Management of lumbar bone stress injury in cricket fast bowlers and other athletes
- Publisher:
- Academy of Science of South Africa
- Publication Type:
- Journal Article
- Citation:
- South African Journal of Sports Medicine, 2023, 35, (1), pp. v35i1a15172
- Issue Date:
- 2023
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Background Recent guidelines including a special series in i The Lancet i have emphasised a minimal role for imaging when assessing low back pain in adults as the majority of patients will have non specific findings on imaging that do not correlate well with pain Objective To assess whether the diagnosis of lumbar bone stress injuries in young athletes should be considered an exception to the recommendation to avoid imaging for low back pain in adults Method Narrative review Results Early lumbar bone stress injury diagnosis has been available via traditional MRI sequences and its precursor Single Photon Emission Computed Tomography SPECT for 25 30 years MRI assessments using bone window sequences such as Volumetric Interpolated Breath hold Examination VIBE have allowed a better understanding of the diagnosis and prognosis of lumbar bone stress injury in young athletes MRI with bone sequences has allowed non radiating scans to serially follow the healing of unilateral stress fractures In the majority of cases non chronic unilateral fractures can heal however this takes three six months rather than the six ten weeks that would be the typical unloading period if using symptoms only as a guide The use of MRI to provide evidence of bony healing as opposed to fibrous union which creates the pars defect that predisposes to further bone stress lesions can lead to better long term outcomes in athletes There is evidence to flag this as a structural lesion which is both painful and more importantly can heal resolve if managed correctly Therefore it represents an important specific diagnostic subset within adult low back pain Conclusion Structural rather than functional management of bone stress injuries in high demand athletes such as cricket pace bowlers is in contrast to the recommendation of functional management for general back pain in adults Structural management is justified when there are demonstrable superior outcomes of having better structure Although this has not y
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