Lumbar Apophyseal Ring Fracture With Central Disc Herniation: A Case Report

Lumbar apophyseal ring fracture (LARF) with central disc herniation is a rare but important cause of neurological symptoms in adolescent athletes, often presenting diagnostic and therapeutic challenges. We report the case of a 14-year-old male professional tennis player who developed persistent bilateral lower extremity tightness and radiating sensations after intensive training, unresponsive to initial physiotherapy. MRI revealed an S1 apophyseal ring fracture with central disc herniation. With surgery declined, the patient underwent a multimodal chiropractic protocol, including targeted spinal manipulative therapy, shockwave treatment, and mechanical lumbar distraction, which contrasts with standard conservative management such as physiotherapy alone. This individualized approach resulted in complete symptom resolution and full return to competitive tennis. At 24-month follow-up, he maintained high function and satisfaction. This case highlights the importance of considering LARF in young athletes with refractory symptoms and demonstrates that, in selected cases, individualized nonsurgical management can achieve excellent long-term outcomes, in alignment with current evidence-based guidelines.