July 16, 2019 by Peter B. Laird
Lumbar Stress Fractures: A Growing Trend in Young Athletes
Stress fractures in one or more of the small bones that make up the lower back, or lumbar, are becoming increasingly common among adolescent and teen athletes.
Regular training for competition in such sports as gymnastics, football, lacrosse, baseball and weight-lifting can be physically demanding and include repetitive motions and stress on the lower spinal column, says Roger Saldana, M.D., pediatric orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute at Baptist Children’s Hospital.
“We are seeing quite a higher number of these, especially as kids become more active in sports and they’re playing for longer hours and are having more demands on them,” says Dr. Saldana. “By far, the most common cause of back pain is muscular. But kids who are doing sports with a lot of hyperextensions of their backs will have much higher incidents of these stress fractures. They happen in a very particular area of the lower back.”
(Video: The Baptist Health News Team hears from Roger Saldana, M.D., pediatric orthopedic surgeon, about lumbar stress fractures in teens and adolescents. Watch now. Video by Steve Pipho.)
In spondylolysis, a crack or stress fracture occurs through the “pars interarticularis,” the small, thin bones of the vertebra that connect the upper and lower facet joints. The “pars” are the weakest part of the lower back structure, and that makes them more vulnerable to “overuse” injuries. While spondylolysis can occur at any age, it is most often appearing in adolescents and teens because their spines are still developing and are even more susceptible.
Most commonly, these stress fractures occur in the fifth vertebra of the lumbar spine, although they can also occur in the fourth lumbar vertebra. A fracture can occur on one side or both sides of the “pars” bone. In more severe cases, spondylolisthesis can develop. This is when a fractured pars separates, allowing the injured portion to shift or slip forward on the vertebra. Surgery may be recommended for spondylolisthesis patients with severe slippages, or for those whose back pain has not improved with nonsurgical treatments.
The most common treatments for lumbar stress fractures are sufficient rest periods and physical therapy which will commonly include “core strengthening” exercises. These exercises strengthen your core muscles including abdominal and back muscles, and the muscles around the pelvis.
“The most common symptom with a stress fracture or slip is lower back pain brought on by overuse during their activity or sport,” says Dr. Saldana. “Often, the pain decreases after they’ve rested for a period of time. But usually pain from a stress fracture doesn’t go away after a couple of days of rest. And it’s almost always in the lower back.”
A young athlete may dismiss the initial symptom of a lumbar stress fracture as typical lower back pain from over-training. But parents should be aware that persistent pain starting at the center of the lower back, and radiating downward, should be evaluated by a physician. Additional symptoms can include muscle spasms, back stiffness, tight hamstrings and difficulty standing or walking.
Physical examinations will likely include ordering imaging tests to pinpoint stress fractures, which can be challenging to detect on X-rays, says Dr. Saldana.
“I’ve gotten anywhere from kids who have had pain for six months to kids who have had back pain for a couple of days,” says Dr. Saldana. “What I usually like to tell parents and athletes is: Pain that doesn’t get better with a few days of rest or doesn’t get better with activity modifications or things you are use to doing, then it’s something that should be evaluated by your pediatrician, who may refer you to an orthopedic specialist.”