Low Back Pain: Could it be a Spondy?

Low back pain is the most common musculoskeletal complaint worldwide, with up to 85 percent of all people experiencing LBP during their lifetimes. However, the most common complaint of low back pain can be more than a muscle strain.

Spondylolysis is a stress or fatigue fracture of the small back bones, called the vertebrae. Spondylolysis is an overuse injury caused by repetitive hyperextension or arching of the back. It is most often occurs in individuals who participate in sports such as gymnastics, diving, volleyball, football, and weight lifting. It is also believed that spondylolysis can be caused due to a family history of this condition. Rarely, spondylolysis can be due to an acute traumatic force such as a sudden blow. In some cases, the stress fracture weakens one vertebra so much that it is unable to maintain its proper position which than can cause another vertebrae to shift or slip called spondylolisthesis. Spondylolisthesis is less common than spondylolysis.

Spondylolysis and spondylolisthesis is commonly seen in adolescent athletes complaining of low back pain. The low back pain generally develops insidiously. Pay attention to low back pain lasting longer the 2-3 weeks, especially if that worsen with arching the back (hyperextension) and twisting. The pain may be central or off to one side of the low back and may radiate to the buttocks or posterior thigh. Athletes may experience muscle spasms or stiffness in their low back in addition to their low back pain.

Spondylolysis

Treatment

It is important to consult a physician with persistent low back pain particularly those whose sports involve lumbar extension as imaging is typically necessary to rule out any injury of the spine. Initial treatment consists of rest from all sports or activities and in some cases back brace may be recommended to prevent hyperextension. The goal is to get the bone to heal back together. Non-steroidal anti-inflammatory medications (such as ibuprofen) or other minor pain relievers (such as acetaminophen) are sometimes recommended for pain in addition to the application of ice.

Physical therapy is often delayed for 6 to 12 weeks to allow for bone healing. 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.

Prevention

Ideally, avoiding repetitive and excessive high impact activities especially those involving hyperextension (kicking, jumping, running, back bends) would minimize the risk of developing a spondylolysis. However, most childhood and adolescent recreational and competitive sports require these activities and are tolerated well by children. Maintaining appropriate conditioning, back and hamstring flexibility, back & core muscle strength and endurance, and cardiovascular fitness can decrease the risk of obtaining spondylolysis. Appropriately warming up and stretching before practice or competition may also reduce the risk of developing spondylolysis. It is important that when wearing proper protective equipment to ensure the correct fit.

Nationwide Children’s Hospital Sports Medicine specializes in diagnosing and treating sports-related injuries in youth, adolescent, and collegiate athletes. Services are available in multiple locations throughout central Ohio.  To make an appointment, call 614-355-6000 or request an appointment online.