Brian T. Swanson
Background and Purpose: Bilateral pedicle stress fractures are extremely rare, with few cases reported in the literature. The pedicle is known to be the second weakest point of the vertebra, has a short moment arm from the vertebral body, and can resist a large amount of cyclic shear forces.1 There have been several reports describing pedicle stress fracture in adolescent athletes.1 However, in those reports the fracture was usually associated with contralateral spondylolysis, and isolated pedicle fractures are rarely found. 1This case report details a conservative approach using manual therapy, Pilates exercises, and sport specific re-training in an adolescent sprinter with bilateral L4 pedicle stress fractures. Case description: A fifteen year old male presented with low back pain due to bilateral L4 pedicle stress fractures; evaluation findings including weak hip flexors and extensors bilaterally, upper abdominals stronger than lower abdominals, quadriceps to hamstring ratio not adequate for a sprinter, and excessive active hip external rotation during running led therapists to believe that the fractures were the direct result of training errors, muscle imbalances, muscle weakness, and poor running biomechanics. The patient’s pain level was assessed using the VAS pain scale and overall functional improvements were evaluated using a Functional Impairment Questionnaire specific to the clinic where treatment was provided. Outcomes: Improvements were observed in overall muscular endurance, strength, joint symmetry, and running mechanics with manual therapy and Pilates exercise. He was able to return to sport. Discussion: An improvement in joint symmetry, muscular endurance, strength, correction of training errors, and resolution of pain will improve the potential of an athlete to return to their desired sport without restriction, following pedicle stress fractures.
Lopez, Erika, "Use Of Manual Therapy And Sport Specific Re-training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report" (2015). Case Report Papers. 41.