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Spondylolysis (Stress fracture in the spine) in Adolescence by Dr Zeinah Keen

spondylolysis

Stress fractures in young adolescence is more common than I realised. I have seen a few cases these last few months in clinic. It is more common in boys and in high risk active sports people with immature bone structure. The repetitive stress of trunk twisting and hyperextension manoeuvres is a major risk factor. The highest risk sports include gymnastics, cricket bowlers, weightlifting, wrestling, ballet dancing, diving, butterfly swimming, ice skating, track and field throwers and golf.
Stress fractures are represented as unique lesions occurring in the pars interarticularis section of the vertebrae, most commonly at L5 and are non-displaced (Reitman C.A. et al, 2016). If the fracture is unstable, it is usually because the defect is occurring on both sides and there may be a slippage forward of the vertebrae, known as a spondylolisthesis. This occurs in about 50% of cases and, more likely in the girls (Miller,J. 2016).

Presenting symptoms usually include;

• Sudden onset of one sided back pain which is sharp pain initially and then becomes dull later.
• The pain is aggravated by bending backwards, standing or pursuing through the activity that caused the injury.
• The pain can radiate to the buttocks or thigh.
• Pain is relieved with rest.
• Tight hamstrings.
• Exaggerated back arch.

Diagnosis is made by clinical symptoms, physical examination and X-rays, CT and MRI scans.

Treatment
There are numerous disagreements among authors as to the optimal means of treating this condition but usually surgery is not indicated and treatment is thus conservative which is successful in 80-85% of teenagers and children. Treatment aims to reduce the pain associated with inflammation around the fracture site and facilitate the healing process. Osteopathic treatment will reduce inflammation (hot and cold, dry needling, soft tissue massage, de-loading taping techniques and avoiding the exercises and activities that aggravate the pain). Anti-inflammatory medication or gels can be useful.
When symptoms have settled a bit, other treatments are incorporated. Hydrotherapy-swimming or walking in the water can help to maintain fitness while reducing the load placed on the affected spinal segment. Restoring normal spine function by mobilising restricted joints adjacent to the injury and improving posture. Improving muscle flexibility with stretches. Deep abdominal core muscle strengthening exercises. Gradual return to sports. This can commence 6-12 weeks’ post injury.
Ultimately a prevention of recurrence is the ideal but most athletes are eager to get back to their sport. Therefore, sufficient rehabilitation is extremely important as well as learning adaptations/self-management techniques to help achieve their goal of returning to their previous sport.

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