Thoraco-lumbar flexion-distraction injury in a competitive gymnast: a case report

A systematic review of injuries in gymnastics

OBJECTIVES

To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes.

METHODS

Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size.

RESULTS

One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations' websites provide no readily available data about injury rates or methods of prevention.

CONCLUSIONS

Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.

Sacral facet fractures in elite athletes

STUDY DESIGN

Case series of elite athletes with sacral facet fractures.

OBJECTIVE

To report a case series of elite athletes with sacral facet fractures that may be an underrecognized career-ending injury.

SUMMARY OF BACKGROUND DATA

Injury of the posterior elements including spondylolysis and spondylolisthesis are well-known causes of back pain in the young athlete, but there has been only 1 previous case report of a sacral facet fracture.

METHODS

This study is a retrospective chart review of 3 elite athletes with severe back pain and sacral facet fractures. An 18-year-old gymnast with a 2-year history of back pain, a 14-year-old gymnast with a 6-month history of back pain, and a 14-year-old tennis player with a 18-year history of back pain.

RESULTS

This series consists of 3 nationally competitive athletes with back pain severe enough to stop participation in sports. All patients had intra-articular sacral facet fractures proven by computed tomography, none of which were recognized on magnetic resonance imaging. Clinically, all had localized pain with back extension. Multiple tests and invasive procedures were performed without significant improvement prior to the correct diagnosis being made. Treatment with minimally invasive removal of the intra-articular fragments led to immediate pain relief and return to sport in 2 patients and transient though not long-lasting pain relief in the patient whose injury was undiagnosed for 2 years.

CONCLUSION

Intra-articular sacral facet fractures may be an underrecognized and misdiagnosed career-ending injury in elite athletes. In patients who have localized pain with back extension, a computed tomographic scan, and not a magnetic resonance image, diagnosed this injury. Although this series is small, it seems that early recognition and treatment of sacral facet fractures maximize chances of pain resolution and return to sport.

Back pain in adolescent athletes

Back pain in the young athlete is a common complaint and often perceived as a challenging problem. A well-directed approach will usually provide the practitioner with a higher comfort zone. The etiology of back pain in the pediatric and adolescent population is different from that of the adult population due to the presence of open physes and increased linear growth velocity. In addition, the frequency and intensity of sports participation in children continues to increase, leading to more overuse injuries. This review article will discuss the anatomy and physiology of the spine and pelvis, as well as focus on the chronic and overuse causes of back pain in the young athlete.

Chiropractic treatment of a pregnant patient with lumbar radiculopathy

OBJECTIVE

The purpose of this report is to describe chiropractic treatment of lower back and unilateral leg pain in a pregnant patient.

CLINICAL FEATURES

A 26-year-old woman in her second trimester of pregnancy had severe pain in her lower back that radiated to her hips bilaterally and to her right leg. She reported tingling down her right lower leg to the dorsum of her foot. Although no diagnostic imaging was performed, her differential diagnoses included lumbalgia with associated radiculopathy.

INTERVENTION AND OUTCOME

Treatment consisted of manual traction in the side-lying position using a specialized chiropractic table and treatment technique (Cox flexion-distraction decompression) modified for pregnancy. Relief was noted after the first treatment, and complete resolution of her subjective and objective findings occurred after 8 visits.

CONCLUSION

When modified, this chiropractic technique appears to be an effective method for treating lower back pain with radiation to the leg in a pregnant patient who cannot lie prone.