In my experience I have not found lower spine injuries to be very common in youth athletes, but they do happen. And maybe the most common lower back injuries in youth and adolescent-aged athletes is spondylolysis. It is estimated that about 40-50% of injuries occurring to the lumbar spine in adolescent children are due to spondylolysis.
Spondylolysis is a stress reaction or stress fracture of the pars interarticularis which is a part of the vertebra highlighted in the picture below.
The first reason why this injury is prevalent in general has to do with the bony anatomy of the lower spine. The joints in the lower spine are aligned to promote bending forward and backwards and does not lend themselves to allow rotation easily. Therefore, when the spine is under repeated, high loads such as it is in rotational sports such as baseball – the pars (vertebral arch) undergoes a great amount of stress that it is not necessarily designed to withstand. Especially if other factors exist for the individual such as poor spinal and hip mobility, or core and glute weakness.
Additionally, training volume or ramping up training volume too quickly can have a significant impact on the bony structures in a negative way leading to a stress reaction.
Several signs and symptoms can occur with spondylolysis. The most telling sign is pain in the lumbar spine and limitation in range of motion - particularly rotation and extension (backward bending).
Because pain is not always present, athletes should be observed for other symptoms including nerve tightness/irritation, specifically in the sciatic nerve going down the back of the leg, which can appear as hamstring tightness.
Patients with spondylolysis may also present with hip tightness, decreased latissimus dorsi flexibility (which can present as loss of overhead motion), and an ability to efficiently recruit muscles of the lower body.
Spondylolysis can only be officially diagnosed after using proper imaging such as a radiograph (X-ray). In some instances, MRIs or CT scans may be necessary to accurately diagnose especially when the injury is a smaller stress reaction. It is important when discussing with your doctor to get an understanding of what type of imaging is preferred and why.
Depending on the severity of the injury, there is a wide range of time needed to take off from sport. In instances of stress reactions, where the bone has begun to weaken but has not yet fractured, it is recommended an athlete take off one to three months to allow the bone to heal. If an athlete’s spine gets to the point of being fractured, the recovery time may be upwards of six to nine months. Recovery time depends on the severity of the fracture, the athlete’s doctor’s preferences, the health of the athlete, and the sport of which the athlete participates. In many instances, especially when a fracture is present, a brace may be recommended to help with the healing process.
For both stress fractures and stress reactions, in addition to rest from sports participation, physical therapy will likely be recommended to address core and overall weaknesses, limitations in spine and hip mobility, poor posture, and body awareness. Generally, physical therapy will take place throughout the entire recovery period, and the therapist will guide the athlete through a gradual return to sport protocol.
Improper treatment of spondylolysis can have severe, lasting effects. The main concern is that the weakness of the pars interarticularis leads to compensation by its counterpoint on the opposite side of the spine. This could lead to stress reactions/fractures on both sides of the spine and an unwanted shifting of the vertebra begins– this is known as spondylolisthesis. In extreme cases this may even require surgery.
While spondylolysis is not completely preventable, steps can be taken to reduce the risk of incurring an injury. Like the injuries we’ve discussed in previous posts, monitoring the intensity and frequency of sports’ participation year-round is of highest importance. Parents and coaches should take note of fatigue in an athlete. This not only includes subjective complaints of fatigue but also noting decreased performance, complaints of back tightness, or even loss of flexibility in the lower extremities. If athletes are competing at a high level of intensity, they should also participate in some type of strength and conditioning program to address any strength, flexibility, or motor control deficits that may be present.