BACK INJURIES IN THE YOUNG ATHLETE

doi:10.1016/S0278-5919(05)70231-3

Clinics in Sports Medicine

Volume 19, Issue 4, 1 October 2000, Pages 663-679

https://doi.org/10.1016/S0278-5919(05)70231-3 Get rights and content

Back injuries in the young athlete are a significant phenomenon, estimated to occur in 10% to 15% of participants.45, 29 The prevalence, however, varies between sports and, in some cases, the specialty position played. In gymnastics, the incidence of back injuries is thought to be 11%, whereas in football linemen, it has been recorded as high as 50%.⁵¹

Back injuries include single-episode macrotrauma (“acute”) and repetitive microtrauma (“overuse”) injuries. Efforts have been successful in minimizing catastrophic acute spinal injuries in contact sports, such as football, hockey, and rugby, through rule changes and equipment modification.73, 83 Noakes et al⁵⁷ recently reported a 46% reduction in the number of spinal cord injuries with the avoidance of the high tackle in schoolboy rugby, in South Africa. On the other hand, the less dramatic, overuse injuries appear to be increasing as more young athletes are required to perform repetitive skills as part of their training programs. What is of concern is that these overuse back injuries, once present, are difficult to overcome, and recur in 26% of males and 33% of females.⁷⁹

This article reviews current concepts in the management of acute back injuries and then addresses overuse back injuries.

Section snippets

Fractures

Acute fractures of the thoracic and lumbar spine occur in collision sports, such as rugby, football, and ice hockey. Thoracic and lumbar compression fractures occur with axial loading in a flexed or vertical posture. They are less frequently associated with catastrophic spinal cord injuries than with cervical spine injuries. Nonetheless, attention to initial, proper spinal immobilization is critical with the fallen athlete to prevent further injury during transportation. The Interassociation

OVERUSE INJURIES

Adolescent and adult injury patterns differ. Forty-seven percent of young athletes presenting at Boston Children's Hospital had a final diagnosis of spondylolysis, whereas most adults presenting at an affiliated adult back center proved to have discogenic pain.⁴⁹ The uniqueness of injuries to the young spine reflects certain growth-related risk factors.

Spondylolysis and Spondylolisthesis

Spondylolysis is a stress fracture of the pars interarticularis, associated with sports that involve repetitive flexion and extension. There is also a strong familial association, and spondylolysis has been identified in approximately 50% of Alaskan natives.⁷⁴ Spondylolysis may be asymptomatic. Sarasta⁷⁰ reported 13% of patients presenting with long-term pain. Athletes, however, present from a different cause, with repetitive stress destabilizing the pars.

The radiographic evaluation of the

Scheuermann's Kyphosis and Atypical Scheuermann's Kyphosis

Scheuermann⁷¹ first described the thoracic kyphosis with three consecutive anterior vertebral bodies wedged at least 5% each, along with associated vertebral end plate changes, Schmorl's nodes, and apophyseal ring fractures. He initially proposed this as an injury of traumatic origins. Repetitive flexion is associated. Sports such as water skiing have a high prevalence, when competitive skiing is started at the age of six.⁸¹ This is differentiated from a juvenile, postural round back, which is

SUMMARY

The 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

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