Re: Spondylolisthesis and swimming

[Guest guest]

Many years ago while attending a continuing education seminar this topic was

discussed in great detail. As to not spread incorrect memories I would suggest

contacting the source. Stanley Paris, PT at the University of St. Augustine.

Newton, PT, CWS

[Guest guest]

A quick search on medline (spondylolisthesis + swimming) revealed the following

articles. Good evidence to encourage backstroke over breaststroke and butterfly

style. Your clinical reasoning was right on target.

Lorraine Tyner, MPT

Phila, PA

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Int J Sports Med. 2000 Jul;21(5):375-9.

Spondylolysis as a cause of low back pain in swimmers.

Nyska M, Constantini N, Cale-Benzoor M, Back Z, Kahn G, Mann G.

Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University,

Israel.

Low back pain (LBP) has recently become a common complaint in swimmers. The

differential diagnosis of LBP in swimmers includes muscle and ligament sprains,

Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and

spondylolysis. Although spondylolysis or listhesis is a frequent injury in the

athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet

dancers, it is infrequently reported in swimmers. We have recently encountered

four adolescent elite swimmers who complained of low back pain and were

diagnosed as having spondylolysis. Three of the patients were either

breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion

in two patients. Increased uptake in bone scan was noted in all patients. CT was

performed only in two patients and revealed the lesion in both. One patient was

diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7

months. The patients were treated successfully by reducing the intensity of

their training program and the use of a corset for at least three months.

Repeated hyperextension is one of the mechanisms for spondylolysis in athletes

as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers

should raise the suspicion of spondylolysis. Plain radiography and bone scan

should be performed followed by SPEC views, CT, or MRI as indicated. If the case

is of acute onset as verified by bone scan, a Boston or similar brace should be

used for 3 to 6 months in conjunction with activity modification and optional

physical therapy. Multidisciplinary awareness of low back pain in swimmers,

which includes trainers, sport medicine physicians, and physical therapists,

should lead to early diagnosis and appropriate treatment.

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Orthopade. 1997 Sep;26(9):755-9.

Engelhardt M, Reuter I, Freiwald J, Bohme T, Halbsguth A.

Orthopadische Universitatsklinik, Friedrichsheim, furt a. M.

Spondylolysis and spondylolisthesis occur predominantly in the lower lumbar

spine. Besides congenital defects such as predisposition of spondylolysis the

correlation between competitive sports activities and an increased incidence of

spondylolysis is proved. In early stages, complete healing can be achieved by

conservative treatment (abstinence from sports activities for 3 months,

orthesis). Persistence of pain, neurologic symptoms and progression of vertebral

slipping are indications for operative treatment (reconstruction of the isthmus,

dorso-ventral spondylodesis). The exercise tolerance depends on the extent of

instability, progression of vertebral slipping and clinical symptoms. The limits

of exercise tolerance vary among the individual athletes and require the

decision of the physician. Backstroke swimming, abdominal and back muscle

strengthening exercises, and types of sport involving smooth movements are

advisable. Sports education in school is possible without restriction in

patients with stable spondylolysis and in those with spondylolisthesis without

unfavourable concomitant factors.

Spondylolisthesis and swimming

> Hello Group - Here's one for the aquatic therapists out there. We recently

received a referral for a young lady with spondylolisthesis and active back

pain. She is an avid swimmer, averaging 3-5 days per week at this activity for

exercise. Her physician recommended she avoid the backstroke until her symptoms

subside. Does anyone have some sound clinical evidence to support or refute

this restriction OR any other words of wisdom on this one? It would seem to me

that avoidance of extreme extension would be the most obvious restriction, which

would lead me to restrict breaststroke or butterfly (her favorite, of course)

before backstroke.

>

> Hooked on Evidence does not address this and I was unable to locate anything

on the Aquatic Section website either.

>

> Lori Dominiczak, PT, MS

> Cedar Haven Rehabilitation Agency

> West Bend WI 53095

>