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Following on from my last blog on overuse injuries in young athletes and leading into cricket season, I thought I’d examine one of the higher risk overuse injuries more closely. Let’s focus on stress fractures of the pars interarticularis (spondylolysis).
These stress fractures are a fairly common cause of persistent lower back pain in the young athlete population (1). These stress fractures are most commonly located in the lower lumbar spine, most typically occurring at the level of L4/5. They can be unilateral or bilateral fractures.
Young athletes that compete in sports which require their lower back to move into repetitive extension and rotation such as cricket, rowing, diving, dancing, gymnastics, athletic throwing sports and some foot ball positions are at increased risk of developing these fractures (2). Young athletes are especially vulnerable to this stress in growth phases (2).
Compared to the adult population, young athletes are far less likely to experience lower back pain as the result of disc pathology, muscle-tendon strain or osteoarthritis (3). In one study, comparing lower back pain in 100 young athletes with 100 symptomatic adults, 47 out of the 100 young athletes were shown to have pars fractures. Compare this with just 5% of the adults from the sample (3).
So when should you as a parent be suspicious that your child has this condition? Generally speaking, if an active child or adolescent complains of lower back pain for a period of two weeks or more this pain should be investigated, especially if they play one of the above mentioned sports and have experienced a recent growth spurt. Often the pain will start insidiously and the young athlete may complain of an aching back which is worse for back extension, running and sore after sport. Often the pain will improve with rest. They may also complain of pain in their back at nighttime.
If it is suspected by your clinician that your young athlete has a pars fracture they will be sent for imaging to confirm this diagnosis. This usually involves a plain film x-ray first and if necessary will be followed up with an MRI.
Rest from strenuous exercise is the best treatment option for Pars fractures. Most young athletes will have to take time off sport for a minimum of 12 weeks and then commence a graduated return. Each athlete is individual however and the time frame for healing will be variable. Taking time out to rest may reduce the likelihood of non-union of the fracture and may reduce the likelihood of surgical intervention.
Importantly, young athletes shouldn’t be complaining about persistent lower back pain! They are not likely to have the same cause of lower back complaints as adults and therefore their lower back pain needs to be promptly investigated. The sooner a pars fracture is identified, the sooner if can be well managed.
(1) DiFioroi, J.P., Benjamin, H.J., Brenner, J., Gergory, A., Jaynthi, N., Landry, G., Luke., A. Over use injuries and burnout in youth sports: a position statement from the American Medical society for sports medicine. British Journal of Sports Medicine 2014; 48:287-288.
(2) Iwamoto, J., Sato, Y., Takeda, T., Matumotomo, H. Return to sports activity by athletes after treatment of spondylolysis. World Journal of Orthopedics, November 18, 2010; 1 (1): 26-30.
(3) Micheli, L., Wood, R. Back pain in young athletes, significant differences from adults in causes and patterns. Archives of pediatric and adolescent medicine, 1995; 149 (1): 15-18.
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