title: Elite male adolescent gymnast who achieved union of a persistent bilateral pars defect.
abstract: An adolescent 15-yr-old male competitive gymnast presented to a university-based multidisciplinary spine institute with a persistent low-back pain for 18 mos. Although the results of x-rays were negative, his pain rendered him unable to compete in his sport any longer. A computed tomography scan was performed, which showed a bilateral pars fracture at L5, without spondylolisthesis. A nuclear medicine bone scan revealed negative findings, confirming chronic nonunion. The patient completed a 4-wk course of physical therapy 6 mos before our intervention, without any relief of pain or radiologic evidence of healing. The patient was treated with a bone stimulator for 4 hrs/day and was recommended to wear a warm-and-form-type brace. Isometric core trunk exercises were also initiated. Only after 6 wks of treatment, the subject showed clinical improvement at the follow-up visit. Computed tomography scan performed 12 wks after the initial scan showed complete union of the fracture correlating with clinical improvement. Two years later, the athlete remains completely pain-free, is training regularly, and is able to compete on a national and, possibly, international level.
authors.affiliation: Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Allan
authors.initials: A
authors.lastname: Vrable
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D002908:Chronic Disease; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D006173:Gymnastics; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011542:Pseudarthrosis / Q000209:etiology / Q000534:rehabilitation*; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D013169:Spondylolysis / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation; D014057:Tomography, X-Ray Computed