BACK PAIN IN YOUNG ATHLETES - SIGNIFICANT DIFFERENCES FROM ADULTS IN CAUSES AND PATTERNS

Objectives: To determine whether there are significant differences in the causes of back pain in young athletes compared with the general ad ult population and to review the diagnosis and assessment of young ath letic adolescent patients who present with this complaint. Design: Ret rospective randomized case comparison study with two cohorts segregate d 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 at hletes (aged 12 to 18 years; mean age, 15.8 years) with a chief compla int of low back pain were compared with 100 adults (aged 21 to 77 year s; 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 ultimat ely shown to have a spondylolysis stress fracture of the pars interart icularis. By contrast, 5% of adult subjects were found to have spondyl olysis 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 i n 27% of the adults, while only 6% of the adolescents were diagnosed a s having muscle-tendon strain. These differences were significant. Spi nal stenosis and osteoarthritis as causes of back pain were encountere d in 10% of the adults, while these conditions were not encountered in the children. Conclusions: There is a significant difference in the m ajor 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 thes e differences to avoid incorrect diagnosis and harmful delays in prope r treatment.