Abstract
HISTORY: A 31-year-old recreational mountain biker presented with a one-month history of 5/10 low back pain. During a weekend excursion, he rode off of a 15 foot drop and landed flexed forward at the waist on his bike with his tailbone landing directly on the rear tire. He experienced immediate low back pain without radiation, numbness or tingling in the legs, or loss of bowel and bladder control. He was able to complete his ride and walk to his car. He continued to have low back soreness (2-4/10) particularly when sitting upright in a chair that limited his normal 5x/week exercise routine. PHYSICAL EXAMINATION: Examination revealed tenderness to palpation off of the midline bilaterally at L3-L4. He was nontender over the sciatic notches with very mild lumbar paraspinal muscle spasm at L2-L4. Forward flexion was 90% of the floor. He exhibited full extension and lateral bend. L1-S1 sensation was intact. Normal squat, heel and toe walk with 5/5 EHL strength bilaterally. He had negative straight leg raises supine and seated. Achilles and Patellar reflexes were 2 and 2+. DIFFERENTIAL DIAGNOSIS: 1. Lumbar Compression Fracture 2. Lumbar Paraspinal Muscle Sprain 3. Lumbar Disc Injury 4. Lumbar Isthmic Spondylolisthesis TEST AND RESULTS: Lumbar spine AP and lateral radiographs: -No evidence of acute fracture or dislocation. No significant degenerative changes. -Partial fusion of the anterior aspects of the vertebral bodies of T12 and L1, possibly congenital. Lumbar spine MRI without contrast: -Partial fusion of T12 and L1 vertebral body. -Degenerative disc disease at L4-L5 with central annular tear of the disc. FINAL WORKING DIAGNOSIS: Central annular tear of the L4-L5 disc TREATMENT AND OUTCOMES: 1. Rest and activity modification for 7 months. 2. Core strengthening physical therapy program for 8 weeks. 3. Negative radiographs rule out compression fracture with continued symptoms 9 months post injury. 4. Return to 65% capacity mountain biking with new onset low back weakness and radiation of pain into left buttock/testicle. Continued to deny red flag symptoms. 5. MRI revealed an annular tear of the L4-L5 disc. 6. Return to physical therapy for core strengthening program. Pain decreased to only upon awakening after 12 of 16 sessions. Gradual return to activity will be implemented with continued pain free progress with physical therapy.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have