Back pain in young athletes. Significant differences from adults in causes and patterns

L. J. Micheli and R. Wood
Department of Orthopaedic Surgery, Harvard Medical School, Boston, Mass.

OBJECTIVES: To determine whether there are significant differences in the causes of back pain in young athletes compared with the general adult population and to review the diagnosis and assessment of young athletic adolescent patients who present with this complaint. DESIGN: Retrospective randomized case comparison study with two cohorts segregated by age and type of activity. SETTING: The adolescent sports medicine clinic of a children's hospital compared with the acute low back pain clinic of an orthopedic hospital. PATIENTS: One hundred adolescent athletes (aged 12 to 18 years; mean age, 15.8 years) with a chief complaint of low back pain were compared with 100 adults (aged 21 to 77 years; mean age, 31.9 years) with acute low back pain. INTERVENTIONS: None. MAIN OUTCOME MEASURES/RESULTS: Sixty-two percent of the adolescents had derangements of their posterior elements associated with the onset of back pain. Forty-seven percent of the 100 adolescents were ultimately shown to have a spondylolysis stress fracture of the pars interarticularis. By contrast, 5% of adult subjects were found to have spondylolysis associated with low back pain. Similarly, discogenic back pain was the final diagnosis in 48 of the 100 subjects in the adult group, while 11 of the 100 in the adolescent group had back pain attributable to disc abnormalities. Muscle-tendon strain accounted for back pain in 27% of the adults, while only 6% of the adolescents were diagnosed as having muscle-tendon strain. These differences were significant. Spinal stenosis and osteoarthritis as causes of back pain were encountered in 10% of the adults, while these conditions were not encountered in the children. CONCLUSIONS: There is a significant differences in the major causes of low back pain in young athletes compared with causes of low back pain in the general adult population. Physicians diagnosing back pain in young athletes must have a specific understanding of these differences to avoid incorrect diagnosis and harmful delays in proper treatment.

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