Proper treatment speeds young athlete recovery

Early diagnosis and the cessation of sports were among the key contributors to a successful return to athletics for children and adolescents diagnosed with stress fractures, according to new research released in June at the annual meeting of the American Orthopaedic Society for Sports Medicine in Quebec City, Canada.

With the increased numbers of children participating in organized athletics, complaints of low back pain are increasing. The diagnosis is often spondylolysis, which is a stress fracture of the posterior elements of the lumbar spine. Although the precise cause has not been conclusively identified, it most commonly occurs among athletes participating in sports that require hyperextension, such as football, soccer, weight lifting, gymnastics, wrestling and diving.

Treatment recommendations for this condition have been inconsistent in past studies, particularly in terms of the effects of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis.

Researchers reviewed the treatment of 132 athletes visiting the hospital between 1990 and 2002 for low back pain with lumbar spondylolysis. The purpose of the study was to clarify the factors affecting patients' prognosis and to identify the most effective non-operative treatment method.

Patients participating in the study received various forms of treatment, including bracing, physical therapy, cessation of sports or a combination of the three. Eighty-six patients stopped all athletic activities for at least three months during their treatment. Ninety-eight patients wore a brace full-time for three months. Sixty-nine patients were prescribed physical therapy that included abdominal strengthening, hamstring stretching and pelvic tilt exercises.

Patients were regularly followed to evaluate regression of symptoms and bony healing. Analysis of treatment incorporated 12 variables such as age, gender, and whether the lesion had formed on one or two sides of the vertebra. Of these variables, the most common factor among those with excellent outcomes was the cessation of sports. Patients who stopped sports during their treatments were 16.4 times more likely (odds ratio) to record an excellent outcome than those who did not.

The second-most common factor among excellent outcomes was the presence of a unilateral spondylolysis (on one side of the vertebra) rather than a bilateral lesion. Patients presenting with a unilateral spondylolysis were 15.9 percent more likely to post an excellent outcome through non-operative treatment.

A third factor common to patients with excellent outcomes was whether they had visited the clinic soon after the onset of symptoms.

The mean duration between the appearance of symptoms and the first visit to the clinic in those reporting excellent outcomes was 25 days. The mean duration for those who reported good, fair or poor results was 191 days.

Researchers also determined that the use of a brace in treatment was not statistically significant among those posting excellent outcomes. Excellent results were recorded among 45 of the 98 patients prescribed to use a brace and three of the 34 who were not.

The researchers state that health care providers should be mindful of lumbar spondylolysis when young athletes complain of low back pain. They conclude that the timely diagnosis and cessation of sports activities in young athletes results more often in treatment success and a pain-free return to sports.

The American Orthopaedic Society for Sports Medicine Web site is at www.sports med.org.