Use Of Manual Therapy And Sport Specific Re-training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report

25 Background and Purpose: Bilateral pedicle stress fractures are extremely rare, with few 26 cases reported in the literature. The pedicle is known to be the second weakest point of 27 the vertebra, has a short moment arm from the vertebral body, and can resist a large 28 amount of cyclic shear forces. There have been several reports describing pedicle stress 29 fracture in adolescent athletes. However, in those reports the fracture was usually 30 associated with contralateral spondylolysis, and isolated pedicle fractures are rarely 31 found. This case report details a conservative approach using manual therapy, Pilates 32 exercises, and sport specific re-training in an adolescent sprinter with bilateral L4 pedicle 33 stress fractures. 34 Case description: A fifteen year old male presented with low back pain due to bilateral 35 L4 pedicle stress fractures; evaluation findings including weak hip flexors and extensors 36 bilaterally, upper abdominals stronger than lower abdominals, quadriceps to hamstring 37 ratio not adequate for a sprinter, and excessive active hip external rotation during running 38 led therapists to believe that the fractures were the direct result of training errors, muscle 39 imbalances, muscle weakness, and poor running biomechanics. The patient’s pain level 40 was assessed using the VAS pain scale and overall functional improvements were 41 evaluated using a Functional Impairment Questionnaire specific to the clinic where 42 treatment was provided. 43 Outcomes: Improvements were observed in overall muscular endurance, strength, joint 44 symmetry, and running mechanics with manual therapy and Pilates exercise. He was able 45 to return to sport. 46