Causes and prevention of low back pain in young athletes Flashcards Preview

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Flashcards in Causes and prevention of low back pain in young athletes Deck (29):
1

How common is low back pain in the pediatric athlete?

10-15%

2

What sports have higher incidence of lower back pain?

1. Football
2. Figure skating
3. Gymnastics
4. Soccer

3

What are risk factors for back injuries?

1. Muscle imbalance
2. Inflexibility
3. Structural differences of the spine
4. Improper training
5. Repetitive spine flexion
6. Poor technique
7. Excessive training

4

What is spondylolysis?

Stress fracture of the pars interarticularis causes by repetitive spinal extension and rotation

5

What sports increase the risk of spondylolysis?

1. Dance
2. Figure skating
3. Gymnastics

6

What is the presentation of spondylolysis

1. Insidious onset of extension-related back pain.
2. Reduced hamstring flexibility.
3. Pain w/ impact activities e.g. running, jumping.
4. Hyperlordosis
5. Paraspinal muscle spasm
6. Hamstring tightness

7

What are the imaging findings with spondylolysis?

1. AP and Lat X-ray: anatomical variants and developmental defects
2. Oblique X-ray lumbar spine: stress reaction of pars interarticularis in 1/3 cases
3. CT bone scan: confirms spondylolysis, monitors healing

8

What is the management of spondylolysis?

1. Avoid painful activities i.e. extension
2. Abdominal strengthening
3. Hip flexor and hamstring stretches
4. Anti-lordotic exercises
5. Custom thoracolumbar orthoses or lumbar braces to limit spinal extension (controversial) x 4-8wk until pain free, then gradually increase activity and wean brace, then restrict activity without brace x 3-6m until pain free

9

What is posterior element overuse syndrome?

Aka "hyperlordotic back pain" or "mechanical/muscular back pain". Constellation of conditions involving the posterior spine, including muscle-tendon units, ligaments and facet joints

10

What is the presentation of posterior element overuse syndrome?

1. Insidious onset of extension-related back pain.
2. Focal tenderness of the lumbar spine
3. Tender paraspinal muscle

11

What are the typical findings on investigation for posterior element overuse syndrome?

Negative

12

What is the management for posterior element overuse syndrome?

1. NSAID
2. Avoidance of extension movements
3. Anti-lordotic exercises
4. Abdominal strengthening
5. Hamstring and thoracolumbar stretches
6. Anti-lordotic bracing untl pain resolves

13

What is the typical prognosis for posterior element overuse syndrome?

Typically resume full activity without pain within 4-8 weeks

14

What is the typical prognosis for spondylolysis?

Typically return to full activities without brace and without pain within 6m

15

What is vertebral body apophyseal avulsion fracture?

Repetitive spinal flexion and extension can injure the ring apophysis resulting in fractures that may posteriorly displace into the spinal canal, along with the intervertebral disc

16

What sports do avulsion fractures commonly occur in?

1. Volleyball
2. Gymnastics
3. Weightlifting

17

What is the typical presentation of a vertebral body apophyseal avulsion fracture?

1. Acute onset flexion related lumbar pain
2. No associated neurological symptoms
3. Spinal flexion and extension limitation
4. Paraspinal muscle spasm

18

What is the typical findings on investigation for vertebral body apophyseal avulsion fracture?

1. Lumbar X-ray: ossified fragment in the canal
2. CT: preferred imaging
3. MRI: may miss injury

19

What is the management of vertebral body apophyseal avulsion fracture?

1. Rest
2. Heat
3. NSAIDs
4. Surgical excision of the fragment if significant neurological findings e.g. significant leg weakness or loss of bowel/bladder control

20

What is the typical prognosis of vertebral body apophyseal avulsion fracture?

Rest for 3-6m for resolution of symptoms

21

How common is disc herniation in young athletes?

11%

22

What is the typical presentation of disc herniation?

1. Acute onset flexion related lumbar pain
2. Back muscle spasms
3. Hamstring tightness
4. Buttock pain sometimes
5. Radicular symptoms (muscle weakness and paresthesias) uncommon
6. Decreased lumbar flexion
7. Positive straight leg raise
8. Decreased reflexes/strength of lower extremities (occasionally)

23

What are the typical findings on investigation for disc herniation?

1. Lumbar X-ray: r/o associated pathological conditions e.g. fractures or tumours
2. MRI: extent of herniation, incld. nerve root impingement, use for porgressive or refractory symptoms

24

What is the management of disc herniation?

1. NSAID
2. Physical therapy
3. Surgery if cauda equina syndrome, progressive neurological deficit or refractory pain

25

What is the typical prognosis of disc herniation?

Usually improve with conservative management in 3-6m

26

What are other causes of low back pain?

1. Inflammation
2. Infection
3. Tumors
4. Visceral pathology

27

What are red flag symptoms for back pain?

1. Fever
2. Night pain
3. Neurological abnormalities
4. Weight loss
5. Malaise

28

What are some low back pain prevention strategies?

1. Reduce training during rapid growth
2. Emphasize proper technique
3. Core-strengthening exercises
4. Hamstring and hip flexor stretches

29

What are return to play guidelines for low back pain?

Return to full play when pain-free ROM and normal strength have been obtained.

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