Lumbar Spine Pain In An Adolescent Rugby Union (RU) Player

History: Sixteen-year-old (16) male RU lock forward presented with lower back pain (8/10) and stiffness after training sessions. He denied any trauma and rest improved the pain. Jogging was painless, but rugby specific & resistance exercise worsened the central, lower thoracic and upper lumbar located pain without any radiation. Pain relieved by NSAID yet worsened as the season progressed despite rest periods and a monitored rehabilitation program. He did experience similar symptoms and signs 11 moths before. A spinal x-ray at the time demonstrated multi-level lumbar endplate degenerative changes and he was managed conservatively as it was at the end of the season. No constitutional symptoms occurred. Further medical and family history unremarkable. Physical Examination: General clinical examination unremarkable. Slight lower thoracic kyphosis. Straight leg rise was positive and central pain in spinal column with deep touch (lower thoracic and severe in the lumbar region) ocurred. No neurological deficit demonstrated. Differential Diagnosis: Nonspecific back pain(muscular strain),Spondylolysis/spondylolisthesis,Scheuermann’s disease,Scoliosis,Intervertebral disc herniation,Vertebral column fractures,Infectious disease,Inflammatory disease,Neoplastic disorders,Congenital disease,Hematological disease. Special Tests and Results: MRI lumbar spine demonstrates intervertebral disc desiccation L2-3 and L5-S1 with endplate irregularity, Schmorl’s nodes,& multilevel mild broad-based intervertebral disc protrusions without nerve root compromise. Final/Working Diagnosis: Lumbar Scheuermann’s disease. Treatment & Outcomes: 1.Discussion and information sharing with patient and parents.2.Discontinue participation in RU and new focus structured exercise for health were prescribed.3.Physical therapy included active rehabilitation, including reduction of spinal loading and incorporation of calisthenic exercises.4.Continued follow up until skeletal maturity is reached,reconsider sport participation and type.