The World Health Organization estimates that most of us will have lower back pain at some point in our lives. For some of us, though, it will start early. Young athletes can be especially prone to lower back pain, and one of the most common causes in adolescent athletes is spondylolysis.
What Is Spondylolysis?
Spondylolysis is a term that describes stress fractures of the pars interarticularis, known as pars for short. The pars is an area of the vertebra (backbone) near the spinal cord. Vertebrae are connected by facet joints, and each facet joint is connected to the joints above and below by the pars.
When the spine is stressed—especially when it’s hyperextended—the pars can become weakened and develop cracks over time. This hyperextension of the spine is particularly common in sports like gymnastics, football and weight training.
Spondylolysis is present in about 5 percent of the pediatric population. It is the most likely cause of back pain in people under the age of 26.
What Are the Symptoms of Spondylolysis?
The most common site of a pars fracture is on the one that connects the lowest lumbar vertebra with the sacrum, the five fused bones above your tailbone. You might see this written as L5-S1, meaning the fifth lumbar vertebra and the first sacral bone.
Very often spondylolysis has no symptoms, and people with the condition don’t know they have it unless it’s found while looking for something else. When symptoms are present, lower back pain is the most common. The pain is sometimes mistaken for a muscle strain. It often radiates to the buttocks and hamstrings, and usually gets worse with activity but improves with rest.
What Causes Spondylolysis?
Because the spines of children and adolescents are still developing, they are more susceptible than adults to spondylolysis. The average age of someone with spondylolysis is 15 to 16. Males are more likely to have spondylolysis than females.
Some sports carry more of a risk of spondylolysis than others. Hyperextending the back is a main driver for the development of the condition. Some of the most common activities that can lead to the condition include:
- Weight training
If left untreated, spondylolysis can progress to a condition called spondylolisthesis. This happens when the vertebra has been weakened so much it can’t maintain alignment in the spinal column. The pars breaks in two, separating the two vertebrae. The result is one of the vertebrae slips forward. Often the slipped vertebrae presses on the intervertebral disc below it, or a nerve or nerve root, resulting in significant pain and possibly nerve damage.
How Can Spondylolysis Be Detected?
When a young patient comes to me with back pain, my first step is to take their medical history. I pay particular attention to any sports in which the patient might participate. If he or she engages in activities with a large component of either extension or rotation (twisting) of the spine, that’s when I’ll begin to suspect spondylolysis.
Next, I’ll perform a physical exam. I’ll examine the patient’s spine, looking for any areas that hurt or feel tender. I may also want to observe the patient walking or standing, which may show me that there’s a problem with the lower back.
If I still think spondylolysis might be the culprit, X-rays will be the next step. This imaging can usually show pars fractures, but sometimes they’re so small they won’t appear. In that case, a magnetic resonance imaging (MRI) or computed tomography (CT) scan can show the hairline fractures or areas of inflammation within the bone.
How is Spondylolysis Treated and Prevented?
The goals of treatment are to reduce symptoms and allow the pars fractures to heal and inflammation in the bone to resolve. Resting and avoiding sports that put the spine into hyperextension or rotation can help improve the pain, as can nonsteroidal anti-inflammatory drugs (NSAIDs).
Most patients benefit from a back brace, which limits movement and allows the fractures to heal and inflammation in the bone to resolve. People with spondylolysis may need to wear a brace for a number of weeks or months.
Physical therapy is generally initiated after approximately 4 weeks of rest and brace immobilization. Initial therapy is focused on lower extremity flexibility and spine neural core stabilization. Activities are advanced over the course of 2-3 months, slowly adding in additional exercises geared specifically towards each individuals specific needs.
Corticosteroid injections, which are powerful anti-inflammatories, are rarely needed for pain that persists despite activity modification, bracing and physical therapy.
If conservative methods of treatment don’t work, surgery is a very rare option. Lumbar spinal fusion hooks vertebrae together, which limits movement of the joints and, therefore, reduces pain.
Preventing spondylolysis is a combination of rest and conditioning. It’s important that young athletes get at least two days of rest per week, and they should consider taking at least one season off per year of their sport. This will give their bodies time to rest and will limit the stress to their spines. Additionally, maintaining a strong core and flexible hip flexors and hamstrings will lessen the negative effects of hyperextension and rotation on the spine.
If you or your child is experiencing lower back pain, request an appointment with me. I can help you determine the source and reason for back pain and devise a treatment plan that’s right for you and your young athlete.