Lumbar Spondylolysis: A Guide for Parents of Young Athletes

As a parent, there’s nothing more concerning than seeing your child in pain. If you have a young athlete who’s been complaining of low back pain, you might be wondering what could be causing it and how you can help. One possibility that’s worth knowing about is a condition called lumbar spondylolysis.

At our chiropractic clinic in Ashland, OR, Dr. Noah Volz and our team have helped many young athletes and their families navigate this diagnosis. We understand how worrying it can be when your child is hurting, and we’re here to provide the guidance and care they need to heal and get back to the activities they love.

In this blog post, we’ll break down what lumbar spondylolysis is, who’s most at risk, and what can be done to treat it effectively and safely.

What Is Lumbar Spondylolysis?

Lumbar spondylolysis is a stress fracture that happens in a part of the vertebra (spine bone) called the pars interarticularis. The pars is a thin strip of bone that connects the upper and lower joints of the vertebra. Its job is to help keep the vertebra stable and aligned.

In young athletes, the pars can develop tiny cracks or fractures from repeated stress and strain on the lower back. This stress often comes from sports that involve a lot of bending backwards (extension), especially combined with rotation.

Some of the sports with the highest risk of lumbar spondylolysis include:

– Gymnastics
– Diving
– Wrestling
– Weightlifting
– Football
– Tennis
– Volleyball
– Dance

While spondylolysis can happen at any level of the spine, it most commonly affects the lowest lumbar vertebra (L5). This is the area that connects the lower back to the pelvis and bears a lot of weight and stress.

What Are the Risk Factors for Lumbar Spondylolysis?

Lumbar spondylolysis is most common in children and teenagers, especially those involved in high-level sports. Some other risk factors include:

– Family history of spondylolysis
– Being male (it’s about twice as common in boys)
– Having tight hamstrings or a swayback posture
– Participating in sports from a young age or at a high intensity

It’s important to note that not everyone with spondylolysis has pain or knows they have it. In fact, studies have found that about 5-7% of the general population has spondylolysis by age 18, but many don’t have any symptoms.

However, for some young athletes, lumbar spondylolysis can be a significant source of pain and disability. It’s actually the most common cause of low back pain in adolescent athletes.

What Are the Symptoms of Lumbar Spondylolysis?

The classic symptom of lumbar spondylolysis is low back pain that’s related to activity. The pain is usually felt in the center of the lower back, but it may spread to the buttocks or backs of the thighs.

Other signs and symptoms may include:

– Pain that gets worse with backwards bending (extension) or standing for a long time
– Pain that feels better with rest or forward bending
– Stiffness and tightness in the lower back, especially first thing in the morning
– Muscle spasms in the lower back or buttocks
– Tight hamstrings or hip muscles

In more severe cases or those that have been untreated for a long time, spondylolysis can progress to a condition called spondylolisthesis. This is when the fractured vertebra starts to slip forward on the one below it. Spondylolisthesis can cause additional symptoms like leg pain, numbness, or weakness.

If your child has any of these symptoms, it’s important to have them evaluated by a healthcare provider who’s experienced in working with young athletes. Early diagnosis and treatment can help prevent the condition from getting worse and improve outcomes.

How Is Lumbar Spondylolysis Diagnosed?

When you bring your child to our chiropractic clinic for low back pain, Dr. Volz will start by asking about their symptoms, sports participation, and medical history. He’ll then do a thorough physical exam to check their posture, spinal alignment, flexibility, and strength.

One of the key tests for lumbar spondylolysis is called the “stork test” or “one-legged hyperextension maneuver.” This involves having your child stand on one leg and then lean backwards. If this move reproduces their pain, it’s a good indication that they may have a pars fracture.

To confirm the diagnosis, imaging tests are usually needed. This may include:

– X-rays to look for fractures or other bony changes
– CT scan to get a more detailed view of the pars and stage of healing
– MRI to check for any damage to the discs or nerves

Your child’s provider will use the results of the exam and imaging to determine if the fracture is new and still healing (active) or old and not likely to heal on its own (inactive). This distinction is important for guiding treatment.

How Is Lumbar Spondylolysis Treated?

The good news is that most cases of lumbar spondylolysis can be treated successfully without surgery. The goals of treatment are to relieve pain, promote healing of the fracture, and prevent progression to spondylolisthesis.

The mainstay of treatment is relative rest and activity modification. This means taking a break from the aggravating sport and any other activities that put stress on the lower back. For active or new fractures, this rest period may need to be as long as 2-3 months to allow the bone to heal.

During this time, your child can stay active with low-impact cross-training activities like swimming, biking, or using an elliptical machine. Dr. Volz may also recommend:

– Pain-relieving modalities like ice, heat, or electrical stimulation
– Gentle chiropractic adjustments to relieve pain and promote healing
– Stretches for tight muscles in the legs and back
– Core and hip strengthening exercises to improve stability
– Postural and breathing exercises to reduce stress on the spine

In some cases, a back brace may be recommended to provide extra support and remind your child to avoid aggravating positions. However, the research is mixed on whether bracing helps healing or just reduces symptoms.

As your child’s pain improves and the fracture starts to heal, they can gradually return to their sport. This process is usually guided by their symptoms and imaging results. Most kids are able to successfully return to play after completing a course of conservative care.

In rare cases, if the fracture doesn’t heal or the slippage is severe, surgery may be considered. However, this is typically a last resort after several months of failed conservative treatment.

The Bottom Line

If your child is a young athlete dealing with low back pain, don’t ignore it or assume it’s just a normal part of playing sports. Lumbar spondylolysis is a common cause of back pain in this age group, but it often goes undiagnosed or misdiagnosed.

The key is to get a proper evaluation from a provider who understands the unique needs of young athletes. With an individualized treatment plan and a little patience, most kids with lumbar spondylolysis can get back to the sports and activities they love without pain holding them back.

If you’re in the Ashland, OR area and are looking for guidance on your child’s back pain, we encourage you to reach out to Dr. Noah Volz and our team. We’re passionate about helping young athletes stay healthy, active, and performing at their best.

References:
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3. Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 2006;40:940-6
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5. Bergmann TF, Hyde TE. Yochum TR, Active or Inactive Spondylolysis and/or Spondylolisthesis: What’s the Real Cause of Back Pain? Journal of the Neuromusculoskeletal System 10:70 – 78, 2002