 4 patients in the terminal defect group showed stress reactions, such as sclerosis at the contralateral pedicle. In the finite element analysis model with an L5 left spondylolysis, the stresses at the contralateral and pars interarticularis were found to increase in all loading modes, with increases as high as 12.6-fold compared to the intact spine. CONCLUSIONS: Unilateral spondylolysis could lead to stress fracture or sclerosis at the contralateral side due to an increase in stresses in the region. CLINICAL RELEVANCE: Surgeons should be aware of possibility of contralateral stress fractures in cases in which patients, especially athletes engaged in active sports, show unilateral spondylolysis and persistent low back pain complaints.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15722292 >Journal Article Research Support, Non-U.S. Gov't United States0363-5465 (Print)'The American journal of sports medicine15722292vDepartment of Orthopedics, University of Tokushima, 3-18-15, Kuramoto, Tokushima 770-8503 Japan. sairyokun@hotmail.comeng<7Standaert, C. J.2002ANew strategies in the management of low back injuries in gymnasts293-300Curr Sports Med Rep15ZAdolescent Adult Athletic Injuries/diagnosis/physiopathology/*therapy Biomechanics Braces Female Gymnastics/*injuries Humans Low Back Pain/etiology/physiopathology/*therapy Male Rehabilitation/methods Spinal Injuries/complications/diagnosis/physiopathology/*therapy Spondylolysis/diagnosis/physiopathology/therapy Sports Medicine/*methods/*trendsOctLow back pain is an extremely common complaint in competitive gymnasts, and these athletes are at risk for multiple potential structural injuries to the spine. Of particular concern among gymnasts is spondylolysis. Unfortunately, there are no published, controlled trials on the diagnosis or treatment of spondylolysis in adolescent athletes. However, based on the current literature, there would appear to be little role for the use of plain radiography in the diagnosis of symptomatic spondylolysis; nuclear imaging with single photon emission computed tomography (SPECT) appears to represent the best screening tool for diagnosis. Given the limited specificity of nuclear imaging in the spine, it is generally best to follow any positive study with a limited thin-cut computed tomography scan of the region of concern on the SPECT. Treatment should be based on the radiographic stage of the lesion. Relative rest is an essential component of care. Although the rehabilitation of gymnasts with lumbar injuries is poorly studied, the related literature would support incorporating the concepts of dynamic lumbar stabilization and sport-specific training into their rehabilitation programs.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12831692 $Journal Article Review United States1537-890X (Print)Current sports medicine reports12831692uPuget Sound Sports and Spine Physicians, 1600 East Jefferson, Suite 401, Seattle, WA 98122, USA. psssp@mindspring.comeng-<7,Tallarico, R. A. Madom, I. A. Palumbo, M. A.20082Spondylolysis and spondylolisthesis in the athlete32-8Sports Med Arthrosc161*Athletic Injuries Braces Health Status Humans Lumbar Vertebrae/*pathology Risk Factors Spondylolisthesis/*diagnosis/pathology Spondylolysis/*diagnosis/pathologyMarmSpondylolysis and spondylolisthesis are common diagnoses made in the athlete suffering from persistent back pain. Although the etiology of this continuum of conditions is uncertain, genetic predisposition and repetitive trauma have been strongly implicated. Sports in which participants are subjected to repetitive hyperextension across the lumbar spine pose a risk for such injuries. Football lineman, oarsmen, dancers, and gymnasts show high rates of these conditions. Treating the athlete with spondylolysis and/or spondylolisthesis can be a challenge. An inherent drive for return to competition, pressure from coaches and family, and obligations to the team can confound decision making on both the part of the patient and the treating physician. Although this motivation for prompt return to sports must certainly be considered, a safe return to competition is paramount.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18277260 $Journal Article Review United States1538-1951 (Electronic)&Sports medicine and arthroscopy review18277260Department of Orthopedic Surgery, State University of New York, Upstate Medical University, Syracuse, NY 13202, USA. richardtallarico@hotmail.comeng<7$Zaman, F. M. Frey, M. Slipman, C. W.2006Sacral stress fractures37-43Curr Sports Med Rep51Algorithms Diagnosis, Differential Fractures, Stress/diagnosis/*etiology/physiopathology/therapy Humans Polymethyl Methacrylate/therapeutic use Risk Factors Sacrum/*injuries/surgery Spinal Fractures/diagnosis/*etiology/physiopathology/therapyFebOSacral stress fractures are a relatively common occurrence and can be a debilitating source of low back pain. They generally occur in two distinctly different patient populations, and are of two different etiologies. Sacral insufficiency-type fractures are seen in elderly osteoporotic persons, and fatigue fractures are seen young active individuals. Although the clinical presentation of these fractures is similar, medical rehabilitation and interventional spine management strategies differ according to etiology. Although conservative management strategies have resulted in good outcomes, other treatment options have recently developed. This article provides an overview of the clinical presentation, pathology, and treatment options for sacral stress fractures and discusses some of the recent literature surrounding this interesting topic.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16483515 $Journal Article Review United States1537-8918 (Electronic)Current sports medicine reports16483515PPenn Spine Center, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.engPK@8I/**refs.FRM 0B< !// !HPRIMARYyearIndex 6ByP/) idreference_type text_stylesauthoryear title pages secondary_title volume numbernumber_of_volumessecondary_authorplace_published publishersubsidiary_authoredition keywords type_of_workdate2)  abstractlabelurltertiary_titletertiary_author notes isbn custom_1 custom_2 custom_3 custom_4alternate_titleaccession_number call_number short_title custom_5 custom_6sectionoriginal_publicationH) reprint_editionreviewed_itemauthor_addressimagecaption custom_7 electronic_resource_number link_to_pdf translated_author translated_titlename_of_databasedatabase_providerresearch_notes language access_datelast_modified_date !! 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