Linemen, Gymnasts at Highest Risk of Spondylolysis

By Dr. Eric W. Edmonds

Low back pain occurs in children, but it is relatively uncommon compared to the frequency of pain identified in the adult population. There are multiple causes of back pain, but one that is seen with increased incidence in young football linemen, gymnasts, dancers and martial artists is spondylolysis.

Spondylolysis is a disorder related to the development of a stress fracture in the lower vertebrae. This stress fracture develops most commonly in adolescents (10- to 15-year-olds). Although it can be a cause of low back pain, the majority of adolescents with spondylolysis do not have symptoms or their symptoms are mild and are often overlooked.

Spondylolysis is seen more often in athletes than in children who do not actively participate in sports. Approximately 3 percent to 7 percent of the general population is thought to have one of these stress fractures. The reason that the previously mentioned group of teenagers (football linemen and gymnasts) are at higher risk for at least having symptomatic stress fractures is due to the repeated hyperextension of the lower back seen in those sports.

The primary symptom of a spondylolysis includes pain in the lower back, especially when bending backward.

The diagnosis can be made based on the clinical story as well as physical exam. Besides location of pain, most teenagers will demonstrate tight hamstrings during the examination.

Treatment is a period of rest from the offending activities and enrollment into physical therapy. Occasionally, surgery is indicated when conservative management fails to improve symptoms. Return to sport is allowed when pain is gone.

This problem can be prevented. Appropriate stretching of hamstring and low back, guided strengthening of core muscles, moderate progression in exercise programs, and early detection and recognition of pain can limit the scope of this injury.

Dr. Eric W. Edmonds is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital-San Diego and an assistant professor of orthopedics at UC San Diego. He can be reached at sports@rchsd.org.