When a 16-year-old football player with two months of worsening back pain showed up in Dr. Thurman Alvey’s exam room, the sports medicine specialist asked about his current symptoms and medical history and knew just how to proceed.
“A year prior, this athlete had been treated by another provider for a right-sided stress fracture,” says Alvey. “Now this teenager had pain on his left side. Knowing his history with stress fractures, we ordered an MRI and blood testing.”
Unsurprisingly, the MRI showed a new stress fracture on the patient’s left side, and his bloodwork came back as suspected for someone with his medical history.
“He had insufficient vitamin D,” says Alvey.
Today, approximately one billion people of all ages and backgrounds worldwide are vitamin D deficient. The fat-soluble compound, which works alongside calcium to keep bones strong and help them heal, is a tell-tale sign of bone health. Additionally, vitamin D helps fight certain diseases, relieve anxiety and depression, and promote good sleep.
To experience the full health benefits it provides, the National Academy of Medicine recommends that a person’s vitamin D levels be between 30 to 100 nanograms per milliliter. Levels ranging from 20 to 30 are considered insufficient, and anything under 20 is deemed deficient.
“The athlete was at 28, which is technically in the insufficient range, but I tell everyone that the standard range doesn’t work for athletes,” says Alvey. “It’s been shown time and time again that bone will not heal unless we have a vitamin D level between 40 and 60.”
To treat the stress fracture, Alvey put the patient in a rigid brace and prescribed a course of vitamin D supplements. Dosage was based on the teenager’s size, weight and current vitamin D levels.
“I want patients to be pain-free before we start moving again,” says Alvey. “He started physical therapy after two weeks of rest, and in eight weeks, he was back at football practice wearing the brace.”
Alvey stresses athletes and non-athletes alike can benefit from boosting their vitamin D levels. While a person’s body naturally absorbs vitamin D from sunlight, it’s not always enough. Supplements and a diet including vitamin D-rich foods, such as fatty fish and fortified dairy products, can help.
Signs and symptoms of vitamin D deficiency can range from simple aches and pains to severe bone and muscle pain or weakness. In a worst-case scenario, a patient can develop a bilateral fracture known as spondylolisthesis, which comes with a lifetime risk of low back pain and may eventually require surgical spinal fusion.
“If we can prevent even one spinal fusion, I feel like we’ve done our job,” says Alvey.
In the case of the high school football player, follow-up scans were positive and included evidence of new healing.
“It’s the outcome we like to have,” says Alvey. “He still looked good at his annual check-up and went on to play in college.”
These recommendations have been excerpted from Coaches Corner, a free monthly webinar series for coaches, athletic directors and athletic trainers. The series, developed and presented by Forté, in partnership with IHSAA, aims to arm coaching and support teams with helpful information to consider when working with their athletes. Subscribe online so you don’t miss an episode.
