Back pain and degenerative abnormalities in the spine of young elite divers

Abstract

Several studies have been published on disc degeneration among young athletes in sports with great demands on the back, but few on competitive divers; however, there are no long-term follow-up studies. Twenty elite divers between 10 and 21 years of age, with the highest possible national ranking, were selected at random without knowledge of previous or present back injuries or symptoms for an MRI study of the thoraco-lumbar spine in a 5-year longitudinal study. The occurrence of MRI abnormalities and their correlation with back pain were evaluated. Eighty-nine percent of the divers had a history of back pain and the median age at the first episode of back pain was 15 years. Sixty-five percent of the divers had MRI abnormalities in the thoraco-lumbar spine already at baseline. Only one diver without abnormalities at baseline had developed abnormalities at follow-up. Deterioration of any type of abnormality was found in 9 of 17 (53%) divers. Including all disc levels in all divers, the total number of abnormalities increased by 29% at follow-up, as compared to baseline. The most common abnormalities were reduced disc signal, Schmorl's nodes, and disc height reduction. Since almost all divers had previous or present back pain, a differentiated analysis of the relationship between pain and MRI findings was not possible. However, the high frequency of both back pain and MRI changes suggests a causal relationship. In conclusion, elite divers had high frequency of back pain at young ages and they run a high risk of developing degenerative abnormalities of the thoraco-lumbar spine, probably due to injuries to the spine during the growth spurt.

Low Back Pain and Injury in Athletes

“…Much of the current sporting literature on low back pain and injury has tended to focus on sports with specific low back demands such as rowing Teitz et al, 2003;Bahr et al, 2004), skiing (Mahlamaki et al, 1988;Eriksson et al, 1996;Ogon et al, 2001;Bahr et al, 2004), gymnastics (Sward et al, 1990;Hutchinson, 1999;Cupisti et al, 2004), diving (Baranto et al, 2006), wrestling (Lundin et al, 2001;Iwai et al, 2004), golf (McHardy & Pollard, 2005), cricket fast bowling (Elliott & Khangure, 2002;Ranson et al, 2010), tennis (Lundin et al, 2001) and American football (Iwamoto et al, 2004). Elite sporting activity is these sports is known to produce significant compressive forces directed at the lumbar spine (Hosea et al, 1989).…”

Thoracolumbar Injuries in Pediatric Athletes: Diagnosis, Treatment, Rehabilitation, and Prevention

“…However, as back pain is also a common symptom in the general population, it has been difficult firmly to establish, in the literature, the relationship between plain radiography or MRI findings and back pain. However, in recent studies, these anatomic abnormalities have been reported to be correlated with the symptoms (Sward et al 1991;Kujala et al 1996a; Baranto et al 2006Baranto et al , 2009b.…”

“…The prevalence of back pain is much higher among active athletes participating in sports with heavy loads on the spine than among other athletes and nonathletes, and it has been reported in between 10 % and 91 % of athletes (Jackson 1979;Sward et al 1990b;Harvey and Tanner 1991;Eriksson et al 1996;Kujala et al 1996a;Sassmannshausen and Smith 2002;Bahr et al 2004;Baranto et al 2006Baranto et al , 2009b. Back pain among athletes may result from acute macrotrauma, repetitive microtrauma (stress), or a combination of these two mechanisms (Kujala et al 1996b).…”

“…A high frequency of radiological abnormalities of the thoracolumbar spine, such as disc degeneration and abnormalities affecting the vertebral endplates and the vertebral ring apophyses, has been reported among athletes in certain sports imposing heavy demands on the spine (such as wrestling, diving, gymnastics, soccer, ice hockey, orienteering, weight lifting, water-ski jumping, and tennis) (Granhed and Morelli 1988;Sward et al 1990a, b;Lundin et al 2001;Baranto et al 2006). These abnormalities appear to be relatively uncommon among top-level athletes before the adolescent growth spurt, but, after the growth spurt, they are found to be more frequent Tertti et al 1990).…”

High stature and body mass might affect the occurrence of Schmorl’s nodes

“…Those changes are also related to high axial loading (Wagner et al 2000;Baranto et al 2006;Nagashima et al 2013). In the past several years, new hypotheses about SN etiology have been proposed.…”