.hO \~ Clin Orthop 2000 March;2000(372):74-84. Copyright @2000 Lippincott Williams & Wi!... Page 1 of 12 Previous Full Text Next Full Text Tips for Treatment Monica L. Orney, MD; Lyle J. Micheli, MD; Peter G. Gerbino II, MD From the Division of Sports Medicine, Children's Hospital,Boston, MA. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 2000;372:74-84 Idiopathic scoliosis and spondylolysis can be common back problems in female athletes.Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessaryto know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common causeof back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stressfracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented. The female athlete is at risk for back injury and back pain. She is at risk becauseback pain and injury are extremely common in general and, by engaging in sports, the spine is placed at increasedrisk. Females who participate in certain sports, such as gymnastics,l1,~13.Q,rn figure skating,.8-.2- and dance,~,~,2Q,rn may have additional risks. A careful sports-specific history and systematic physical examination usually is sufficient to detennine the risk factors that may have contributed to back injury and resultant pain. Understanding these risk factors is the key to successful treatment. Risk factors arise from the host (preexisting medical condition) or the environment (training error). The relative weight given to specific risk factors varies depending on the athlete's age, level of intensity, location of back injury and chronicity of symptoms, and gender. Female-specific risk factors have only recently been identified, although much more research is neededto clarify this issue fully. An additional concern for the physician who treats young female athletes is spinal deformity and idiopathic scoliosis, in particular. Idiopathic scoliosis, the most prevalent spinal deformity in patients in North America, primarily affects young women..{ill.,lli Early detection through screening at school, now mandatory in most states,allows for early diagnosis and monitoring, often with the opportunity to institute treatment with the use of a brace and therapy, and to avoid fusion surgery. Issuesof treatment using a brace, and even sports participation after corrective surgery, are frequent issues for 6/4/2003 http://ipsappOO2.1wwonline.com/content!getfile/95/28/ 1 O/fulltext.htm