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October 10, 1980

Back Pain in an Adolescent-Reply

Author Affiliations

Memorial Hospital Chicago

JAMA. 1980;244(15):1673-1674. doi:10.1001/jama.1980.03310150013011

In Reply.—  Disk protrusion does occur in 15-year-old boys, but rarely so. Low-back myofascial strain is by far the more common injury in a young man with strong muscles guarding a healthy spine. Straight leg-raising can rotate the pelvis and through ligamentous or muscle pull irritate the lumbosacral region, producing pain in this condition.1 Radiation or referral of pain can occur without nerve root irritation, and, indeed, the experimental injection of hypertonic saline solution into the lumbosacral supraspinous ligament has generated sciatic-like pain reaching as far distal as the calf.2 Restricted kick is nonspecific; although it might suggest quadriceps weakness, it could as well indicate guarding to avoid discomfort.In the face of usual and symmetrical deep-tendon reflexes, normal sensation, unilateral positive straight leg-raising (unconfirmed by forced ankle dorsiflexion) only at 70° and roentgenographic findings negative for disk space or foraminal narrowing or pathological condition, I believe the