Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.
BACKGROUND
Bone stress reaction is prevalent among cricket fast bowlers. Few studies have addressed the sensitivity and specificity of imaging for diagnosis, and follow up assessment has been poorly investigated.


OBJECTIVE
To determine whether there was an association between back pain and bone stress reaction as measured by computed tomography (CT) scan in young cricket fast bowlers.


METHODS
Ten young cricket fast bowlers were included in the study. Nine bowlers presented to a physiotherapy practice with low back pain and were later diagnosed with lumbar stress fractures, while one was an experienced bowler with no pain. All players had a CT scan after presenting to the physiotherapy practice. Pain was assessed according to a subjective scale (0-10) where 10 represented the player's subjective, maximum pain score. Recovery and rehabilitation of all players was monitored until they returned to full participation.


RESULTS
There was no consistency in the relationship between pain and CT scan results. For example, one subject had evidence of un-united stress fractures after 15 months of rest but had experienced moderate pain for only 2 weeks after the onset of symptoms, in contrast to another subject who had intermittent pain for 11 months even though CT scan showed multiple stress fractures ranging from partially healed to fully healed status at 3 months.


CONCLUSIONS
There is dissociation between back pain and bone stress reaction as measured by CT scan. Therefore, CT scan does not provide objective evidence for ongoing management or decision concerning return to sport in cricket fast bowlers.
Millson
H B
HB
Research Unit for Exercise Science and Sports Medicine, UCT/MRC, PO Box 115, University of Cape Town, Newlands 7725, Cape Town, South Africa. helenmil@mweb.co.za
Gray
J
J
Stretch
R A
RA
Lambert
M I
MI
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D001696:Biomechanical Phenomena; D015775:Fractures, Stress / Q000150:complications / Q000000981:diagnostic imaging*; D020022:Genetic Predisposition to Disease; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D008297:Male; D011446:Prospective Studies; D013169:Spondylolysis / Q000150:complications / Q000000981:diagnostic imaging* / Q000235:genetics; D014057:Tomography, X-Ray Computed / Q000379:methods*