Case 11: A 16-year-old football lineman presents with 3 weeks of low back pain in the off-season. He has been doing team conditioning and weight training and remembers his back hurting after squatting 350 pounds. He has right sided low back pain that goes into his buttocks region. He denies weakness into his legs. He has pain when he drives in the car or sits for a long time.
Disc disease, a bulging of the intervertebral disc with or without nerve root impingement, is more frequently an adult back disorder but does occur in adolescents. Athletes lifting weights are particularly prone to disc problems due to improper positioning or lifting excessively heavy weight especially with squatting. Athletes present with low back pain that may radiate into the buttocks or leg or cause parasthesis into the lower extremities. Pain worsens with forward flexion, sitting, or driving. Straight leg raises may be positive however, some adolescent disc bulging may be more central without nerve root impingement resulting in a negative straight leg test. Lower extremity strength and sensation is usually normal but may be compromised with nerve root impingement. Atrophy, weakness, or neurologic symptoms signal more serious disease and should be evaluated appropriately. Radiographs (AP and lateral) are normal although may show some narrowing of the joint spaces on lateral view. An MRI may show disc bulging or nerve root impingement.
Treatment is typically conservative and consists of a daily core body/ lumbar stabilization rehabilitation program in the neutral or extension biased position along with hamstring and hip rotator flexibility. Use of a lumbar support pillow can decrease stress on the disc while sitting. Avoiding prolonged sitting or stationary positions may help circumvent significant discomfort. In acute cases, steroids may be used to help decrease inflammation but are not a mainstay of treatment in adolescents. Rarely, surgery is necessary for disc decompression. Proper weight training technique and discussion regarding weight training is suggested.
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