Case 12: A 16-year-old tennis player has had 3 weeks of worsening low back pain. She thinks it may have started after twisting to hit a forehand out of her reach. She isolates the pain to the right low back and has pain with sudden movements and twisting. She has some radiation of pain into the buttocks. She has extreme tenderness when she tries to get out of bed, a chair, or the car. She is tender over the right SI joint and has decreased mobility and pain on this side with forward flexion. She has a positive Patrick/FABER test.
The sacroiliac (SI) joint has limited movement (2-4°) but can be a source of pain in adolescent athletes, especially females. Twisting or loading of the joint with activity may cause acute pain. Symptoms are similar to those with muscular low back pain but are directed at the SI joint. Tenderness to palpation at the SI joint along with a positive Patrick's/ FABER test (flexion, abduction, external rotation of the hip) are typical. Mobility of the SI joint may be excessive or limited on the affected side with forward flexion. Radiographs of the SI joint are normal.
Treatment is conservative. Physical therapy consists of daily flexibility and core body strengthening. Mobilization or manipulation of the joint by a physical therapist may help relive acute symptoms. Attention to equal weight loading of the legs especially when changing positions can help to decrease acute increases in pain. Heat, ice, and nonsteroidal antinflammatories are used but do not typically relieve all pain. Occasionally injections (steroids or prolotherapy) are used to relieve discomfort. (For further discussion of back pain during adolescence, see Chapter 10.)
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Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.