Red Flags and Pathology in Athletic Back Pain, Including Pars Defects

Athletes are as susceptible as anyone to malignancy, infection, fracture, inflammatory disorders and cauda equina syndrome, so Thomas advises assuming serious pathology until it can be ruled out. His clinical reasoning model then looks at four pillars: pathology, pain, psychosocial factors and physical factors. Most athletes have non-specific low back pain, because the disc, facet joint, ligament, bone or muscle cannot be confirmed as the source with clinical tests. Around 5% to 10% have a specific disorder: radicular pain, radiculopathy or central canal stenosis. Pars defects are more common in athletes and range from stress reaction to spondylolysis, non-union and spondylolisthesis. About 6% of asymptomatic adults have one, against about 30% of adolescent athletes with back pain, especially in sports with extension and rotation such as fast bowling, diving and gymnastics, partly because the pars matures only around age 25. The single leg stork test is not reliable enough, so MRI or CT is the gold standard. Spondylolisthesis can bring radicular symptoms and neurological changes.