Studies of Spondylolysis found among weightlifters

Chronic Lower Back Pain in Weight Lifters: Epidemiology, Evaluation, and Management

» Chronic lower back pain (LBP) is common in both nonathletes and weight lifters, but the diagnosis and treatment should be approached differently in these 2 populations based on the unique movement patterns causing the pain.» Injury rates of weight lifters are far less than those of contact sports, ranging from 1.0 to 4.4 injuries per 1,000 workout hours. However, the lower back was consistently one of the top 2 injury sites for weight lifters, accounting for anywhere from 23% to 59% of all injuries. LBP was most often associated with the squat or deadlift.» Guidelines for evaluating general LBP are applicable to weight lifters, including a thorough history and physical examination. However, the differential diagnosis will change based on the patient's lifting history. Of the many etiologies of back pain, weight lifters are most likely to be diagnosed with muscle strain or ligamentous sprain, degenerative disk disease, disk herniation, spondylolysis, spondylolisthesis, or lumbar facet syndrome.» Traditional recommended therapies include nonsteroidal anti-inflammatory drugs, physical therapy, and activity modification, which are often insufficient to resolve pain and prevent injury recurrence. Because most athletes will want to continue to lift weights, lifting-specific behavior modifications focused on improved technique and correcting mobility and muscular imbalances are important aspects of management in this patient population.

The Incidence of Pars Interarticularis Defects in Athletes

STUDY DESIGN

Literature review.

OBJECTIVE

To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk.

METHODS

Electronic searches were performed using PubMed, Ovid Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Database of Controlled Trials from their dates of inception to September 2017, with the following keywords: "spondylolysis," "sports," "low back pain," and "pars defects."

RESULTS

A total of 509 total articles were retrieved, of which 114 were used in the final review. The incidence of pars interarticularis defects was found to be highest in diving (35.38%), cricket (31.97%), baseball/softball (26.91%), rugby (22.22%), weightlifting (19.49%), sailing (17.18%), table tennis (15.63%), and wrestling (14.74%). Only 5 studies reported the management instituted for their participants, and these were all case reports. Of 74 players with spondylolysis in these studies, 70 (94.59%) underwent conservative treatment and 4 (5.41%) underwent surgical treatment. 61 (82.43%) returned to their previous level of play, 6 (8.11%) retired, and the disposition of the final 7 was not reported.

CONCLUSION

The current medical literature provides good evidence that the incidence of pars interarticularis defects is higher in the athletic population, with the highest incidence in diving. There remains no gold standard protocol for the management of pars interarticularis defects. Further research is required to compare conservative therapy to surgical therapy and to compare the various surgical techniques to each other.

Changes in the spinopelvic parameters of elite weight lifters

OBJECTIVE

To describe the changes in the spinopelvic parameters in weight lifters and evaluate the factors leading to spinal anatomical changes (eg, spondylolysis and listhesis).

DESIGN

Case-control study.

SETTING

Tertiary, institutional.

PARTICIPANTS

The study group participants were practicing weight lifters in the athletes' village of the 2012 London Olympics. A total of 21 elite weight lifters were enrolled. Their data were compared with those of 45 healthy volunteers in the control group.

INTERVENTIONS

Comparative radiological evaluations were performed among the 21 elite weight lifters. Spinopelvic parameters (radiographic analysis), including total (TLL), upper (ULL), and lower (LLL) lumbar lordoses, sacral slope, pelvic tilt (PT) and incidence, lumbar index, and disc angles, were assessed.

MAIN OUTCOME MEASURES

The proportional ratio of ULL and LLL to TLL (ULL/TLL and LLL/TLL) was measured to describe the proportion effect. These values were compared with those of the control group. Weight lifters with and those without anatomical changes were subdivided into a deformed and nondeformed group, respectively, and further analyzed for differences. The correlation between these spinal parameters and the amount and duration of weight lifting training was also analyzed.

RESULTS

Anatomical changes in the lumbar spine were seen in 6 weight lifters (28.6%, P = 0.01). The mean TLL, ULL, and LLL values (59.8, 22.6, and 37.2 degrees, respectively) were increased, whereas PT (10.3 degrees) was decreased in the athletes compared with the volunteers (P = 0.001, 0.005, 0.07, and 0.018, respectively). The ULL/TLL was higher in the deformed group than in the nondeformed group (P = 0.036). The duration and amount of weight lifting training were not correlated with the spinopelvic parameters measured in this study.

CONCLUSIONS

The elite weight lifters had increased lumbar lordosis and decreased PT compared with the healthy volunteers. The ULL/TLL ratio may be used as a predictive marker for lumbar deformation.

A biomechanical comparison of three spondylolysis repair techniques in a calf spine model

SUMMARY OF BACKGROUND DATA

Previous work has demonstrated the efficacy of lumbar pedicle screw hook rod (PSHR) techniques and the Buck screw in the stabilization of spondylolysis. The mechanical behavior of lower profile cervical implants used to create PSHR, hybrid cable plate constructs, and titanium miniplating has not previously been described.

METHODS

Calf lumbar spines (L2-L6) were utilized for testing (n=27). Intervertebral rotation was measured in the intact spines across the L4-5 segment before and after creation of bilateral pars interarticularis defects. Defects were then stabilized with one of three repair techniques, PSHR, miniplate, or cable plate (CP) constructs. (n=9). A 5-Nm load was applied in flexion-extension, lateral bending and axial rotation. Fracture displacement was measured under flexion-extension and lateral bending modes.

RESULTS

Osteotomy of the pars interarticularis increased intervertebral rotation from 4.6° to 9.2° (P<.05). The three techniques of repair reduced intervertebral rotation without statistical superiority of one method. In lateral bending the miniplate was most effective in reducing pars defect displacement (0.6mm, P<0.05). Although, the miniplate provided lower defect displacement in flexion-extension and axial rotation, these differences were not statistically significant.

CONCLUSIONS

Bilateral miniplate fixation demonstrates superiority in restoring stability in lateral bending as compared to pedicle screw hook rod techniques and cable plate constructs. In flexion-extension and axial rotation, it was as effective as a PSHR method. Consideration of anatomic plate designs warrants consideration.

LEVEL OF EVIDENCE

IV.

Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007

BACKGROUND

As participation in weight training in the United States increases, the number of persons at injury risk increases.

PURPOSE

To examine weight training-related injuries in patients presenting to US emergency departments from 1990 to 2007. Study Design Descriptive epidemiology study.

METHODS

Weight training-related injury data were analyzed from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System. Sample weights provided by this organization calculated national estimates of weight training-related injuries from the 100-hospital sample.

RESULTS

From 1990 to 2007, 25 335 weight training injuries were seen in US emergency departments, correlating to an estimated 970 801 injuries nationwide. Patients' mean age was 27.6 years (range, 6-100 years); 82.3% were male. The upper trunk (25.3%) and lower trunk (19.7%) were the most commonly injured body parts. The most common diagnosis was sprain/strain (46.1%). The most common mechanism of injury was weights dropping on the person (65.5%). A large number of injuries occurred with free weights (90.4%). Males had a larger proportion of upper trunk injuries (26.8%; injury proportion ratio [IPR], 1.45; 95% confidence interval [CI]: 1.36-1.57; P <.001) than females (18.4%). Females had a larger proportion of foot injuries (22.9%; IPR, 2.09; 95% CI: 1.93-2.26; P <.001) than males (11.0%). Persons 12 years and younger had a larger proportion of hand (37.9%; IPR, 2.08; 95% CI: 1.76-2.46; P <.001) injuries than persons 13 years or older (18.2%). Persons 55 years and older were injured more when using machines (18.2%; IPR, 1.96; 95% CI: 1.47-2.61, P <.001) than persons 54 years and younger (9.3%). Persons using free weights sustained a greater proportion of fractures/dislocations (23.6%; IPR, 2.44; 95% CI: 1.92-3.09; P <.001) than persons using machines (9.7%).

CONCLUSION

Further research is needed to drive development of targeted, age- and gender-specific, evidence-based injury prevention strategies to decrease injury rates among weight training participants.

Degenerative disease in lumbar spine of military parachuting instructors

Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study. Past radiographs were examined and compared to current anterolateral and lateral views of the lumbar spine, in order to determine the prevalence of degenerative changes and document possible progression. Doubtful radiographic changes in the lumbar spine were identified in 47.4 percent of the parachuting instructors, mild degeneration in 9.6 percent, moderate degenerative disease in 10.9 percent and severe radiographic changes in 5.5 percent. Schmorll nodes were found in 8.1 percent of the subjects. Traction spurs--osteophytes were identified in 6.8 percent. The degenerative changes correlated with age and the number of jumps. Spondylolysis of L5-S1 and L3-L4 segments were observed in 12.2 and 1.4 percent respectively. Progressive spondylolisthesis was found in 2 subjects. No correlation was found between the severity of radiographic changes and either the prevalence and the severity of low back pain. The present findings provide a rational for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis. Further study has to be done comparing parachuting instructors to a non-parachuting group, or equivalent physically active individuals, in order to assess the effect of sport-background on the development of degenerative changes.

Strength training for children and adolescents

Strength, or resistance, training for young athletes has become one of the most popular and rapidly evolving modes of enhancing athletic performance. Early studies questioned both the safety and the effectiveness of strength training for young athletes, but current evidence indicates that both children and adolescents can increase muscular strength as a consequence of strength training. This increase in strength is largely related to the intensity and volume of loading and appears to be the result of increased neuromuscular activation and coordination, rather than muscle hypertrophy. Training-induced strength gains are largely reversible when the training is discontinued. There is no current evidence to support the misconceptions that children need androgens for strength gain or lose flexibility with training. Given proper supervision and appropriate program design, young athletes participating in resistance training can increase muscular strength and do not appear to be at any greater risk of injury than young athletes who have not undergone such training.

The retroisthmic cleft. Scintigraphic appearance and clinical relevance in patients with low back pain

This article describes the scintigraphic appearance of both a symptomatic and asymptomatic retroisthmic cleft in two athletes with low back pain. This lesion, which involves the lamina, is the least common of the neural arch defects of which spondylolysis is the most common. The anatomy of the lesion is discussed and illustrated. The literature about the possible cause of these lesions is reviewed. The report emphasizes the valuable role of radionuclide bone imaging in patients who have pain of potentially osseous origin, and who have a lesion of uncertain physiologic significance seen on an anatomic study such as a plain x-ray, CT scan, or MRI.

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Spondylolysis of the lower back, particularly that involving the isthmus between the superior and inferior articular processes (pars interarticularis), is generally attributed to stress fracturing caused by movement of the affected vertebra relative to the vertebra below. The finding of isthmic spondylolysis in the first vertebra of a fused sacrum is thus unusual and requires explanation. Although unrepresented in the clinical literature, sacral spondylolysis has been reported for archaeological specimens and appears to be especially prevalent in North American Inuit. A study of 373 Inuit sacra from Alaska and Canada produced 16 examples of spondylolysis (eight from each area). All but one of the affected individuals were male, and nearly all were young adults, many between 18 and 20 years of age. All cases of sacral spondylolysis observed in this study were judged to have resulted from stress fracturing that occurred while S1 was still unfused, and most appear to have been in the process of healing, following fusion of S1 with S2, when death occurred. The high frequency observed in these people is attributed to unusual stresses becoming concentrated in the lower back of adolescent males due to such activities as weight lifting, wrestling, kayak paddling, and harpooning, combined with, and perhaps even contributing to, delayed maturation (S1-S2 fusion) of the sacrum.

Musculoskeletal injuries caused by weight training. Guidelines for prevention

Tens of thousands of U.S. children, adolescents, and young adults are using weights either recreationally, to train for sports, or to compete in weight lifting, power lifting, or body building contests. Weight use may cause significant musculoskeletal injury. This review summarizes for the clinician the best available information on injury risks and prevention.

Occupational spondylolysis and spondylolisthesis

Spondylolysis and spondylolisthesis are not uncommon causes of low back pain and sciatica among the general population. Symptoms from these complaints also appear to be increasing in frequency among those who participate in competitive sports, especially those resulting in heavy pressures on the lumbar spine. Neural arch dysplasia is often a predisposing factor and there is evidence that genetic factors may play a role. Isthmic spondylolysis and mild spondylolisthesis not exceeding 10 mm can be satisfactorily cured by a simple operation involving screwing of the defect. Younger patients have better results and the operation permits the patient to withstand double loading on the lumbar spine so that most can return to work, including heavy manual labour, and to their previous sporting activities.

Low back pain among retired wrestlers and heavyweight lifters

The lifetime incidence and prevalence of low back pain among 32 retired wrestlers (ages 39 to 62 years) and 13 retired heavyweight lifters (ages 40 to 61 years) were evaluated and compared to the corresponding results in a cross-sectional study of 716 men (ages 40 to 47 years). The radiologic findings and the findings upon physical examination in the athletes were compared to the findings in another study of normal, active, similarly aged men who were sampled at random. The lifetime incidence and prevalence of low back pain was higher among the wrestlers (59%) compared with both the lifters (23%) and the control group (31%). The tolerance for backache seemed to be higher among the athletes than the controls. A higher frequency of old fractures was found among the wrestlers. The athletes with fractures had a higher frequency of low back pain. A significant decrease in disk height was found among the lifters.

Changes in the cervical spine in association football players

Forty-three former players for the National Football Team of Norway were examined clinically and radiologically for degenerative changes in the cervical spine. Compared with men of the same age groups the onset of degeneration was 10-20 years earlier and the frequency of degeneration was significantly higher. Degenerative changes were not especially high in “headers”, but this group had a higher frequency of subjective complaints and clinical findings such as reduced cervical movements.

Spondylolysis in Athletes

The high occurrence of spondylolysis in these athletes suggests that certain sports actions predispose athletes to fractures in the neural arches of the lumbar vertebrae.

Olympic Weight-Lifting Injuries

Because most Olympic weightlifting injuries are caused by inflexibility and improper technique, the well-trained lifter concentrates on improving these abilities.