Suzanne M. Tanner

Low back pain in young athletes : a practical approach

SummaryLumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat.Factors predisposing the young athlete to back injury include the growth spurt, abrupt increases in training intensity or frequency, improper technique, unsuitable sports equipment, and leg-length inequality. Poor strength of the back extensor and abdominal musculature, and inflexibility of the lumbar spine, hamstrings and hip flexor muscles may contribute to chronic low back pain.Excessive lifting and twisting may produce sprains and strains, the most common cause of low back pain in adolescents. Blows to the spine may create contusions or fractures. Fractures in adolescents from severe trauma include compression fracture, comminuted fracture, fracture of the growth plate at the vertebral end plate, lumbar transverse process fracture, and a fracture of the spinous process. Athletes who participate in sports involving repeated and forceful hyperextension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis. The large sacroiliac joint is also prone to irritation. The signs and symptoms of disc herniation in adolescents may be more subtle than in adults. Disorders simulating athletic injury include tumours and inflammatory connective tissue disease. Often, however, a specific diagnosis cannot be made in the young athlete with a low back injury due to the lack of pain localisation and the anatomic complexity of the lumbar spine.A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques. Diagnostic tests may be considered, though, for the adolescent athlete whose back pain is severe, was caused by acute trauma, or fails to improve with conservative therapy after several weeks. Radiographs, bone scanning, computed tomography, and magnetic resonance imaging may help identify, or exclude serious pathology.Fortunately, the majority of cases of low back pain in adolescents respond to conservative therapy. Immediate treatment of an acute injury, such as a sprain or strain, includes cryotherapy, electrogalvanic stimulation, anti-inflammatory medications and gentle exercises. Prolonged bed rest should be avoided since atrophy may occur rapidly. Strong analgesics are also usually contraindicated, except for sleep, since they mask pain and may allow overvigorous activity.Early strengthening exercises include the Williams flexion exercises and/or McKenzie extension exercises. Both exercise motions may often be prescribed. Athletes with an acute disc herniation, however, should only perform extension exercises initially. Athletes with spondylolysis, spondylolisthesis and facet joint irritation should initially be limited to flexion exercises.Brief sessions of walking, pool walking or jogging, and upright cycling may be started when tolerated to maintain aerobic conditioning. The proper timing for an athlete to return to activity depends on the demonstration of functional skills necessary to perform a specific sport. The final component of a young athletes’ back rehabilitation programme includes a long term stretching, and back and abdominal strengthening programme.

How we manage plantar fasciitis

In brief: Plantar fasciitis is a prolonged overuse injury that is potentially incapacitating and causes heel or arch pain. It is common among runners and athletes who participate in jumping sports such as basketball. The onset of pain is insidious, and an athlete may tolerate it for weeks before seeking medical advice. Although few runners can remember a particular moment or event when pain began, plantar fasciitis usually occurs after sudden increases in mileage, frequency of running, or running speed. Combined therapy, including relative rest, Achilles tendon stretching, medication, and heel cups, alleviates the pain in most athletes.

Solar injury and heat illness : treatment and prevention in children

In brief Children are particularly susceptible to solar injury to the skin and eyes and to heat illness-heat cramps, heat exhaustion, and heatstroke. Because sunburn during childhood is linked to subsequent skin cancer, aggressive prevention through use of sunscreens and other protective measures is critical. Physicians should screen for risk factors for heat illness, such as hypohydration, obesity, poor conditioning, and certain illnesses. Heat illness can be effectively prevented through acclimation, proper hydration, and advance event planning.

Treating-and Preventing-Little League Elbow.

In brief Little League elbow-a common overuse injury-not only causes pain and disability in young pitchers, but it can lead to problems later in life. Proper diagnosis and treatment, therefore, are paramount. Too much throwing is the major contributing factor in this condition, so prevention must include limiting the number of pitches. Prevention also entails on- and off-season strengthening programs, proper warm-up and stretching exercises, rehabilitation of previous injuries, and correction of improper mechanics.

Chest pain in active Young People. Is it cardiac

In brief Chest pain in children and adolescents is usually benign and noncardiac, unlike that in adults. Some of the more common causes are activity related, such as chest wall trauma and exercise-induced asthma. A careful history and physical examination will often provide a diagnosis, though about one third of causes are idiopathic. Most patients will not require extensive testing or referral. Education and reassurance are essential for relieving patient and parent anxiety.

Best of the Literature

‘Best of the Literature’ presents summaries of sports medicine-related articles culled from more than 30 medical journals. Experts comment on what the new findings add to current medical thinking and on the implications for practice.

Shocking the Feet to Treat Plantar Fasciitis

‘Best of the Literature’ presents summaries of sports medicine—related articles culled from more than 30 medical journals. Experts comment on what the new findings add to current medical thinking and on the implications for practice.

MRI for Predicting Meniscus Repair

‘Best of the Literature’ presents summaries of sports medicine-related articles culled from more than 30 medical journals. Experts comment on what the new findings add to current medical thinking and on the implications for practice.