Chronic low back pain, the diagnosis posted for Franck Ribéry undoubtedly hides a more complex reality. Two specialists analyze the state of health of the French footballer.
Will play or not play? Eight days before the opening of the World Cup in Brazil, France football is in fact suspended from the state of health of Franck Ribery. The star of Bayern Munich presents, it is true, a worrying record, while the preparation phase of the Blues ends this Sunday against Jamaica.
The attacking midfielder withdrew the last two games and has been suffering from chronic low back pain for six weeks, according to the medical staff of the French team. According to The Parisian, Franck Ribéry would have remained in the Nice region after France’s draw against Paraguay last Sunday. The player would have received a visit from Thierry Laurent, one of the three physiotherapists of the staff. Traces of osteoarthritis and herniated disc would be at the origin of the pain which is not only present when he tries to train or perform physical efforts, also specifies the daily.
“What is certain is that Franck Ribéry not only has low back pain and the word chronic is inappropriate”, underlines for his part Professor François Rannou, rheumatologist at Cochin hospital (14th) contacted by why actor. So what is the man with the 81 caps suffering from?
Bankruptcy of diagnosis and care
“The definition of chronic low back pain is pain in the lower back that has lasted for more than three months. Franck Ribéry, who has been in pain for six weeks, corresponds, for his part, to the definition of subacute low back pain which lasts between 6 weeks and 3 months. Nevertheless, this painful condition of the lumbar spine is a symptom. In fact, it does not correspond to any specific pathology. He signs an attack of the spine.
Listen to Prof. François Rannou, rheumatologist at Cochin hospital : ” In 95% of cases, low back pain is linked to damage to the joints between the vertebrae or muscles. And in 5% of cases, it can have a secondary origin: a tumor, an infection, or a vertebral compression.… “
A finding that amazes this rheumatologist at the end of this time. “Someone under the age of 30, who has had back pain for six weeks, and who doesn’t have a specific diagnosis, that’s not possible. Today, comments the Pr François Rannou, with imaging techniques, one should normally know what he’s got. “And this professor of medicine at the University of Paris Descartes leans more towards active disc disease, a common pathology in high-level footballers. “It is an isolated inflammatory lesion of the intervertebral disc. A pathology little known to doctors, see rheumatologists, ”he explains.
For him, if the diagnosis is wrong, it is worrying, because it must certainly lead to inappropriate care on this footballer. “If he has this pathology and is treated with physiotherapy and osteopathy, this is not the right solution. These techniques only work in people who are not sick, and do not have a real lesion. However, this pathology is linked to microtrauma of the vertebral endplates. ”
To be complete, this spine specialist thinks of a second type of lesion which may be due to posterior joint pain in the dorsolumbar hinge. Finally, last hypothesis, a herniated disc which is recurrent in footballers.
Treated correctly, Franck Ribéry could see his condition improve very quickly, believes Professor Rannou. “If he has active disc disease and is given the right treatment, within 48 hours, it’s over. In any case, he would pass a very difficult course. It’s a waste because if we infiltrated it directly into the disc, it would be resolved quickly, ”he concludes.
Low back pain, a symptom with multiple causes
For the Dr Patrick Le Goux, doctor elected to the executive committee of the French Tennis Federation (FFT), “The problem with low back pain is that very often the causes are multiple. In the majority of cases, it is not one thing that hurts but a collection of things. This is why it is necessary to have a global analysis of this symptom ”. For example, this sports doctor at the FFT observed, like many viewers, that Franck Ribéry stood very straight, very rigid. “We have the impression that there is no lumbar flexibility,” he emphasizes.
Listen to Dr Patrick Le Goux, rheumatologist at Amboise-Paré hospital (Boulogne-Billancourt) : ” From the moment we diagnose this poor postural state, rehabilitation is very important. Sometimes, this is even what allows the athlete to come back… “
As for medical examinations, Dr. Patrick Le Goux refuses to believe that Franck Ribéry has not benefited from the best imaging techniques that exist. “I think he has access to the most efficient techniques, but the imaging must be at the service of a correct clinical examination. You have to know why it hurts and what will trigger the pain. We have to reassure people, examine them. “” You are in pain because you made X times this gesture, your back is a bit like that, so you have to work like that instead. This is how we must behave, says Dr. Patrick Le Goux, instead of dramatizing.
In conclusion, however, our specialist gives a little advice concerning the hospital part of the follow-up, recalling the importance of the scintigraphy examination which may not have been done. “It would allow us to see a possible stress fracture of the posterior arch of the intervertebral isthmus. It is very common in sports where there is lumbar hyperextension. This is the case of tennis, but also of football … ”, he concludes.
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