umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clinical Examination, Spondylolysis and Adolescent Athletes
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
The Swedish school of Sport and health science, Deans office, Stockholm, Sweden.
2013 (English)In: International Journal of Sports Medicine, ISSN 0172-4622, E-ISSN 1439-3964, Vol. 34, no 3, p. 263-267Article in journal (Refereed) Published
Abstract [en]

Symptomatic spondylolysis is a stress reaction caused by microtrauma during physical exercise, an imaging diagnostic subgroup of Adolescent Low Back Pain (ALBP), found in adolescent athletes. Early diagnosis increases the possibility of healing. Thus, it is important to divide ALBP into subgroups. The aim of this study was to evaluate clinical tests that can distinguish symptomatic spondylolysis from other forms of ALBP in order to facilitate early referral for diagnostic imaging. The investigation subjects were a prospective case series with a control group, 25 subjects with ALBP and 13 subjects that had no history of LBP. The 2 groups were examined using the same clinical protocol. MRI of the whole lumbar spine was performed in both the case and control groups and CT investigations of the L4 and L5 vertebrae were performed in the case group. Significant differences between the 2 groups were found in 8 of our clinical tests. No clinical test, alone or in combination, could distinguish between spondylolysis and other forms of ALBP. As 88% of the subjects in the case group had MRI findings and almost 50% had spondylolysis, MRI should be performed at an early age in young athletes with ALBP.

Place, publisher, year, edition, pages
2013. Vol. 34, no 3, p. 263-267
National Category
Sport and Fitness Sciences
Identifiers
URN: urn:nbn:se:umu:diva-60941DOI: 10.1055/s-0032-1321723ISI: 000315166200014PubMedID: 23027361OAI: oai:DiVA.org:umu-60941DiVA, id: diva2:564892
Available from: 2012-11-05 Created: 2012-11-05 Last updated: 2019-01-30Bibliographically approved
In thesis
1. Low back pain in adolescent athletes
Open this publication in new window or tab >>Low back pain in adolescent athletes
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Globally Low back pain (LBP) is one of five leading causes of years lived with disability (YLD), and LBP is a common complaint among adults as well as adolescents and adolescence athletes. During adolescents, the LBP often is considered as non- specific without structural findings and thus not needed to be further diagnosed or treated specifically. However, LBP that begins in adolescence often continue through adulthood, and since adolescent athletes with high physical activity seems to have more LBP than less physically active adolescents, high physical loading during adolescence, might be a risk factor for LBP later in life.

Studies: Epidemiology: The Standardized Nordic Questionnaire adjusted for adolescence was used to investigate the prevalence of LBP during adolescence (16-19 years old individuals).

Retrospective study: A ten-year follow-up on symptomatic low back spondylolysis patients identified on MRI or CT. Sixteen out of nineteen identified patients agreed to answer a questionnaire and to have their case-history reviewed.

Case-control study: Twenty-five patients (13-19-year-old boys and girls) with LBP and 13 pain free individuals (controls, 14-19-year-old boys and girls) were investigated with physical examination and MRI. If the patients had findings on MRI a CT investigation was performed.

Clinical study: Twelve of 14 patients (a subgroup from the case-control study) with Spondylolysis on MRI and CT were evaluated with a modified Hollenberg classification (six levels). These patients were re-evaluated with MRI and CT after 3 months of treatment with complete rest from sports activity.

Differential diagnosis: Five adolescent patients with on-going LBP/thigh pain previously treated in other clinics, were reevaluated for a “second opinion”.

Results: Epidemiology study: The prevalence of LBP among adolescents was 46% (N= 2522) with an annual incidence of 42 %. Girls reported more LBP than boys (52 % versus 40 %). Individuals who were active in sports > 6 h/w had significantly more LBP compared with less physically active individuals. 

Retrospective study: Thirteen of the 16 individuals had a second MRI/CT investigation and thus 52 out of the initial 64 pars interarticularis where investigated a second time (mean 3 months after the first investigation). These patients had had different treatments, most commonly rest for 3 months. In total, 7 out of 16 individuals healed (44%).

Case control study: In 22/25 patients (88%) there were clinical findings and MRI findings such as spondylolysis, disc herniated discs, disc degeneration and injuries to the vertebral body. In 13/25 patients (52%) spondylolysis of different stages were found. No clinical test alone, or in combination, could reliably diagnose spondylolysis, and could thus not be used as a selection test for patients who need further diagnostics with MRI and CT.

Clinical study: Using a combination of MRI and CT examination the early signs of skeletal injury (oedema, incomplete fracture) to the pars interarticularis were detected. Patients diagnosed with these early stages healed significantly better than if diagnosed in later stages (complete fracture and pseudoarthrosis).

Differential diagnosis: The second opinion with careful physical examination and MRI examination diagnosed stress reactions in the pelvic ischial tuberosity in the patient seeking help for pain in the lower back/thigh. After guided rehabilitation, all these patients returned to previous sport activities.

Conclusions: LBP is common during adolescence, more common in girls and in highly active individuals. LBP must be taken seriously, especially in adolescent athletes who not seldom have fractures in pars interarticularis (Spondylolysis). If diagnosed early, there seems to be good potentials to heal the fracture with 3 months ́ of rest from loading (sport activity). Differential diagnoses such as stress reactions in the pelvic ischial tuberosity should be taken into consideration.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2019. p. 59
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2014
Keywords
Adolescence, Ischial Tuberosity, Low Back Pain, Oedema, Pars Interarticularis, Physical Activity, Pseudoarthrosis, Sport Activity, Stress fracture, Stress reaction
National Category
Physiotherapy
Research subject
Sports Medicine
Identifiers
urn:nbn:se:umu:diva-155848 (URN)978-91-7855-024-1 (ISBN)
Public defence
2019-02-22, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish National Centre for Research in Sports, 330610018
Available from: 2019-02-01 Created: 2019-01-30 Last updated: 2019-01-31Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Sundell, Claes-GöranLarsén, Karin H

Search in DiVA

By author/editor
Sundell, Claes-GöranLarsén, Karin H
By organisation
Sports Medicine
In the same journal
International Journal of Sports Medicine
Sport and Fitness Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 340 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf