Editor's note: This is the second column in a two-part series. Visit www.vaildaily.com to read the first column.

In the previous article, we discussed the typical but benign back disorders that can plague the child athlete. We also laid the groundwork for the more serious disorders that children can develop while playing sports. We will now investigate these pain generators.

The first disorder we will discuss is Scheuermann's disease. With this disorder, the growth plates are not as strong as normal and can fragment and fracture under load. These fractures are painful. The pain tends to be the upper portion of the lower back (six inches above the belt line) and the spine region behind the chest area (thoracic spine). Adolescents that overload these growth plates typically play in sports that significantly compress the spine. Examples are football, wrestling, weight lifting, bump skiing and gymnastics. Many times, rest and bracing can allow the fractures to heal. There are some special cases where the spine deforms due to wedging of the vertebra. See. Figure 1.

The second condition is isthmic spondylolysis. Unlike Scheuermann's disorder, this condition normally occurs in the lowest level of the spine at L5-S1 (at the beltline). Isthmic spondylolysis is estimated to be found in one of every 20 adolescents. This disorder occurs with sports that require repeated extension (bending backwards) like gymnastics, football, tennis, diving and wrestling. Repeated backwards bending stresses the area of the spine called the pars interarticularis (Latin for “area between the joints”).

The bone fatigues from too much bending back and forth and does not have time to heal before the next round of activities again stresses the area. This is similar to taking a wire coat hanger and bending it up and down until the metal fatigues and breaks. This break may be found only on one side or on both sides. Catching this impending fracture early, before the bone actually breaks, makes treatment easier and more successful. If the bones fracture on both sides, treatment is more difficult and surgery may be in order. See Figure 2.

Most people think of degenerative disc disease as an adult problem. This is where genetics plays a big role. Disc wall tears can strike in this age group. Back pain occurs and is located in the lower back (around the belt line). Diagnosis can lead to treatment that can manage the pain. If the degenerative disc disease progresses, it can lead to a disc herniation.

Disc herniation in an adolescent can occur in two ways, through a standard tear in the disc wall (a herniated disc) or through a fracture of the endplate of the vertebra. Just like in Scheuermann's disease, the growth plate in the adolescent is still open. As stated before, the area of attachment of the growth plate to the vertebra is somewhat weak and a stress riser. The disc wall may not tear in its substance, but may fracture off a piece of its insertion, leaving a bony mass in the canal.

Interestingly, children and adolescents with disc herniations that compress nerves normally do not develop leg pain. This has to do with the resilience of the nerves in the adolescent. Pain is typically found in the back but can radiate down to the buttocks and possibly the upper thigh. Early diagnosis is helpful to return the child to sports.

If you would like more specific information about these disorders, look for information at http://NeckandBack.com or the book “Everything You Wanted to Know About the Back.”

Dr. Donald Corenman is a spine surgeon with The Steadman Clinic in Vail. Email comments about this column to cschnell@vaildaily.com.