RE: Pars...

[Guest guest]

Getting a high school athlete to discontinue sport would be next to impossible. My son did not even let people know his back hurt him in HS; through xc, basketball and track. In his senior year of HS he had back pain so severe after games early in the season he said he could barely walk...but he never told me or others...he wanted to play! He finally listened to his body and others when his body wouldn't let him do otherwise 1 1/2 years later. Conservative care did not improve his problem in the short term and did not allow him to get back into competition so he "saw the writing on the wall". I would add the the ability for the fracture to heal is a small window, when skeletal maturity is attained the prognosis for "healing" is pretty poor. Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724 From: DrSHirsch@...Date: Sun, 13 Mar 2011 21:03:37 +0000Subject: Pars...

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.

Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my "sick bed" (worst cold I've ever had ;-(

Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.

I was hoping for just this: other's opinions.

Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .

Please, keep them coming and Thanks so much to all of you.

Surah

[Guest guest]

Terry Yochum gave a seminar on this about 100 years ago. He complained about “iatrogenic loss of sports enjoyment” or something to that effect. He theorized that a spondy was NOT a contraindication of competitive sports but looks so scary that docs bench the athlete unnecessarily. (Sort of sounds sort of like the recommendations my patients get from well meaning but uninformed physicians who tell them that c-spine fusion contraindicates spinal manipulation; but sky diving, skiing, and wake boarding, professional hockey, bull riding, you get the picture...no problem.) Yochum showed an Australian football player who had a grade 5 spondy (L5 wasn’t even in the same zip code as the sacrum) and the guy was doing fine.

I have the notes at the clinic and with my new zippy Fujitsu Scansnap, will scan them in and send them over.

Abrahamson

P.s. doesn’t know everything.

Hey ,

What... is the Airspeed Velocity of an Unladen Swallow?

On 3/13/11 2:03 PM, " Surah " <DrSHirsch@...> wrote:

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.

Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my " sick bed " (worst cold I've ever had ;-(

Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.

I was hoping for just this: other's opinions.

Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .

Please, keep them coming and Thanks so much to all of you.

Surah

[Guest guest]

True! Just ask Phil Zapf to show you his films! However, if the goal is healing of the pars the logical approach would to be diminish extension loading on the injured segment, improve muscle balance and somehow stimulate osteoblastic activity if posssible... or just life go on; that is the patients (and/or parental) choice. Lots of studies SUGGESTING causation, but no studies revealing the smoking gun, so maybe everything I think i've learned is total BS. Besides, if they do need gentle Chiro care for symptomatic relief thats a life-long Chiro patient, right? Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724DrSHirsch@...; From: drscott@...Date: Sun, 13 Mar 2011 16:10:09 -0700Subject: Re: Pars...

Terry Yochum gave a seminar on this about 100 years ago. He complained about “iatrogenic loss of sports enjoyment” or something to that effect. He theorized that a spondy was NOT a contraindication of competitive sports but looks so scary that docs bench the athlete unnecessarily. (Sort of sounds sort of like the recommendations my patients get from well meaning but uninformed physicians who tell them that c-spine fusion contraindicates spinal manipulation; but sky diving, skiing, and wake boarding, professional hockey, bull riding, you get the picture...no problem.) Yochum showed an Australian football player who had a grade 5 spondy (L5 wasn’t even in the same zip code as the sacrum) and the guy was doing fine.

I have the notes at the clinic and with my new zippy Fujitsu Scansnap, will scan them in and send them over.

Abrahamson

P.s. doesn’t know everything.

Hey ,

What... is the Airspeed Velocity of an Unladen Swallow?

On 3/13/11 2:03 PM, "Surah" <DrSHirsch@...> wrote:

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.

Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my "sick bed" (worst cold I've ever had ;-(

Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.

I was hoping for just this: other's opinions.

Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .

Please, keep them coming and Thanks so much to all of you.

Surah

[Guest guest]

...and another thing. My son hasn't had a follow-up bone scan or MRI so the fracture may still be the same. However he symptom-free (mostly) and doesn't want to know whether he is "healed" or not right now because what would be the alternative? Not run? Not a solution for him. Plus, have you ever seen the size of the needle used when they do a bone scan? Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724DrSHirsch@...; From: drscott@...Date: Sun, 13 Mar 2011 16:10:09 -0700Subject: Re: Pars...

Terry Yochum gave a seminar on this about 100 years ago. He complained about “iatrogenic loss of sports enjoyment” or something to that effect. He theorized that a spondy was NOT a contraindication of competitive sports but looks so scary that docs bench the athlete unnecessarily. (Sort of sounds sort of like the recommendations my patients get from well meaning but uninformed physicians who tell them that c-spine fusion contraindicates spinal manipulation; but sky diving, skiing, and wake boarding, professional hockey, bull riding, you get the picture...no problem.) Yochum showed an Australian football player who had a grade 5 spondy (L5 wasn’t even in the same zip code as the sacrum) and the guy was doing fine.

I have the notes at the clinic and with my new zippy Fujitsu Scansnap, will scan them in and send them over.

Abrahamson

P.s. doesn’t know everything.

Hey ,

What... is the Airspeed Velocity of an Unladen Swallow?

On 3/13/11 2:03 PM, "Surah" <DrSHirsch@...> wrote:

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.

Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my "sick bed" (worst cold I've ever had ;-(

Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.

I was hoping for just this: other's opinions.

Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .

Please, keep them coming and Thanks so much to all of you.

Surah

[Guest guest]

Hi doc,

If you haven't already, you may want to determine whether or not the segment is stable through traction, flex, ext films as well as SPECT imaging. Stability should be a major deciding factor in determining whether the patient be taken out of sports. The literature doesn’t really support taking an athlete out for a stable spondy. However, Basketball with it's jumping and proclivity toward lumbar hyper extension could be aggravating.

If it's stable, try all the things you mentioned with perhaps a focus on flexion type of exercises and stretching. Chances are he's a bit hyperlordotic. Attempt to really strengthen the low back and abdominals to a high degree. Consider bracing especially if he has a pronounced lordosis. (Boston Brace I believe.) Minimize any extension while adjusting lumbars, Ice a lot esp. when sore.. Traction may also provide some relief.

Good luck,

ph Medlin D.C.

From: Surah

Sent: Sunday, March 13, 2011 2:03 PM

Subject: Pars...

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my "sick bed" (worst cold I've ever had ;-(Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.I was hoping for just this: other's opinions. Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .Please, keep them coming and Thanks so much to all of you.Surah

[Guest guest]

Attached is a nice study which shows good response to bracing and removal from sport for a few months. Below is support for not limiting sport, unless pain or slippage is noted. Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724Spondylolysis or

isthmic spondylolisthesis activity restrictions

In the past, patients have often been advised to limit their

activities (especially participation in sports and active exercise) to avoid

causing advancement of the spondylolysis. However, new information developed

from modern imaging tests and recent research indicates that reduced activity

and/or rest to protect the spondylolysis from slipping may not always be

necessary. Rest is only necessary if the patient becomes symptomatic. Rest can

help eliminate the pain, and when the pain resolves the patient can resume his

or her normal activities.

Often adolescents are

pulled from their sports participation because of fears that their

spondylolysis will lead to spondylolisthesis (slippage of the affected

vertebra) and that the slippage will become so severe as to cause permanent

damage or paralysis. Adults with spondylolysis are also often counseled to

avoid rigorous exercise and/or physically demanding jobs. However, in published

medical literature, there are no instances of a patient in a work, industrial,

or sports-related environment that has experienced trauma causing

spondylolisthesis to slip further and produce neurological deficit or

paralysis.

Sophisticated imaging

modalities such as single-photon

emission computed tomography (SPECT) bone scans and magnetic resonance imaging

(MRI) scans of the spine now provide the ability to evaluate the physiological

changes that are associated with spondylolysis. This information allows

for the important distinction between active and inactive spondylolysis.

·

Active

spondylolysis. On the SPECT scan an

active spondylolysis shows uptake, and an MRI scan shows bone marrow edema

adjacent to the pars defect. These findings indicate that there is

activity/movement associated with the pars defect, which is likely to produce

symptoms of low back pain.

·

Inactive spondylolysis. If there are no indications of

activity with the pars defect, then the spondylolysis is considered inactive

and any low back pain the patient is experiencing is probably incidental

(meaning that there is probably another cause of the patient’s lower back pain,

such as a muscle strain).

Even though activity

restriction is not always necessary, careful management of spondylolysis is

always advisable. Acute (active) spondylolysis requires more intensive

management, while symptoms from spondylolysis that has moved into a chronic

(inactive) phase can be managed conservatively.1

Reference:

1Bergmann TF, Hyde TE,

Yochum TR. Active or Inactive Spondylolysis and/or Spondylolisthesis: What's

the Real Cause of Back Pain? Journal

of the Neuromusculoskeletal System. 2002:10:70-78.

From: DrSHirsch@...Date: Sun, 13 Mar 2011 21:03:37 +0000Subject: Pars...

Thanks all for your responses (and keep 'em coming :-) This forum is so great for this type of thing.

Anyway, true about US and end plates; my preliminary thoughts (I wrote this right after receiving the MRI report and from my "sick bed" (worst cold I've ever had ;-(

Was thinking a short stint of low setting US to help decrease the swelling. He thinks this happened a couple weeks ago when someone slammed into him during a basketball game.

I was hoping for just this: other's opinions.

Do other's agree with ? I've got to tell this young man he won't be playing tennis or basketball for 1 year? Thanks for sharing your experience, .

Please, keep them coming and Thanks so much to all of you.

Surah

1 of 1 File(s)

lumbar spondylolysis in children and adolescents.pdf