Nerve: Radiculopathy and Cauda equina syndrome

Presentation:
Nerve pathology can present as radiating pain from back to buttock down to the calf and ankle. It can be accompanied by muscle weakness or incoordination. An alarming sign of the involvement in sphincter function, which means that one’s bowel and bladder function is impaired (Cauda equina syndrome). In the latter situation, one should seek urgent medical attention to prevent permanent neurological damage.

Pathology:
Nerve can be compressed by the different anatomical structures in our spine, namely intervertebral disc (by a prolapsed disc), osteophyte (bone spur from degeneration) and vertebra itself in mal-alignment (spondylolisthesis) or itself fragment in trauma setting (retropulsed fragment).

Prevention and treatment:
Compared to previous causes of lower back pain, nerve pathology are less responsive to physical therapy as its pathology involved compression of nerve, instead of soft tissue wear and tear. In addition to conservative management, surgery in terms of minimal invasive surgery for persistent radiculopathy or even urgent spine surgery for cauda equina is required.

Bone: Pars stress reaction and fractures (spondylolysis)

Presentation:
Most cases of spondylolysis are asymptomatic, and when causes symptoms, it would present as back pain, especially with an extended back position (hyperlordosis). In severe stage, it may associated with hamstring (posterior thigh muscle) tightness and spasm.

Pathology:
Pars interarticularis is the thin bone segment adjoining two levels of vertebra, which is under high stress at extension (e.g. arch back) and axial loading (e.g. jumping, flipping). With repetitive hyperextensive (rather than acute injury), especially with dancers or gymnasts with over-training and hyperflexibility, pars interarticularis will undergo reactive changes and even fracture.

Prevention and treatment:
For asymptomatic dancers with incidental finding of pars reaction or defect, they can proceed with their training and dancing as tolerated. For symptomatic cases, physical therapy and bracing can be employed. Bracing can offer protection while the fracture heals, and physical therapy can maintain and strengthen core muscle. However, if the above fails, one may need to consider surgery to repair the pars defect.

In summary, low back pain, just like most other dance injuries, is a troublesome health issue that may hinder dancers’ performance and progression. However, with proper training and conditioning, low back pain is preventable and very treatable. To get the best shape out of yourself, it is recommended to work with a certified coach, be mindful of your body’s condition and do not hesitate to seek medical help with the symptom is severe, atypical or persistent.

神經：神經根病和馬尾神經壓迫綜合症

表徵：
從神經病理學上可理解成由背部到臀部、再到小腿和腳踝的放射性疼痛，亦可與肌肉無力或動作不協調同時發生。當括約肌功能也被牽涉其中，將會是一個警號，這意味著患者的腸臟和膀胱功能已受損（馬尾綜合症）。若出現後者的情況，患者應尋求緊急醫療護理，避免永久性的神經系統損害。

病理：
神經可以被我們脊柱的不同解剖結構擠壓著，例如：椎間盤（椎間盤突出症）、骨贅（退化引起的骨刺）和排列錯亂的椎骨（脊椎滑脫）或因創傷而形成的椎骨碎片（退回碎片）。

預防及治療：
與先前下腰痛的病因相比，物理療法對牽涉神經的病因療效較遜色，因為其病理學涉及神經受壓，而不是軟組織的磨損。除了保守的治療方法外，還需要進行針對持續性神經根病的微創手術，甚至針對馬尾神經的緊急脊柱手術。

骨頭：椎弓壓力反應和骨折（脊椎崩裂）

表徵：
大多數脊椎崩裂的病例是無症狀的，當引起症狀時，患者會有背痛，尤其是背部位置過長（脊柱前凸過度）。到嚴重階段，它可能與膕繩肌（大腿後肌）繃緊和痙攣有關。

病理：
關節間是連接兩節水平椎骨的薄骨節段，在伸展（例如拱背）和軸向負荷（例如跳躍、翻騰）時承受很大的壓力。尤其在舞者或體操運動員因過度訓練和關節過鬆症而導致的反覆性過度伸展（非急性損傷）情況下，椎弓峽部會發生反應性變化甚至折斷。

預防及治療：
對於無症狀的舞者，若偶然發現椎弓壓力反應或缺陷，他們可以繼續接受訓練和跳舞。對於有症狀的病例，可以採用物理療法和支架支撐。支架可以在骨折癒合的同時提供保護，而物理療法可以維持和強化核心肌肉。但是，如果上述的方法不湊效，則可能需要接受手術以修復椎弓的缺損。

總括而言，與大多數其他舞蹈傷患一樣，下背部疼痛是一個棘手的健康問題，可能會妨礙舞者的表演和進步。但是，通過適當的訓練和調適，腰背疼痛是可以預防和治療的。為了使自己的身體保持最佳狀態，您應與具專業資格的教練一起訓練，注意身體的狀況，並在出現嚴重、不尋常或持續的症狀時果斷求醫。