Spondylolysis – A stress Fracture of the lower back

What are Stress Fractures?

A  stress fracture is a crack that forms in the bone. They can range from inflammation of the bone right through to a complete stress fracture which is a cortical break. Stress fractures are the result of excessive, repetitive loads on bone causing microdamage which the remodeling process fails to repair.

Lumbar stress fractures are largely confined to the posterior vertebral arch especially the pedicle. Spondylolysis is the term used for a radiologically confirmed defect of the pars interarticularis (PI) which is found between the inferior and superior process of the neural arch at the junction between the laminae and pedicles. Spondylolysis is a stress fracture of the spine of the lower back. The high incidence of stress reactions of the PI is due to this being the weakest and thinnest point of the vertebral arch 

An injury to the PI occurs on a stress fracture continuum, commencing with a stress reaction (early spondylolysis), stress fracture (late spondylolysis), fracture and slippage (spondylolisthesis) (Kountouris et al 2018).

What are the symptoms of a stress Fracture of the lower back?

Pain in the lower back and specifically pain into extension (leaning backwards) are features of spondylolysis. There are no clinical tests able to diagnose spondylolysis. Diagnosis is made using clinical reasoning and/or imaging, specifically MRI or CT. X-ray is less effective at diagnosing Spondylolysis. However, athletes with no lower back pain have also been found to have changes to the bone on imaging also. Therefore, if an athlete has no pain, but has changes on MRI it does not necessarily mean they have to rest from their sport. 

Who typically gets a stress fracture of the lower back? 

Spondylolysis is common in youth athletes and especially in sports with repetitive loading that requires extension and rotation such as gymnastics, hurling  and cricket. Therefore, adolescents who play high level sport who present with low back pain, need a full examination to rule out Spondylolysis. High incidences in youth is attributed to the bones in the lumbar spine not being fully developed and therefore weak. 

What are the Risk factors for stress fractures of the lower back 

Risk factors for Spondylolysis include

  • Increased load (increased volume and/or intensity of training), 
  • Poor technique 
  • Imbalance in musculature
  • Low bone mineral density
  • Low Body Mass index- low body weight
  • Poor nutrition
  • High impact sports

How are stress fractures of the lower back  treated?

Management includes rest or modifying your activity levels, rehabilitation exercises to correct any muscle imbalance and weakness, physiotherapy for pain and tightness. Bracing can be used but the evidence to support their use is mixed. If Physiotherapy management fails surgery is an option. 

How can we help you? 

At Sligo Physio Space we can carry out a detailed assessment of your back pain and decide if you may have a spondylolysis. From here we will decide if you need imaging, and then give you advice on modifying your activity levels and design an appropriate rehabilitation program. We can liaise with your GP or sports doctor to ensure you get the best possible outcome. 

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