Jackson and colleagues radiographed the lumbar spines of 100 competitive young female gymnasts to find how often they had pars interarticularis defects.
Radiographic survey of 100 volunteer gymnasts aged 6 to 24 competing at regional to international level, training up to 40 hours a week. Gymnasts referred for back pain were excluded.
Key Findings
11 of 100 gymnasts had bilateral L5 pars defects, 6 of them with grade 1 spondylolisthesis. The authors put this at four times the 2.3% reported for white females generally.
Back pain that interfered with training had occurred in 19 of the 89 without defects. Of the 11 with defects, 6 reported prior back pain.
Three gymnasts with back pain had negative first radiographs and later films showed new pars defects.
Pain with a defect was chronic and dull, usually not tied to one injury, and markedly worse with hyperextension such as back walkovers.
Spina bifida occulta was present in 9 of the 11 gymnasts with defects and in 29 of the 89 without. The authors call its role speculative.
Of 12 gymnasts referred for back pain and excluded from the series, 4 with negative radiographs had bone scans and 2 showed increased uptake in the posterior elements.
Board pearl
Negative radiographs do not rule out a developing pars defect. The authors suggest restricting activity early may let a stress reaction heal before it shows on radiographs.
Authors' conclusion
Low back pain in the young gymnast should be a warning sign. Close scrutiny of pars interarticularis in these young athletes will reveal a high incidence of developing defects.
Jackson and colleagues radiographed the lumbar spines of 100 competitive young female gymnasts to find how often they had pars interarticularis defects.
Radiographic survey of 100 volunteer gymnasts aged 6 to 24 competing at regional to international level, training up to 40 hours a week. Gymnasts referred for back pain were excluded.
Key Findings
11 of 100 gymnasts had bilateral L5 pars defects, 6 of them with grade 1 spondylolisthesis. The authors put this at four times the 2.3% reported for white females generally.
Back pain that interfered with training had occurred in 19 of the 89 without defects. Of the 11 with defects, 6 reported prior back pain.
Three gymnasts with back pain had negative first radiographs and later films showed new pars defects.
Pain with a defect was chronic and dull, usually not tied to one injury, and markedly worse with hyperextension such as back walkovers.
Spina bifida occulta was present in 9 of the 11 gymnasts with defects and in 29 of the 89 without. The authors call its role speculative.
Of 12 gymnasts referred for back pain and excluded from the series, 4 with negative radiographs had bone scans and 2 showed increased uptake in the posterior elements.
Board pearl
Negative radiographs do not rule out a developing pars defect. The authors suggest restricting activity early may let a stress reaction heal before it shows on radiographs.
Authors' conclusion
Low back pain in the young gymnast should be a warning sign. Close scrutiny of pars interarticularis in these young athletes will reveal a high incidence of developing defects.