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Back pain and degenerative abnormalities in the spine of young elite divers

A 5-year follow-up magnetic resonance imaging study

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Several studies have been published on disc degeneration among young athletes in sports with great demands on the back, but few on competitive divers; however, there are no long-term follow-up studies. Twenty elite divers between 10 and 21 years of age, with the highest possible national ranking, were selected at random without knowledge of previous or present back injuries or symptoms for an MRI study of the thoraco-lumbar spine in a 5-year longitudinal study. The occurrence of MRI abnormalities and their correlation with back pain were evaluated. Eighty-nine percent of the divers had a history of back pain and the median age at the first episode of back pain was 15 years. Sixty-five percent of the divers had MRI abnormalities in the thoraco-lumbar spine already at baseline. Only one diver without abnormalities at baseline had developed abnormalities at follow-up. Deterioration of any type of abnormality was found in 9 of 17 (53%) divers. Including all disc levels in all divers, the total number of abnormalities increased by 29% at follow-up, as compared to baseline. The most common abnormalities were reduced disc signal, Schmorl’s nodes, and disc height reduction. Since almost all divers had previous or present back pain, a differentiated analysis of the relationship between pain and MRI findings was not possible. However, the high frequency of both back pain and MRI changes suggests a causal relationship. In conclusion, elite divers had high frequency of back pain at young ages and they run a high risk of developing degenerative abnormalities of the thoraco-lumbar spine, probably due to injuries to the spine during the growth spurt.

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References

  1. Adirim TA, Cheng TL (2003) Overview of injuries in the young athlete. Sports Med 33:75–81

    Article  PubMed  Google Scholar 

  2. Alexander J (1976) Effect of growth rate on the strength of the growth plate-shaft function. Skeletal Radiol 1:67–76

    Article  Google Scholar 

  3. Alexander J (1977) Scheuermann’s disease. A traumatic spondylodystrophy? Skeletal Radiol 1:209–221

    Article  Google Scholar 

  4. Andersson SJ, Rubin BD (1994) Evaluation and treatment of injuries in competitive divers. In: Buschbacher B, Braddom RL (eds) Sports medicine and rehabilitation: a sport specific approach. Hanley and Belfus, Philadelphia, PA, pp 111–122

    Google Scholar 

  5. Arkin A, Katz J (1956) The effects of pressure on epifpyseal growth. J Bone Joint Surg Am 38:1056–1076

    PubMed  Google Scholar 

  6. Badman BL, Rechtine GR (2004) Spinal injury considerations in the competitive diver: a case report and review of the literature. Spine J 4:584–590

    Article  PubMed  Google Scholar 

  7. Caine D, Lindner K (1985) Overuse injuries of growing bones: the young female gymnast at risk? Physician Sports Med 13:51–64

    Google Scholar 

  8. Dalton SE (1992) Overuse injuries in adolescent athletes. Sports Med 13:58–70

    Article  PubMed  CAS  Google Scholar 

  9. Ehrenhaft J (1943) Development of the vertebral column as related to certain congenital and pathological changes. Surg Gynecol Obstet 76:282–292

    Google Scholar 

  10. Epstein N, Epstein J (1991) Limbus lumbar vertebral fractures in 27 adolescents and adults. Spine 16:962–966

    PubMed  CAS  Google Scholar 

  11. Eriksson K, Nemeth G, Eriksson E (1996) Low back pain in elite cross-country skiers. A retrospective epidemiological study. Scand J Med Sci Sports 6:31–35

    Article  PubMed  CAS  Google Scholar 

  12. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  13. Gabriel JL (1990) US diving safety manual. US Diving Publications, Indianapolis

    Google Scholar 

  14. Goldstein JD, Berger PE, Windler GE, Jackson DW (1991) Spine injuries in gymnasts and swimmers. An epidemiologic investigation. Am J Sports Med 19:463–468

    Article  PubMed  CAS  Google Scholar 

  15. Good P (2000) Permutation tests. Springer, Berlin Heidelberg New York

    Google Scholar 

  16. Granhed H, Morelli B (1988) Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med 16:530–533

    Article  PubMed  CAS  Google Scholar 

  17. Halvorsen TM, Nilsson S, Nakstad PH (1996) Stress fractures. Spondylolysis and spondylolisthesis of the lumbar vertebrae among young athletes with back pain. Tidsskr Nor Laegeforen 116:1999–2001

    PubMed  CAS  Google Scholar 

  18. Harvey J, Tanner S (1991) Low back pain in young athletes. A practical approach. Sports Med 12:394–406

    Article  PubMed  CAS  Google Scholar 

  19. Hawkins D, Metheny J (2001) Overuse injuries in youth sports: biomechanical considerations. Med Sci Sports Exerc 33:1701–1707

    Article  PubMed  CAS  Google Scholar 

  20. Hellström M, Jacobsson B, Swärd L, Peterson L (1990) Radiologic abnormalities of the thoraco-lumbar spine in athletes. Acta Radiol 31:127–132

    Article  PubMed  Google Scholar 

  21. Hogan KA, Gross RH (2003) Overuse injuries in pediatric athletes. Orthop Clin North Am 34:405–415

    Article  PubMed  Google Scholar 

  22. Jackson DW (1979) Low back pain in young athletes: evaluation of stress reaction and discogenic problems. Am J Sports Med 7:364–366

    Article  PubMed  CAS  Google Scholar 

  23. Jackson DW, Wiltse LL, Cirincoine RJ (1976) Spondylolysis in the female gymnast. Clin Orthop 117:68–73

    PubMed  Google Scholar 

  24. Keene JS, Drummond DS (1985) Mechanical back pain in the athlete. Compr Ther 11:7–14

    PubMed  CAS  Google Scholar 

  25. Kozar B, Lord R (1983) Overuse injury in the young athlete: reasons for concern. Physician Sports Med 11:116–122

    Google Scholar 

  26. Kujala UM, Taimela S, Erkintalo M, Salminen JJ, Kaprio J (1996) Low-back pain in adolescent athletes. Med Sci Sports Exerc 28:165–170

    PubMed  CAS  Google Scholar 

  27. Kujala UM, Taimela S, Viljanen T (1999) Leisure physical activity and various pain symptoms among adolescents. Br J Sports Med 33:325–328

    PubMed  CAS  Google Scholar 

  28. Lundin O, Hellström M, Nilsson I, Swärd L (2001) Back pain and radiological changes in the thoraco-lumbar spine of athletes. A long-term follow-up. Scand J Med Sci Sports 11:103–109

    Article  PubMed  CAS  Google Scholar 

  29. Mooney V, Cairns D, Robertson J (1976) A system for evaluating and treating chronic back disability. West J Med 124:370–376

    PubMed  CAS  Google Scholar 

  30. Palmer H (1949) A description of a technique whereby functional pain may be diagnosed from organic pain. N Z Med J 48:187–213

    PubMed  CAS  Google Scholar 

  31. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878

    Article  PubMed  CAS  Google Scholar 

  32. Rubin BD (1999) Aquatic sports injuries and rehabilitation; the basics of competitive diving and its injuries. Clin Sports Med 18:293–303

    Article  PubMed  CAS  Google Scholar 

  33. Rubin BD (1983) Orthopedic aspects of competitive diving injuries. US Diving, Indianapolis

    Google Scholar 

  34. Schmorl G, Junghanns H (1971) The human spine in health and disease, 2nd edn. Grune & Stratton, New York

    Google Scholar 

  35. Semon RL, Spengler D (1981) Significance of lumbar spondylolysis in college football players. Spine 6:172–174

    Article  PubMed  CAS  Google Scholar 

  36. Swischuk LE, John SD, Allbery S (1998) Disk degenerative disease in childhood: Scheuermann’s disease, Schmorl’s nodes, and the limbus vertebra: MRI findings in 12 patients. Pediatr Radiol 28:334–338

    Article  PubMed  CAS  Google Scholar 

  37. Swärd L, Hellström M, Jacobsson B, Nyman R, Peterson L (1990) Acute injury of the vertebral ring apophysis and intervertebral disc in adolescent gymnasts. Spine 15:144–148

    Article  PubMed  Google Scholar 

  38. Swärd L, Hellström M, Jacobsson B, Nyman R, Peterson L (1991) Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine 16:437–443

    Article  PubMed  Google Scholar 

  39. Swärd L, Hellström M, Jacobsson B, Peterson L (1990) Back pain and radiologic changes in the thoraco-lumbar spine of athletes. Spine 15:124–129

    Article  PubMed  Google Scholar 

  40. Szot Z, Boron Z, Galaj Z (1985) Overloading changes in the motor system occurring in elite gymnasts. Int J Sports Med 6:36–40

    Article  PubMed  CAS  Google Scholar 

  41. Tertti M, Paajanen H, Kujala UM, Alanen A, Salmi TT, Kormano M (1990) Disc degeneration in young gymnasts. A magnetic resonance imaging study. Am J Sports Med 18:206–208

    Article  PubMed  CAS  Google Scholar 

  42. Tertti MO, Salminen JJ, Paajanen HE, Terho PH, Kormano MJ (1991) Low-back pain and disk degeneration in children: a case–control MR imaging study. Radiology 180:503–507

    PubMed  CAS  Google Scholar 

  43. Tsai L, Wredmark T (1993) Spinal posture, sagittal mobility, and subjective rating of back problems in former female elite gymnasts. Spine 18:872–875

    Article  PubMed  CAS  Google Scholar 

  44. Verni E, Prosperi L, Lucaccini C, Fedele L, Beluzzi R, Lubich T (1999) Lumbar pain and fin swimming. J Sports Med Phys Fitness 39:61–65

    PubMed  CAS  Google Scholar 

  45. Videman T, Sarna S, Battie MC, Koskinen S, Gill K, Paananen H, Gibbons L (1995) The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine 20:699–709

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge the financial support of The Medical Society of Göteborg, Sweden, Trygg-Hansa Insurance Company, The Research Council of the Swedish Sports Confederation and Government grants under the LUA agreement. The authors acknowledge the support of Prof. Jon Karlsson, Sahlgrenska Academy at Göteborg University and the assistance of the statistical advisor Professor Anders Odén, PhD, Romelanda, Sweden. The authors thank radiology technician P-A Svensson, Department of Radiology at Queen Silvia’s Children’s Hospital, Sahlgrenska University Hospital, Göteborg. The study was approved by the Ethics Committee at the Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.

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Correspondence to Adad Baranto.

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Baranto, A., Hellström, M., Nyman, R. et al. Back pain and degenerative abnormalities in the spine of young elite divers. Knee Surg Sports Traumatol Arthr 14, 907–914 (2006). https://doi.org/10.1007/s00167-005-0032-3

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  • DOI: https://doi.org/10.1007/s00167-005-0032-3

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