Nutrition in Combat Sports

10 Children in Combat Sports 163
should be avoided or modified, and correct posture in front-stance should be attained
to reduce stress on the posterior elements. A flexible lumbar support brace, which is
often used for up to 6 weeks, may help reduce pain and muscle spasm associated
with the injury. [34] Bracing also may facilitate return to training. [35]
10.5.3.2 Spondylolysis
Spondylolysis, or stress fracture of the pars interarticularis, presents with similar symptoms
to posterior element overuse syndrome. Typically, the onset of pain is insidious,
and is localized to the lower lumbar region. L5 is most commonly involved, [35] followed
by L4 and, much less frequently, L3. Symptoms are often present for several
months before presenting for evaluation. Pain increases with extension of the spine.
There may be an associated decrease in hamstring flexibility on the affected side.
The results of physical examination may be indistinguishable from that of posterior
element overuse syndrome, with maximal pain on provocative hyperextension, focal
tenderness over the site of the pars lesion, and pain loading the posterior elements in a
supine position. Nerve root signs, such as positive straight leg raise test, may be
present, particularly if spondylolisthesis (forward slippage of one vertebra over the
next caudal segment) is present.
Although much less frequently encountered than posterior element overuse syndrome,
any young athlete presenting with a history of at least 3 weeks of lumbar
pain on extension should be assessed for spondylolysis. Radiographs of the lumbar
spine should be obtained. Oblique views are best for evaluation of the pars interarticularis,
although some authors [39] have advised against the routine use of
obliques since only one third of lesions are identified due to orientation of the beam
with respect to the defect. [40] A lateral view, coned to the suspected level of the
lesion, may be more sensitive than regular lateral radiographs. [41] (Fig. 10.5 )
Technetium-99 single-photon emission computed tomography (SPECT) bone
scan is useful to assess activity at the site of the lesion or to detect stress reactions
that are too early to be seen on plain radiographs. A positive bone scan suggests
that the lesion is healing or has the potential to heal. [42] Computed tomography
(CT) scanning may be used to assess degree of bony healing in a child who is not
responding to management. Management is as for posterior element overuse syndrome;
However, a custom thoraco-lumbar orthosis may be necessary to expedite
safe return to modified training in some combat sports. Such a brace is typically
worn 23 h/day until the lesion is clinically healed (up to 6 months).
10.6 Combat Sports in Children with Chronic or Infectious
Diseases
Combat sports such as traditional and modern martial arts, boxing, and wrestling are
all categorized as contact/collision sports by the American Academy of Pediatrics
(AAP). [43] Although some martial arts are “noncontact,” some degree of contact
may still occur, albeit in a more limited fashion. Table 10.3 lists some of the medical