Low Back Pain: Could it be a Spondy?

What is Spondylolysis?

Spondylolysis is a stress or fatigue fracture of an area of the spine called the pars interarticularis. Typically, spondylolysis is caused by repetitive hyperextension (arching) and rotation of the back; muscle tightness & strength imbalances of the back and core muscles may also contribute. This repetitive or excessive force causes injury that exceeds the bone’s ability to heal. Rarely, it can occur due to an acute fracture with severe trauma from a sudden blow. This injury is commonly seen in adolescent athletes complaining of low back pain.

What are Common Signs and Symptoms?

Common signs and symptoms of spondylolysis include:

• Chronic pain (>2-3 weeks) in the low back that is worse with hyperextension & twisting
• Stiffness of the lower back
• Tightness of the hamstring muscles

Can Spondylolysis Be Prevented?

The following can decrease the risk of obtaining spondylolysis:

• Using proper technique
• Wearing proper protective equipment and ensuring correct fit
• Appropriately warming up and stretching before practice or competition
• Maintaining appropriate conditioning, back and hamstring flexibility, back & core muscle strength and endurance, and cardiovascular fitness

What Increases the Risk for Spondylolsis?

Risk factors associated with spondylolysis include:

• Any sport in which movement causes hyperextension (arching) of the back with either excessive rotation or repetition. It is commonly seen in:
  • Gymnastics
  • Football
  • Diving
  • Weightlifting
  • Dance
  • Rifle shooting
  • Wrestling
  • Tennis
  • Swimming
  • Running
  • Volleyball
  • Track and field
  • Rugby
  • Contact sports
• Poor physical conditioning (strength and flexibility)
• Inadequate warm-up before practice or play
• Family history of spondylolysis
• Poor technique

What Possible Complications are Associated with Spondylolysis?

The following are potential complications associated with spondylolysis:

• Delayed healing or resolution of symptoms, particularly if sports are resumed too soon
• Frequent recurrence of symptoms, resulting in a chronic problem; appropriately addressing the problem the first time decreases frequency of recurrence
• Chronic pain and non-healing of the fracture
• Prolonged disability
• Progression to spondylolisthesis (slippage or movement of one vertebra on another)

How is Spondylolysis Commonly Treated and What is the Prognosis?

Initial treatment consists of rest from activities that cause the pain (no hyperextension). Non-steroidal anti-inflammatory medications (such as ibuprofen) or other minor pain relievers (such as acetaminophen) are sometimes recommended for pain. Application of ice may also be used to relieve pain. A back brace may be recommended to prevent hyperextension. As pain subsides, a referral to a physical therapist or athletic trainer may be recommended for evaluation and further treatment. Rehabilitation exercises focus on improving strength and flexibility and learning proper back mechanics. Symptoms typically improve within 6-12 weeks and return to sport is often possible within 3-6 months. Surgery is rarely necessary and is reserved for those athletes who have persistent pain despite 6 to 12 months of appropriate conservative treatment.