HISTORY: A 28-year-old male professional attacking midfielder sustained a trauma in his left lumbar region during the second half of a match in Brazil’s Division 1 Soccer League. After receiving the ball, he suffered impact from the knee of an opposite’s team player in his left lumbar region. The player received sideline examination, presenting with pain in the site of trauma and mild pain during flexion of the spine; the remaining physical examination showed no other abnormalities. He returned to the field and played the rest of the game. In the locker room, after the match, and on the following day, before the scheduled practice, he still reported back pain.
PHYSICAL EXAMINATION: Sideline examination revealed moderate tenderness to palpation of his left lumbar region. The athlete had normal sensation, reflexes and strength of his lower extremities. He presented with normal active range of motion of his spine, but mild pain on flexion. The same symptoms persisted after the game. On the next day, his clinical features were still unchanged.
DIFFERENTIAL DIAGNOSIS: 1. Soft tissue contusion 2. Lumbar Vertebral Fracture 3. Acute Spondylolysis or Spondylolisthesis 4. Visceral Injury
TEST AND RESULTS: Lumbar Spine Computed Tomography revealed fractures of the Left Transverse Processes of the L3 and L4 vertebrae, without any adjacent injuries.
FINAL/WORKING DIAGNOSIS: Fracture of Left Transverse Processes of the L3 and L4 vertebrae.
TREATMENT AND OUTCOMES: 1. Removed from activities with the rest of the group. 2. In the first week after the injury, the athlete used a brace, analgesic medication and received analgesic physical therapy, composed of electrotherapy, laser therapy and myofascial release techniques. 3. From the 2nd until the 4th week, initiated active mobility of the spine, isometric exercises for lumbar stabilization, hydrotherapy and impact free aerobic exercises. 4. From weeks 4 to 6, started strength exercises for the superior and inferior limbs, and spine. Also submitted to gradual exposition to the sporting gesture in the training field. 5. Returned to soccer practice after 40 days from the date of injury.