Spine and Pelvis Injuries in Athletes
Cervical and thoracic spine
Understand the difference between transient stingers/burners (unilateral, resolves) and cervical cord neurapraxia or fracture. Red flags include bilateral symptoms, neck pain with neurologic deficit, and midline tenderness-these require immobilization and imaging. Scheuermann disease causes thoracic kyphosis in adolescents; spondylolysis causes low back pain in young athletes, especially gymnasts and linemen.
Lumbar spine
Spondylolysis and spondylolisthesis are high-yield: extension-related pain, positive single-leg hyperextension test, and imaging with oblique or lateral views. Disc herniation causes radicular pain; cauda equina (saddle anesthesia, bowel/bladder dysfunction) is an emergency.
Pelvis
Distinguish hip flexor/adductor strains from pelvic ring injury. Osteitis pubis causes groin pain in kicking athletes. In adolescents, apophyseal injuries (ASIS avulsion) occur at tendon attachments.
Rule of thumb
Midline cervical tenderness or bilateral neurologic symptoms after a collision = immobilize and image; never clear on the field. For young athletes with extension-related back pain, suspect spondylolysis and restrict extension activities pending evaluation.