Dr. Henry Pang - Doctor
Translation: Stacey Yeung - Dance Science Researcher
11 March 2020
Nerve: Radiculopathy and Cauda equina syndrome
Nerve pathology can present as radiating pain from back to buttock down to the calf and ankle. It can be accompanied by muscle weakness or incoordination. An alarming sign of the involvement in sphincter function, which means that one’s bowel and bladder function is impaired (Cauda equina syndrome). In the latter situation, one should seek urgent medical attention to prevent permanent neurological damage.
Nerve can be compressed by the different anatomical structures in our spine, namely intervertebral disc (by a prolapsed disc), osteophyte (bone spur from degeneration) and vertebra itself in mal-alignment (spondylolisthesis) or itself fragment in trauma setting (retropulsed fragment).
Prevention and treatment:
Compared to previous causes of lower back pain, nerve pathology are less responsive to physical therapy as its pathology involved compression of nerve, instead of soft tissue wear and tear. In addition to conservative management, surgery in terms of minimal invasive surgery for persistent radiculopathy or even urgent spine surgery for cauda equina is required.
Bone: Pars stress reaction and fractures (spondylolysis)
Most cases of spondylolysis are asymptomatic, and when causes symptoms, it would present as back pain, especially with an extended back position (hyperlordosis). In severe stage, it may associated with hamstring (posterior thigh muscle) tightness and spasm.
Pars interarticularis is the thin bone segment adjoining two levels of vertebra, which is under high stress at extension (e.g. arch back) and axial loading (e.g. jumping, flipping). With repetitive hyperextensive (rather than acute injury), especially with dancers or gymnasts with over-training and hyperflexibility, pars interarticularis will undergo reactive changes and even fracture.
Prevention and treatment:
For asymptomatic dancers with incidental finding of pars reaction or defect, they can proceed with their training and dancing as tolerated. For symptomatic cases, physical therapy and bracing can be employed. Bracing can offer protection while the fracture heals, and physical therapy can maintain and strengthen core muscle. However, if the above fails, one may need to consider surgery to repair the pars defect.
In summary, low back pain, just like most other dance injuries, is a troublesome health issue that may hinder dancers’ performance and progression. However, with proper training and conditioning, low back pain is preventable and very treatable. To get the best shape out of yourself, it is recommended to work with a certified coach, be mindful of your body’s condition and do not hesitate to seek medical help with the symptom is severe, atypical or persistent.
中文翻譯： 楊子慧 - 舞蹈科學研究員
1. Amari, R., Sakai, T., Katoh, S., Sairyo, K., Higashino, K., Tachibana, K., & Yasui, N. (2009). Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review. Archives of orthopaedic and trauma surgery, 129(3), 397-401.
2. Roussel, N., De Kooning, M., Schutt, A., Mottram, S., Truijen, S., Nijs, J., & Daenen, L. (2013). Motor control and low back pain in dancers. International journal of sports medicine, 34(02), 138-143.
3. Kline, J. B., Krauss, J. R., Maher, S. F., & Qu, X. (2013). Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: a case series. Journal of dance medicine & science, 17(1), 24-33.
This article was accomplished by the author in his/her personal capacity. The opinions expressed in this article do not reflect the view of the official statement of CUHK and HKADMS. It is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with an appropriate professional for specific advice related to your situation.
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