Stress fractures commonly appear in the lower back are known as spondylolysis and is found in a small percentage of the overall population. A stress fracture has been found to be prevalent among young athletes, mostly individuals whose bones are not fully matured and still growing.
The categories of people that are commonly affected are athletes who engage in physical activities that involve repetitive hyperextension of the low back. Spondylolisthesis is often regarded as a complication of spondylolysis when the stress fracture occurs from both sides of the spine causing slipping or forward (anterior) displacement of one vertebral body over another.
What are the Symptoms of Stress Fractures?
- Burning pain in the lower back, it is sharp at the beginning and over time becomes a dull pain
- Pain worsened by arching, standing or 'stress' activities especially with increased training
- Pain can spread into the butt or thigh
- Normal neurological signs
- Pain relieved by rest
What are the Causes of Stress Fractures?
Any activities that can overstress the pars interarticularis can result in the development of stress fractures. The cause can also be attributed to activities that involve repetitive rotation and or hyperextension.
Below are the lists of sports which have been identified to be responsible for the emergence of stress fractures:
- Cricket bowlers
- Butterfly swimming
- Ballet dancing
- Ice skating
- Track and field throwers eg javelin
How a Stress Fracture is Diagnosed?
The symptoms of stress fractures play a crucial role in its diagnosis as well as the physical examination on the spinal cord, with the assessment of a possible spondylolysis or spondylolisthesis to include a small X-ray images of the lumbar spine.
It seems that SPECT bone is the most sensitive study to detect active spondylolysis. CT and MRI can be used to search for possible spondylolysis. Bone scintigraphy can also be useful in distinguishing the acute response to stress reaction (spondylolysis) from chronic defects.
The most common finding on a physical examination is a pain in the lower back and pain with an extension of the lumbar spine. The hamstring tightness is another very common finding in patients with spondylolysis.
Treatment of Stress Fractures
The initial treatment of athletes suffering from spondylolysis is conservative with an emphasis on pain control. It is also important for athletes to stay clear of any activity that can lead to an increase in the amount of stress at the site of injury, including:
- Extension/hyperextension of the lower back
- Some activities such as running and jumping
- All activities leading to a collision
The use of back support can also be recommended for some athletes. As soon as the pain subsides, an athlete can continue with rehabilitation activities that center on control and stability of the lumbar spine and pelvis. Exercises will initially focus on core stabilisation to help locate and maintain the neutral position of the pelvis in order to minimise or eliminate the extension / hyperextension of the lower back.
Once an athlete is able to find and retain this position in static positions, the exercises will progress to include advanced static core stabilisation, dynamic core stabilisation and ultimately returning to sporting activities.