Accurate diagnosis of chronic low back pain in a high-level college athlete: a case report

Abstract

: A 21-year-old woman who was high-level college softball player presented with a 6-month history of low back pain that had been treated unsuccessfully by medication at local clinics. There was tenderness in the left paravertebral muscle at the lower lumbar level. X-ray and computed tomography revealed congenital scoliosis and an L6 hemivertebra. Short tau inversion recovery magnetic resonance imaging showed a fluid collection at the left L6-S1 facet joint. We performed a diagnostic facet injection, consisting of 1% % lidocaine and steroids, that was infiltrated into the left facet joint at L6-S1. Her persistent low back pain disappeared immediately after the facet block. We diagnosed left-sided facet arthritis at L6-S1. Due to her multiple congenital anomalies, excessive loading occurred at the facet joint. Therefore, we opted for conservative management, including mobilization of the thoracic spine and stretching of hamstrings and quadriceps. This case report underscores the importance of accurate diagnosis of low back pain and of the diagnostic utility of short tau inversion recovery magnetic resonance imaging and lumbar facet block in young athletes with chronic spinal pain.

Is scoliosis a source of pain?

“…Few case reports published on the coexistence of back pain and congenital scoliosis underline the atypical nature of such a combination (unusual curve pattern, unusual pain type, accidental diagnosis in an apparently healthy individual). [23][24][25] Neuromuscular (NM) scoliosis prevalence greatly varies among the different pathologies, from 25% in cerebral palsy, 50% in poliomyelitis, 60% in myelodysplasia, 65% in spinal muscular atrophy (SMA), up to 80% in Friedreich ataxia and 90% in Duchenne muscular dystrophy. 26 The rationale of the management of NM scoliosis consists primarily in preserving or restoring the gross motor functions of sitting, standing, or walking.…”

“…Few case reports published on the coexistence of back pain and congenital scoliosis underline the atypical nature of such a combination (unusual curve pattern, unusual pain type, accidental diagnosis in an apparently healthy individual). 23 – 25 …”

A Study on the Effect of Core Strength Strengthening Training on Exercise-Induced Lumbar Injuries

“…In daily sports training, athletes are prone to minor lumbar injuries or sprains due to insufficient warm-up and overloading of the lumbar region, and such conditions, if not treated in a timely manner or treated incompletely, can easily lead to lumbar injuries, which will not only affect the effectiveness of training, but also be detrimental to the physical health of athletes. Softball [6], high jump [7], gymnastics [8], and soccer [9,10] have a high likelihood of causing lumbar injury; therefore, the treatment of lumbar injury has received a lot of attention from researchers. Feng et al [11] studied the rehabilitation effect of massage combined with thermomagnetic therapy on lumbar injury and found that the therapy significantly improved the lumbar muscle strength and spinal column activity after two to four weeks of treatment and could be promoted in clinical applications.…”