Compression Fracture and Lingering Back Muscle Pain

author : AMSSM
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Can you give me any information as to why those muscles are still feeling sore and if this will affect my training long term? I'm planning on doing a full Ironman in 2016.

Member Question

I'm a 47-year-old female triathlete.  I've been an athlete all of my life and rarely, if ever, have had any serious injuries or issues.  Four months ago I fell and fractured my T11 vertebrae.  It was a compression fracture.  I did not require long-term meds, a brace or PT.  At three weeks post injury, my neurosurgeon said I could return to running anytime based on my level of pain.  I have since been running, cycling and swimming as well as working on muscular endurance with light weight lifting.  I do however, still have muscle pain in my back.  It feels like DOMS from weight training but it never goes away.  On scale from 1-10, I'd say the pain is a 2 or 3.  Since my injury I've also been dealing with pain, stiffness, or soreness in most other joints in the lower body.  Of course my neurosurgeon's office just says to rest. Can you give me any information as to why those muscles are still feeling sore and if this will affect my training long term? I'm planning on doing a full Ironman in 2016.

Answer from Samuel Schimelpfenig MD FAAP
Member AMSSM

There are 12 vertebrae that form the thoracic portion of the spinal column. They are intermediate in size between the larger lumbar vertebrae below and the smaller cervical vertebrae above. The alignment of the thoracic spine is oriented in slight kyphosis (outward bend) and is stabilized by the ribcage (T1-T9). The bottom three vertebrae (T10-12) do not articulate with the ribcage and are able to move somewhat, which helps with overall spine flexibility, but also makes these thoracic vertebrae more prone to injury.

Compression fractures usually occur in the setting of trauma, such as a fall, during which the force on the affected vertebra causes a collapse of its bony architecture. In an older person with a history of osteoporosis, a compression fracture can occur without trauma. The pain from a compression fracture is usually sharp and localized to the injured bone. It is usually easily identified on regular X-Ray, although CT scans are sometimes used as well.

Acutely, the fracture is managed with a few days of bed rest and pain control; a back brace may be used as well. Walking and other light activities follow the bed rest as the pain improves. On average, the total time for healing is 8-12 weeks. Repeat X-rays are done periodically to monitor healing and to watch for the potential for the injury to worsen or not heal correctly. A spine rehabilitation regimen under the direction of a physical therapist is often helpful to regain core muscle strength and flexibility. As a general rule, most athletes are able to return to their sport once the pain is fully resolved and motion is normal. 

There are several possibilities for your ongoing muscle soreness that, depending on the cause, may or may not affect your Ironman training regimen. I will assume you have had repeat X-Rays showing that your fracture has healed satisfactorily, but if not I would encourage you to follow-up with neurosurgery to make sure. As mentioned, sometimes there can be progression of the original injury that would contribute to your lingering symptoms. Most likely the injury simply has not fully healed at this point, but it would be worth ruling other things out. It may also be a matter of deconditioning and inflexibility involving your core musculature, which could be addressed with a regimen of physical therapy. Although PT was not felt to be necessary initially, your lingering symptoms would warrant further exploration of that option.

Finally, in regard to the “pain, stiffness, or soreness in most other joints in the lower body” one should always consider other diagnoses that may be unrelated to your compression fracture but coincidentally might be manifesting around the same time. A visit with your primary care provider may be helpful to rule out any other underlying issues such as forms of arthritis, inflammatory diseases, or nutritional deficiencies.

I would be cautious about pushing your training regimen too much until the cause of your symptoms is known, or the pain resolves. Remember, a general rule for return to sport in the setting of a compression fracture is the absence of pain at the site of the injury.

Samuel Schimelpfenig MD FAAP
Sioux Falls, South Dakota

 

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date: March 17, 2015

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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