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Introduction: The purpose of this study was to evaluate healing frequency in different stages of stress reactions in the Pars Interarticularis (PI) using a classification system with MRI and CT. The intervention was 3-month rest from physical activity, without a brace, with the exception of activities of daily living.

Materials & Method: Twelve adolescent athletes with different stages of Spondolysis were included in the study. They had pathology in the Pars Interarticularis and were clinically examined with MRI and CT 3-6 weeks after debut of Low Back Pain (LBP) and re-evaluated after 3 months intervention with rest from physical activity.

Results: A combination of MRI and CT scanning to investigate suspected injuries to Pars Interarticularis in adolescent athletes revealed 6 different stages of Spondolysis that ranged from marrow oedema to pseudoarthrosis. After 3 months of rest from physical activity the early stages of Pars Interarticularis injuries healed significantly better than the later stages with rest from physical activity.

Conclusion: The combination of MRI and CT revealed 6 stages of stress reactions instead of 4 as in Hollenberg’s staging with MRI only. In the 3 earliest stages, of these 6, rest from physical activity for 3 months can heal the stress reaction.

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.

Introduction: Low back pain (LBP) defined as ache or pain in the lowest part of the back is a common experience among people all over the world. The lifetime prevalence is reported to be as high as 84%, and the prevalence of LBP seems to be almost the same among adolescents as among adults. The risk for having LBP later in life if you experienced LBP in adolescence is high.

Material and Methods: In this cross‐sectional study of 2550 students aged 16‐20 years, we used the Standardized Nordic Questionnaire for the analysis of musculo‐skeletal symptoms. We studied gender difference, prevalence, and disability of Low back pain. We also studied differences in LBP in adolescent athletes depending on hours spent on sports or physical activity.

Results: Significantly, more girls than boys had had problems sometimes during their life. Those who participated in sports reported LBP to a significantly higher extent than those who were physically inactive in their spare time. Gender and spare time sports were important risk factors for getting LBP some time in life. There was a higher risk for girls to have low back pain problems more than 30 days or daily the last year if they had had low back pain some time earlier in life.

Conclusion: This study shows that low back pain (LBP) is common among Swedish adolescents, more common among girls than boys. High sport activity was associated with the risk of having LBP, length of time with LBP, and disability due to LBP.

Introduction: Stress-Related Bone Injuries (SRBI) in the Tuber Ischiadicum (TI) is a possible preliminary diagnosis in adolescent athletes with pain in the pelvic region or in the back of the thigh. The condition requires an early diagnosis in order to heal properly. We describe five cases of young athletes seeking a physiotherapist for pelvic or back thigh pain.

Materials and methods: Five patients previously diagnosed with lower back pain, groin pain, pelvic or back thigh pain underwent a Physical Examination (PE) by a physiotherapist to identify the pathogenesis of the pain. The PE led to the preliminary diagnosis of SRBI in the TI, which was confirmed by an MRI. The patients were treated with rest and Personally Guided Rehabilitation (PGR).

Results: All cases had a positive eccentric hip extension test and pain provocation on palpation on the TI. MRI found different levels of stress reactions/fractures in the enthesis of the TI. After rest and rehabilitation, all subjects returned to their previous level of physical activity.

Conclusion: PE appeared to identify adolescent athlete patients with SRBI in the TI requiring an MRI. The correct diagnosis led to a quick return to the previous level of physical activity.

Clinical relevance: An early and correct diagnosis thru a thorough PE can lead to complete healing and a return to sports.

Low back pain (LBP) is common in adolescence as well as in adulthood but the reason for LBP differs between the different age groups. Stress reaction is a reason for LBP in adolescence and there is a discussion about the progression from stress reactions to spondylolysis, which in turn can develop into spondylolisthesis.

Sixteen out of nineteen MRI identified subjects with spondylolysis agreed to take part in the whole investigation that included a questionnaire and reexamination of MRI scans performed at the time of diagnose and after the initial treatment (84,2%) with mean age of 15,5 years at diagnosis and mean age of 20.8 at the time of follow-up 1-12 years after diagnosing.

We found a mean time between first symptom of low back pain and time of diagnosis of 28 weeks (0-127 weeks) and a mean activity level of 8.9 hours a week at follow-up with the questionnaire. From the studied MRI investigations seventeen pedicels out of 31 had healed with rest from physical activity as treatment. Seven individuals that displayed spondylolysis on the final MRI had at follow-up (1-12 years after diagnosing) got relief of symptoms and had return to a high level of physical activity. The subject that developed spondylolysis with out healing could thus to a great extent still be physically active.