Lateral bending differentiates early-stage spondylolysis from nonspecific low back pain in adolescents.

BACKGROUND: Early-stage spondylolysis (ESS) is one of the common causes of acute low back pain (LBP) in adolescents. Although accurate diagnosis of ESS is important for providing appropriate treatment, differentiating ESS from other low back disorders is difficult by physical signs alone. OBJECTIVES: To elucidate the most common characteristic, namely, motion-provoking LBP, in patients with ESS. DESIGN: Retrospective comparative cohort study. METHOD: We included and categorized adolescents (n = 112; age, <18 years) with acute LBP (<1 month) into the ESS (n = 71) and nonspecific LBP (NS-LBP) (n = 41) groups based on magnetic resonance imaging (MRI) findings. Patients were evaluated using a visual analog scale (VAS), Oswestry Disability Index (ODI), and degree of pain using a numerical rating scale (NRS) provoked by hyperextension, hyperflexion, right and left rotations, and lateral bending in standing position.; the value were compared between the 2 groups. A cut-off value of significance was obtained using receiver operating characteristic (ROC) analysis. RESULTS: The mean scores for VAS and ODI and NRS of each test were as follows (ESS/NS-LBP): VAS, 6.5/6.0; ODI, 19.7/24.6; hyperextension, 4.1/4.1; hyperflexion, 2.4/3.0; rotation, 2.1/2.2; and lateral bending, 2.9/2.2. The ESS group had a significantly greater number of LBP cases provoked by lateral bending than the NS-LBP group. A cut-off lateral bending of 3.5 yielded a diagnosis of ESS. CONCLUSIONS: Our results indicate that lateral bending is the greatest motion-provoking characteristic of LBP in patients with ESS.

Utility of Physical Examination Findings for Predicting Low-Back Pain in Adolescent Patients with Early-Stage Spondylolysis: A Retrospective Comparative Cohort Study.

INTRODUCTION: This study aimed to elucidate low-back pain (LBP) characteristics, i.e., its qualities, extent, and location, in patients with early-stage spondylolysis (ESS). METHODS: We recruited patients (≤18 years old) who presented with acute LBP lasting up to 1 month. Patients were divided into ESS and nonspecific LBP (NS-LBP) groups based on their magnetic resonance imaging findings; patients showing no pathological findings that might explain the cause of LBP were classified as NS-LBP. All patients were evaluated using the following tests: hyperextension and hyperflexion (pain provocation tests in a standing position), pain quality (sharp/dull), pain extent (fingertip-sized area/palm-sized area), and pain location (left and/or right pain in side [side]/central pain [center]). We have also compared outcomes between the ESS and NS-LBP groups in terms of gender and physical symptoms. RESULTS: Of 101 patients, 53 were determined to have ESS (ESS group: mean age: 14.3 years old; 43 males/10 females), whereas 48 had no pathological findings explaining the LBP origin [NS-LBP group (mean age, 14.4 years old; 31 males/17 females)]. Chi-squared test has identified gender (male), a negative result on hyperflexion test, pain extent (fingertip-sized area), and pain location (side) to be significantly associated with ESS. Among these, regression analysis revealed that male gender and LBP located on the side were significantly associated with ESS (p<0.05). CONCLUSIONS: Although the hyperextension test is generally considered useful for ESS, we demonstrated that its association is not deemed significant. Our results indicate that male gender, a negative result of the hyperflexion test, fingertip-sized pain area, and LBP on the side may be specific characteristics of ESS. Of these physical signs, male gender and LBP located on the side are characteristic factors suggesting ESS presence.

Does the single-limb stance reflect chronic ankle instability in an athlete?

BACKGROUND: The single-limb stance with closed eyes has been widely used to evaluate chronic ankle instability as static balance; however, there was lack of consideration of whether difference in age, frequency of previous ankle sprain or physical ability influenced single-limb stance. RESEARCH QUESTION: We hypothesized that the single-limb stance might not reflect subjective ankle instability and function on physical activity in people who perform sports activities. METHODS: In total, 102 high school basketball players were recruited to evaluate their physical performance at the beginning of the season. Participants were divided into five groups based on the frequency of previous ankle sprain. Karlsson ankle function score (K score) was considered as a subjective ankle function score, that was divided into various components. Each component and the single-limb stance test with center of pressure (COP) analysis was observed between the frequency of ankle sprains with one-way ANOVA and compared using Spearman's rank correlation coefficient to verify the relationship between the K score and COP. RESULTS: For COP parameters, no difference was observed in the history of ankle sprains. The K score was lower in participants with three previous ankle sprains than in those with a different number of ankle sprains for instability, stiffness, running, work activities, support, and total K score for all parameters. There were weak negative correlations (r = -0.19∼-0.35) between K score and COP parameters among participants with no history of ankle sprain or only once. In contrast, there were strong positive correlations (r = 0.69∼0.87) among history of ankle sprain at third. SIGNIFICANCE: The single-limb stance might not accurately reflect an athlete's ankle instability and function on physical activity. Clinically, therapists should choose suitable evaluation tools depending on the athlete's activity level to check for chronic ankle instability.

Characteristics of low back pain in adolescent patients with early-stage spondylolysis evaluated using a detailed visual analogue scale.

STUDY DESIGN: Retrospective comparative cohort study. OBJECTIVE: To elucidate the characteristics of low back pain (LBP) in adolescent patients with early-stage spondylolysis (ESS). SUMMARY OF BACKGROUND DATA: ESS is a common cause of acute LBP in adolescents. When treating patients with ESS, early diagnosis is important; however, early diagnosis is difficult without magnetic resonance imaging. METHODS: Adolescent patients (n = 77) with acute LBP showing no pathological findings on plain radiography were included (<1 m after onset). Patients were divided into ESS and nonspecific LBP (NS-LBP) groups by conducting magnetic resonance imaging; patients showing no pathological findings that explain the cause of LBP were classified as NS-LBP. LBP was evaluated using a traditional visual analogue scale (VAS; 0-10 cm), Oswestry Disability Index, and a detailed VAS scoring system in which pain is independently evaluated in 3 different postural situations (in motion, standing, and sitting); the values were compared between the 2 groups. RESULTS: Of 77 patients, 41 (mean age: 14.6 yr; 33 adolescent boys/8 adolescent girls) had ESS and 36 (mean age: 14.3 yr; 20 adolescent boys/16 adolescent girls) were considered to have NS-LBP. Respective traditional VAS and Oswestry Disability Index scores were 4.9, 16.1 in the ESS group, and 6.2, 26.3 in the NS-LBP group. Both scores were significantly higher in the NS-LBP group. The results of the detailed VAS revealed that the ESS group showed significantly greater pain intensity while in motion than while standing or sitting (4.2, 2.0, and 2.0, respectively), whereas the NS-LBP group showed similar pain intensities in all 3 postural situations (5.3, 4.0, and 4.9, respectively). CONCLUSION: This study revealed that LBP characteristics may provide important information for distinguishing ESS from other low back disorders. Because early diagnosis is essential for the treatment of ESS, MRI examination is recommended for patients showing severe pain in motion, but less pain when standing or sitting.