Prolonged low-back pain in young athletes: a prospective case series studyof findings and prognosis

We investigated the prognosis of low-back pain and the association of clini cal symptoms and anatomic findings among young athletes. Consecutive patien ts, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical exa mination, and plain radiographs and magnetic resonance images were also obt ained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities: that correspon ded with the location and type of clinical symptoms. Twelve subjects had ch anges in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction, Six out of ei ght buys and two out of 11 girls had stress reaction (P = 0.043). Restricti on of painful activities was recommended to all subjects, restriction of ac tivities and these of a dynamic low-back brace for the first 3 months was r ecommended to patients with posterior vertebral arch stress reaction. The s elf-reported intensity of low-back pain (scale 0-100) among all ale patient s was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follo w-up (P < 0.0001), In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoidi ng the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.