17 year old elite soccer player has left lower back pain. Left low back painful symptoms, episodes a couple times over the past couple years. He does not currently have any right-sided symptoms but he has had right-sided lower back pain in the past.

1. Clinical Case Studies

2. 17 yo Elite Soccer Player with Left LBP
History
• He is a competitive soccer player from
England and is a high-level prospect for
playing at a major university in the United
States when he graduates high school
• Left low back painful symptoms, episodes a
couple times over the past couple years
• He does not currently have any right-sided
symptoms but he has had right-sided lower
back pain in the past.

3. History
• He had return of pain in September 2018 after he had
performed in 3 summer soccer camps. He also played a
couple of matches and had a tryout for national team
• He had tried to play a match in January but was only
able to play about 20 minutes. He had gone through
some practices as well but unfortunately was unable to
participate secondary to incapacitating left low back
pain
• He describes stabbing pain in the left lower back that
he rates a 5–9/10. He currently has no right-sided
symptoms and no leg pain
• Physical examination note no radiculopathy and only
left lower back pain upon extension

4. Flexion/Extension X-Rays
No slip and well preserved disc height

5. Sagittal CT Scans
Right SideLeft Side

6. Axial CT Scan

7. MRI T2 Axial

8. STIR Images Adjacent L Pars Images

9. Questions
• Do his symptoms match
the history given by the
patient?
• Do his symptoms match
the findings on the CT
and MRI?

10. Both Questions-Yes
• His initial right lower back
pain was the pars stress
fracture on the right side
that finally fractured
completely
• This fracture “unloaded”
the right side eliminating
right lower back pain and
then causing loading
stress of the intact left
pars

11. Conclusion
• His current pain is left
sided lower back pain
as the left sided pars is
now undergoing a
stress reaction due to
the right side not able
to share load
• The STIR images
confirm the left pars is
probably going to have
an impending fracture

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