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Lawrance SE, Boss E, Jacobs M, Day C. Current Clinical Concepts: Management of Common Lumbar Spine Posterior Column Disorders in Young, Active Individuals. J Athl Train 2022; 57:1021-1029. [PMID: 35788849 PMCID: PMC9875703 DOI: 10.4085/1062-6050-0161.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.
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Affiliation(s)
- Scott E. Lawrance
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Emily Boss
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Meghan Jacobs
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Carly Day
- Department of Intercollegiate Athletics, Purdue University, West Lafayette, IN
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Morimoto M, Okada R, Sugiura K, Manabe H, Inokuchi T, Tezuka F, Yamashita K, Takao S, Fujitani J, Sairyo K. Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players. Orthop J Sports Med 2022; 10:23259671221125513. [PMID: 36250034 PMCID: PMC9561668 DOI: 10.1177/23259671221125513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Baseball is one of the most popular sports in Asia. It is known that baseball
can easily lead to back pain. However, there has been no survey of low back
pain (LBP) and lumbar disc degeneration in Japanese professional baseball
players to date. Purpose: To investigate the cause of LBP and lumbar degeneration in professional
Japanese baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of Japanese professional
baseball players with LBP who visited our hospital. Data were collected from
July 2018 to April 2021. We also investigated whether the results differed
between players in their 20s and 30s or between pitchers and fielders. Data
analysis was performed using the chi-square test. Results: We surveyed 32 professional baseball players. The most frequent causes of LBP
among players in their 20s (n = 21) were lumbar disc herniation (LDH; 57%)
and spondylolysis (24%). Of the players with spondylolysis, 50% had
adult-onset spondylolysis. Players in their 30s (n = 11) most commonly had
discogenic pain (55%) as well as LDH and facet joint arthritis (each 18%).
The incidence of lumbar intervertebral disc degeneration was significantly
higher in players in their 30s (91%) than those in their 20s (14%), as was
the incidence of Schmorl nodes and Modic type 1 changes. There was no
significant difference in the cause of LBP or the incidence of lumbar
intervertebral disc degeneration between pitchers and fielders
(P = .59). Conclusion: Among professional baseball players in their 20s, lumbar degeneration was
less common, and they most frequently developed diseases less related to
degeneration, such as LDH. However, among players in their 30s, lumbar
degeneration was more advanced, and degenerative diseases such as discogenic
pain occurred more frequently. Research on training methods could lead to
the prevention of LBP. Our data may be applicable to other professional
athletes and will contribute to diagnosis and treatment.
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Affiliation(s)
- Masatoshi Morimoto
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan.,Masatoshi Morimoto, MD, PhD, Department of Orthopedics,
Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan (
)
| | - Ryo Okada
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Takashi Inokuchi
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Syoichiro Takao
- Department of Diagnostic Radiology, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Junzo Fujitani
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
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Asai R, Tatsumura M, Okuwaki S, Gamada H, Funayama T, Hirano A, Yamazaki M. Characteristics of Adult-Onset Acute Lumbar Spondylolysis Treated Conservatively. Spine Surg Relat Res 2022; 7:83-88. [PMID: 36819633 PMCID: PMC9931413 DOI: 10.22603/ssrr.2022-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Lumbar spondylolysis typically arises during adolescence, whereas its onset in adulthood is rare. Several studies have reported incidentally identified terminal-stage spondylolysis in adults, but only one case series has investigated acute lumbar spondylolysis lesions with bone marrow edema in adults. Methods We retrospectively investigated lumbar spondylolysis in patients aged 18 years or older. Age at diagnosis, sex, competitive sporting level, and competitive sporting discipline were investigated in each patient. The level of the affected vertebra, pathological stage, bone union, and treatment period were analyzed for each lesion. Results The study included nine patients (eight males and one female), aged 18-22 years old, with 14 acute lumbar spondylolysis lesions. Four patients were soccer players (two professionals, and two amateurs), four were amateur track and field athletes, and one was an amateur basketball player. The affected vertebral levels were L3 in two lesions, L4 in seven lesions, and L5 in five lesions. The pathological stage was pre-lysis stage in two lesions, early stage in eight lesions, and progressive stage in four lesions. Ten lesions achieved bone union with conservative therapy. The average treatment period was 84.7 days. Conclusions The adult-onset lumbar spondylolysis patients were young, up to their early 20s, and generally professional sportspeople performing at an elite level. Most of them were performing a sport that has been reported to have a high risk of causing lumbar spondylolysis. L4 was the most affected vertebral level in contrast to L5, which has been reported in adolescent lumbar spondylolysis. Bone union was achieved for most lesions with conservative therapy.
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Affiliation(s)
- Reo Asai
- Department of Medical Education and Training, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan,Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Hirano
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Linton AA, Hsu WK. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Curr Rev Musculoskelet Med 2022; 15:259-271. [DOI: 10.1007/s12178-022-09760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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A Novel Technique for Spondylolysis Repair With Pedicle Screws, Rod and Polyester Band: Case Report With Technical Note and Systematic Literature Review. Spine (Phila Pa 1976) 2020; 45:E1682-E1691. [PMID: 32947495 DOI: 10.1097/brs.0000000000003697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and case report. OBJECTIVE Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques. SUMMARY OF BACKGROUND Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described. METHODS The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars. RESULTS Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred. CONCLUSION The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury. LEVEL OF EVIDENCE 2.
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Ruff AN, Cornelson SM, Wells CB, Kettner NW. Neural Arch Bone Marrow Edema and Spondylolysis in Adolescent Cheerleaders: A Case Series. J Chiropr Med 2020; 18:335-342. [PMID: 32952480 DOI: 10.1016/j.jcm.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 10/23/2022] Open
Abstract
Objective Spondylolysis is 1 of the most common sources of low back pain in children and adolescents; however, there is still a great deal of confusion in regard to etiology, clinical presentation, and diagnostic imaging findings. It is imperative for clinicians to recognize that persistent low back pain is strongly indicative of spondylolysis, especially in high-performance athletes. This case series demonstrates a comprehensive diagnostic spectrum of spondylolysis and its treatment in 2 competitive adolescent cheerleaders. Clinical Features In case 1, a 12-year-old female competitive cheerleader presented with a gradual onset of subacute low back pain. Comprehensive clinical examination indicated imaging studies that identified bilateral L5 grade 1 stress reaction, consisting of neural arch bone marrow edema (BME). Treatment included spinal adjustments, rehabilitation, and myofascial therapy. In case 2, 15-year-old female competitive cheerleader presented with insidious chronic low back pain that was provocative with extension. Magnetic resonance imaging revealed a left L5 grade 1 pars interarticularis stress reaction. Computed tomography demonstrated right L5 pars grade 3 and left L5 healing spondylolysis. Treatment included spinal adjustments and rehabilitation exercises. She was also seen by a physical therapist who prescribed a lumbar spine flexion brace. Intervention and Outcome Diagnosis of BME and spondylolysis led to temporary cessation of cheerleading activities in cases 1 and 2. The individual in case 1 self-discharged with a list of rehabilitation exercises and was lost to follow-up. The individual in case 2 was able to return to sport pain free approximately 5 weeks after seeking treatment. Conclusion Spondylolysis is common in adolescent athletes, and the presence of BME precedes spondylolysis. Primary spine providers could consider this diagnosis in any adolescent, especially an athlete, who has persistent low back pain. Timely diagnosis will optimize treatment outcomes.
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Affiliation(s)
- Ashley N Ruff
- Radiology Department, Logan University, Chesterfield, Missouri
| | | | - Courtney B Wells
- Human Performance Center, Logan University, Chesterfield, Missouri
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The Prevalence of Abnormalities in the Pediatric Spine on MRI: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E1185-E1196. [PMID: 32355138 DOI: 10.1097/brs.0000000000003527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE The aim of this study was to provide an overview of the prevalence of reported musculoskeletal abnormalities on magnetic resonance imaging (MRI) of the pediatric spine. SUMMARY OF BACKGROUND DATA Back pain is a common complaint and significant health issue, already in children. Several studies have investigated musculoskeletal abnormalities of the pediatric spine as possible cause of low back pain (LBP). However, it is not clear which abnormalities are the most prevalent among children. METHODS A systematic literature search on the prevalence of musculoskeletal spinal abnormalities on MRI in children was conducted in the Embase, Medline Ovid, and Cochrane CENTRAL databases. Risk of bias (RoB) was assessed using a checklist based on the Downs and Black checklist. General information on study and patient characteristics and the prevalence of spinal abnormalities were extracted from the studies. Prevalence data were presented in three subgroups: nonathletes without LBP, participants with LBP, and athletes. Prevalence data of the most reported abnormalities were pooled using random-effects proportion meta-analysis. The study protocol was prospectively registered in PROSPERO (CRD42017080543). RESULTS The search resulted in 16,783 articles, of which 31 articles (2373 participants) were included in this systematic review. Two-thirds of the studies had a low RoB. The pooled prevalence in nonathletes without LBP, participants with LBP, and athletes without LBP was respectively 22%, 44%, and 22% for disc degeneration, 1%, 38%, and 13% for herniated discs, 5%, 22%, and 11% for endplate changes, and 0%, 30%, and 6% for pars fractures. CONCLUSION Disc degeneration, herniated discs, endplate changes, and spondylolysis are the most reported spinal abnormalities on MRI in children in literature. Spinal abnormalities seen in adults are already prevalent in children with LBP, with the highest prevalence for disc degeneration and herniated discs. LEVEL OF EVIDENCE 2.
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Lumbosacral Defects in a 16th-18th-Century Joseon Dynasty Skeletal Series from Korea. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7406797. [PMID: 30050941 PMCID: PMC6040263 DOI: 10.1155/2018/7406797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
Paleopathological evidence for congenital and degenerative disorders of the lumbosacral vertebrae is informative about ancient individual lifeways and physical conditions. However, very few studies have focused on the paleopathology of the lumbosacral vertebrae in ancient skeletal series from East Asia. One reason for the lack of studies is that skeletal samples from East Asia are typically insufficient in size to represent populations for comparative studies within the continent. Here, we present the first comprehensive analysis of lumbosacral defects in an East Asian human skeletal sample, examining occurrences of spina bifida occulta (SBO), lumbosacral transitional vertebrae (LSTV), and spondylolysis in remains from Joseon tombs dating to the 16–18th centuries in Korea. In this study, we present an alternative methodology for understanding activities of daily life among ancient Koreans through paleopathological analysis.
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D'Angelo Del Campo MD, Suby JA, García-Laborde P, Guichón RA. Spondylolysis in the past: A case study of hunter-gatherers from Southern Patagonia. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 19:1-17. [PMID: 29198391 DOI: 10.1016/j.ijpp.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 06/07/2023]
Abstract
Spondylolysis is a fracture of the pars interarticularis, the portion of the neural arch that lies between the superior articular facets and the inferior articular facets. Clinical evidence has suggested repetitive trauma to be the most probable cause, even though morphological weakness of the vertebra is probably also involved. Prevalence is between 3% and 8% in modern populations, while in archaeological samples it varies from 0% to 71.4%. Considering that very little data about this condition is available in past populations from the southern extreme of South America, the aim of this paper is to analyze the spondylolysis in a human skeletal sample from Southern Patagonia and, at the same time, to explore the prevalence of spondylolysis in archaeological contexts around the world to gain a better understanding of the results presented here. The Southern Patagonian skeletal series analyzed here showed a prevalence of 20%, with lower prevalence in the pre contact sample (11.1%) than in the contact period (23.1%). Skeletons from the Salesian Mission "Nuestra Señora de La Candelaria" showed a higher prevalence (25%) than the sample of skeletal remains recovered from outside the mission (20%), suggesting that changes in lifestyle of hunter-gatherers during contact could be implicated in the development of spondylolysis in this sample. A worldwide survey displays a wide range of prevalence figures in American and Asian samples and low diversity between African and European populations. Hunter-gatherers from Southern Patagonia showed similar values to those observed in other American samples.
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Affiliation(s)
- M D D'Angelo Del Campo
- Laboratorio de Ecología Evolutiva Humana (LEEH), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), 508 Street No 881, ZIP: 7631 Quequén, Buenos Aires, Argentina; Núcleo de Estudios Interdisciplinarios sobre Poblaciones Humanas de Patagonia Austral (NEIPHPA), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA). 508 Street No 881, ZIP: 7631, Quequén, Buenos Aires, Argentina; Laboratorio de Poblaciones de Pasado (LAPP), Departamento de Biología, Facultad de Ciencias, Universidad Autónoma de Madrid (UAM), C/Darwin 2, E-28049, Madrid, Spain.
| | - J A Suby
- Laboratorio de Ecología Evolutiva Humana (LEEH), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), 508 Street No 881, ZIP: 7631 Quequén, Buenos Aires, Argentina; INCUAPA-CONICET, Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano, Universidad del Centro de la Provincia de Buenos Aires (UNCPBA), Grupo de Investigación en Bioarqueología, Argentina; CONICET, National Council of Science and Technology, Argentina
| | - P García-Laborde
- Laboratorio de Ecología Evolutiva Humana (LEEH), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), 508 Street No 881, ZIP: 7631 Quequén, Buenos Aires, Argentina; Núcleo de Estudios Interdisciplinarios sobre Poblaciones Humanas de Patagonia Austral (NEIPHPA), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA). 508 Street No 881, ZIP: 7631, Quequén, Buenos Aires, Argentina; CONICET, National Council of Science and Technology, Argentina
| | - R A Guichón
- Laboratorio de Ecología Evolutiva Humana (LEEH), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), 508 Street No 881, ZIP: 7631 Quequén, Buenos Aires, Argentina; Núcleo de Estudios Interdisciplinarios sobre Poblaciones Humanas de Patagonia Austral (NEIPHPA), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA). 508 Street No 881, ZIP: 7631, Quequén, Buenos Aires, Argentina; CONICET, National Council of Science and Technology, Argentina
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Wasser JG, Zaremski JL, Herman DC, Vincent HK. Prevalence and proposed mechanisms of chronic low back pain in baseball: part i. Res Sports Med 2017; 25:219-230. [PMID: 28128007 DOI: 10.1080/15438627.2017.1282361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.
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Affiliation(s)
- Joseph G Wasser
- a Department of Orthopaedics and Rehabilitation, Division of Research; Interdisciplinary Center for Musculoskeletal Training and Research , University of Florida , Gainesville , FL , United States of America
| | - Jason L Zaremski
- a Department of Orthopaedics and Rehabilitation, Division of Research; Interdisciplinary Center for Musculoskeletal Training and Research , University of Florida , Gainesville , FL , United States of America
| | - Daniel C Herman
- a Department of Orthopaedics and Rehabilitation, Division of Research; Interdisciplinary Center for Musculoskeletal Training and Research , University of Florida , Gainesville , FL , United States of America
| | - Heather K Vincent
- a Department of Orthopaedics and Rehabilitation, Division of Research; Interdisciplinary Center for Musculoskeletal Training and Research , University of Florida , Gainesville , FL , United States of America
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Sairyo K, Nagamachi A. State-of-the-art management of low back pain in athletes: Instructional lecture. J Orthop Sci 2016; 21:263-72. [PMID: 26850924 DOI: 10.1016/j.jos.2015.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022]
Abstract
In this paper, we describe "state of the art" on the diagnosis and treatment for low back pain in athletes. Lumbar motion that induces specific pain would be a clue to the exact diagnosis. In the flexion pain group, lumbar herniated nucleus pulposus is the most common disorder. Discogenic pain and type 1 Modic endplate inflammation may also cause flexion pain; however, the diagnosis is sometimes difficult. In children and adolescents, apophyseal ring fracture is prevalent. In the extension pain group, lumbar spondylolysis is very common, especially in pediatric athletes. In adults, facet pain due to overloading would be the pathology, while low back pain with trunk rotation is not common. However, throwing athletes, such as pitchers and hammer throwers, may experience this kind of pain; facet arthritis contralateral to the throwing arm would be the origin of the pain. Low back pain on lumbar lateral bending is rare, but we experienced some cases in golfers in whom type 1 Modic change at the lateral corner was the source of pain. In this article, we explained strategies for state-of-the-art diagnosis and minimally invasive treatment.
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Affiliation(s)
- Koichi Sairyo
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Akihiro Nagamachi
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
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Sairyo K, Nagamachi A, Matsuura T, Higashino K, Sakai T, Suzue N, Hamada D, Takata Y, Goto T, Nishisho T, Goda Y, Tsutsui T, Tonogai I, Miyagi R, Abe M, Morimoto M, Mineta K, Kimura T, Nitta A, Higuchi T, Hama S, C. Jha S, Takahashi R, Fukuta S. A review of the pathomechanism of forward slippage in pediatric spondylolysis: The Tokushima theory of growth plate slippage. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 62:11-8. [DOI: 10.2152/jmi.62.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | | | | | - Naoto Suzue
- Department of Orthopedics, Tokushima University
| | | | | | | | | | | | | | | | - Ryo Miyagi
- Department of Orthopedics, Tokushima University
| | | | | | | | | | | | | | - Shingo Hama
- Department of Orthopedics, Tokushima University
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