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EP-12 Clinical Cases

An Uncommon Cause Of Persistent Back Pain In A Dancer

1242

Chin, Joseph; Yao, Katherine

Author Information
Medicine & Science in Sports & Exercise: August 2021 - Volume 53 - Issue 8S - p 406-407
doi: 10.1249/01.mss.0000763956.81495.48
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HISTORY: A 16-year-old dancer presented with 3 months of lower back pain that gradually increased with time without any clear inciting events. Pain was greater on the right, worse with extension and relieved with flexion. Quality was sharp and aching without radicular symptoms.

PHYSICAL EXAM: Spine alignment was normal. There was no midline, paraspinal, nor SI joint tenderness. Spine flexion was painless. Spine extension, facet loading, and stork test bilaterally provoked pain. Motor strength was grossly 5/5 and sensation was intact at all dermatomes. Faber was positive.

DIFFERENTIAL DIAGNOSIS: 1 Spondylolysis 2 Disc herniation 3 Baastrup’s disease 4 Spinous process apophysitis

TESTS AND RESULTS: MRI lumbar spine was negative for spondylolysis, spondylolisthesis, and disc herniation. Interspinous bursitis and facet arthropathy were found at L4-5 and L5-S1.

FINAL/WORKING DIAGNOSIS: Baastrup’s disease typically affects older adults. However, as this case demonstrates, young athletes who perform repetitive spinal extension such as gymnasts and dancers may also suffer from this. Patients present with midline tenderness, pain exacerbated by extension and relief with flexion. Young athletes may be frustrated by negative workups since few providers actively evaluate for this. Repetitive stress on interspinous ligaments and spinous processes can lead to instability and pain from abutting hypertrophic spinous process and adventitious bursas. In adults, imaging may show approximation and sclerosis of spinous processes. In young athletes, MRIs may show only interspinous bursal fluid. Conservative treatment with rest from spine extension, therapy, and spine flexion exercises has some success. It is difficult to treat in athletes because of the extensive rest time required for bursitis to improve. It may require interventional injections if chronic.

TREATMENT AND OUTCOME: NSAIDS were prescribed and dance was modified to avoid spine extension. PT was done for core stabilization and to correct biomechanics. Her pain remained unchanged after 1 year. She completely refrained from dance and continued core strengthening for an additional 2 months before resumption of dance with some improvement. She was offered but deferred injections to the interspinous ligamentous bursa, choosing to continue to modify her dance.

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