Co-diagnoses of spondylolysis and femoroacetabular impingement: a case series of adolescent athletes

Abstract

Locating the source of lumbopelvic–hip pain requires the consideration of multiple clinical pathways. Although low back pain has an incidence of 50% in the adolescent population, the pathophysiology in this population typically differs from that of other age groups. Dynamic mechanical impairments of the hip, such as femoroacetabular impingement, may contribute to the pathogenesis of adolescent low back pain. Eight adolescent male athletes who presented to a single provider with a primary complaint of low back pain with hip pain or motion loss on exam and were ultimately diagnosed with lumbar spondylolysis and dynamic mechanical hip issues between 2009 and 2011 were included. The age at spondylolysis diagnosis ranged from 15 to 19 years (mean ± standard deviation: 16.3 ± 1.3 years). Seven patients had cam-type impingement, whereas one presented with pincer-type impingement. All patients demonstrated either decreased internal rotation at 90 degrees of hip flexion and neutral abduction or pain on the Flexion Adduction Internal Rotation test on at least one of hip. All eight patients were treated initially with 6 weeks of physical therapy consisting of attempted restoration of hip motion and the graduated progression of hip and spine stabilization exercises. Five patients (62.5%) returned to sport at an average of 11.2 weeks (range: 6–16 weeks). For three patients (37.5%), hip pain and motion loss persisted, thus requiring surgery. All subjects had symptoms for at least 6 weeks, with 6 months as the longest duration. This report is the first documented series of adolescent athletes with co-diagnoses of spondylolysis and femoroacetabular impingement. Study Information: This retrospective case series was approved by the Institutional Review Board at Hospital for Special Surgery.

Back pain in adolescent athletes: a narrative review

“…Lumbar bracing may be used, however, should be saved for patients who fail to improve without bracing, as there is controversy regarding the impact of bracing on clinical outcomes and concern that the restriction may increase movement at the lumbosacral junction. [31][32][33] Several primary articles support early initiation of physical therapy as opposed to long periods of immobilization, which allows earlier return to sport, possibly due to minimizing muscle atrophy and deconditioning. [32][33][34][35][36][37] Physical therapy should be guided towards strengthening deep abdominals and multifidus muscles in conjunction with sport-specific exercises.…”

“…Dynamic weightbearing exercises can also be used in later stages of therapy. [31][32][33] Hamstring tightness has been correlated to low back pain in certain sports disciplines, however, research regarding addressing hamstring tightness in treating low back pain and the integration of this into physical therapy protocols is required. 38 The results of conservative treatment are generally excellent.…”

“…Estimated rates of return to sport are above 90% within six months with the majority of patients reporting resolution of pain symptoms. 31,32,35 The high likelihood of return to sport should be outlined in order to minimize hesitation of activity and fear of re-injury. 32,36…”

Association between hip joint impingement and lumbar disc disease in elite rowers

“…6 The possible relationship between FAI and lumbar spine pathology has been noted in a study of adolescent group of athletes in other sports. 10 The reduced range…”

“… 6 The possible relationship between FAI and lumbar spine pathology has been noted in a study of adolescent group of athletes in other sports. 10 The reduced range of femoral movement and increased pelvic tilt seen during hip flexion in individuals with cam type FAI may put additional stress through the lumbar spine. 9 This may a contributing factor to the high rates of lumbar injuries observed in rowers.…”