Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

07 ALA MY PROBLEMS

Nicholas Hora, DO; Emily Barnett, OMS-II; Jordan Kittle, MS, LAT, ATC; Marigrace Lynch, MS, LAT, ATC; Matthew Chung, DO; Mark Rogers, DO Corresponding author: nhora@vcom.edu

VCOM-Virginia, Blacksburg, Virginia, Virginia Tech Sports Medicine

Osteopathically, she had sacral and innominate somatic dysfunction. Differential Diagnosis: Mechanical low back pain secondary to muscle spasms, disc herniation, spondylolisthesis, spondylolysis, vertebral stress fracture, sacroiliitis, sacral stress fracture. Tests and Results: Lumbar XR: No acute osseous injury or translation on flexion/extension views; Lumbar MRI: Partially seen edema of left sacral ala with possible fracture line, facet arthropathy at L4-L5, no significant canal or foraminal stenosis; Pelvis MRI: Non displaced left sacral ala fracture; DEXA Scan: Bone density within normal limits; Metabolic testing was unremarkable aside from low testosterone at 7.3 ng/dL. Final/Working Diagnosis: Left sacral ala stress fracture Treatment: Both nutritional support and activity modification are of benefit for athletes with stress fractures. Patient was started on Calcium, Vitamin D, Vitamin K2, and Magnesium supplementations in addition to the use of a bone stimulator. Activity level was modified to non-impact and complete rest initially. She was removed from the water. OMT was used to treat the somatic dysfunctions.

Context: Sacral ala fractures are uncommon in athletes in general but have the highest incidence in long distance runners. In swimmers, rib stress fracture would be the most common. This is a case of back pain in a swimmer that did not have a suspicious mechanism, making it more unique. The pain pattern described below provide an important reminder of the sclerotomal and myotomal distributions that may help with differential diagnosis. Report of Case: A 20-year-old female swimmer presented to the clinic with acute onset low back pain. Located in the middle-lower back and radiated down the left glute. Occasionally, the pain went to the knee, with subjective paresthesia. The pain was worse with sitting and walking, without significant pain while in the pool. She reported no urinary or bowel incontinence. She was consistent with her rehabilitative exercises with her athletic trainer. She was in no acute distress. 2+ reflexes bilaterally at L4 and S1. Tenderness to palpation along the lumbar paraspinal muscles at L3-L5 and pain with flexion and extension. Positive left standing Kemp’s test, supine straight leg raise, Bragard’s, Nachlas, Gaenslen’s, and Yeoman’s with SI engagement. Pain with bilateral slump test on the left, discomfort posteriorly with hip thrust, and mid-back pain with Hibb’s bilaterally.

Return to Activity: Currently, she can lie supine and sit for prolonged periods with minimal pain. She is using a donut to sit in class. At 3 weeks, she could complete activities of daily living with minimal symptoms and is continuing nutritional supplementation. She began to incorporate upper body weight training (no spinal hinging), non-axial loading resistance band strength, and light cardio such as incline walking with occasional increase in pain. She remains out of the water and monitored clinically. Comments: Data on sacral stress fractures is mostly composed of case reports due to the uncommon nature of this injury. Majority of the reported cases have been in distance runners or individuals who play contact sports. Additionally, some patients have nutritional deficiencies. This patient did not fit any of the above categories. It is hypothesized that chronic hyperextension activity from swimming butterfly, along with perhaps less technically sound dryland exercises resulted in altered mechanics and loading of her lower spine.

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138 Edward Via College of Osteopathic Medicine (VCOM)