A Sting in the Tail -Sacral Stress Fractures as a Cause of Lower Back Pain in Jūdōka: A Case Report

Introduction: Rubens-Duval et al. in 1960 reported finding a high prevalence of back problems in black-belt-level senior jūdōka. Since then many more authors have found evidence in support of long-time jūdō practice being associated with degenerative vertebral changes. The present paper introduces and discusses a recent case of a sacral stress fracture in a jūdōka. Case presentation: A 27-year-old Caucasian male jūdō black belt presented with lower-back pain. The subject was competitively active at the non-elite level in the middleweight category (-81 kg). Flexion-abduction-external-rotation (FABER), Gaenslen’s, and Scour test were all positive, but squish test was not. Clinical and MRI findings were consistent with a stress fracture of the right hemi-sacrum “Denis zone-I”. Differential diagnosis: Nonspecific low-back pain, sacral joint dysfunction, ligamentous or muscular strains, Scheuermann’s Disease, sciatica, spondylolysis, spondylolisthesis, tendinitis, Paget’s disease, Cushing’s syndrome, primary bone cancer, and spinal metastases. Treatment: Reduction of sports competitive activities and training load temporarily improved symptoms. When deemed appropriate and training intensity was increased the pain quickly returned. Physical therapy produced no significant improvement in symptoms. Uniqueness of the study: Sacral stress fractures have not previously been described in association with jūdō practice. Conclusion: Sacral stress fractures should be considered when jūdōka present with lingering lower-back pain. Prompt and correct diagnosis is crucial to adapt the subject’s training regime and ensure proper healing. Currently, there is no established best treatment for sacral stress fractures. Whilst prolonged bed rest is generally effective, it is considered a poor option for athletes, especially for those involved in weight class events. Noninvasive treatment options include pulsed electromagnetic fields (PEMF), low-intensity pulsed ultrasound (LIPU), and especially, extracorporeal shockwave therapy (ESWT), but largescale randomized clinical studies validating their therapeutic effectiveness are still lacking.