Back Injury- Basketball

HISTORY: A 21-year-old female, Division I basketball player, presented with bilateral low back pain that began 1 year ago. The pain was described as stiffness and was worse in the morning. The pain was exacerbated with standing, lumbar flexion and extension and hip flexion. The pain was alleviated with sitting and stretching. The player reported multiple flops during basketball season, where she intentionally fell backwards onto the court onto bilateral buttocks. PHYSICAL EXAMINATION: No visible deformity of lumbosacral spine. Lumbar spine range of motion was limited in flexion and extension, with pain. Sidebending was full, with pain. Tender to palpation of bilateral SI joints and paraspinals.Neurologic examination was normal. Lumbar seated slump positive bilaterally.FADIR positive bilaterally, FABER positive on right.SI distraction positive bilaterally, SI compression and Gaenslen’s negative bilaterally, Patrick’s positive on right. DIFFERENTIAL DIAGNOSIS: 1.Lumbar discogenic pain2.Sacroiliac joint dysfunction3.Spondylolysis 4.Facet joint mediated-pain TEST/RESULTS: MRI lumbar spine with early degenerative disc disease and mild facet arthritis. MRI sacroiliac joints with sclerosis on both sides of the anterior inferior aspects of the sacroiliac joints, right greater than left, consistent with osteitis condensans ilii. Rheumatological workup including HLA-B27, ESR, CRP, RF were all negative. ANA was positive. FINAL/WORKING DIAGNOSIS: Osteitis condensans ileii TREATMENT/OUTCOMES: 1.Activity modification including avoiding lumbar flexion, “flopping”. Educated on proper lifting mechanics. 2.Meloxicam 15 mg daily, cyclobenzaprine 10 mg nightly PRN for spasms. Consider short course of oral steroid. 3.Physical Therapy for core, hip abductor and hip extensor strengthening. 4.Consider referral to interventional spine for SI joint injection if she does not improve with conservative management in 6-8 weeks. 5.Given it is off season, recommend a gradual return to sport protocol with goal of pain-free sport-specific drills, overseen by ATC. 6. At 3-month follow-up, she reported significant improvement with PT, with 75% pain relief. She was able to progress back into full sport participation. 7. At 4-month follow-up, prescribed additional pelvic floor PT to address lower pelvic pain.