Lumbar Stress Fracture
A lumbar stress fracture is medically known as a spondylolysis.
The stress fracture of the lower back is typically seen in athletes who go into forceful extension including:
- High jumpers.
- Tennis players.
- Fast bowlers in cricket.
- Swimmers who specialise in butterfly.
The stress fracture affects a piece of bone in the back called the pars inarticularis. This bone connects the facets in the back to the vertebral body.
The forces that cause this condition are the repetitive hyperextension movements, especially if combined with rotation.
When faced with repetitive stress over a significant period of time the bone starts to fatigue and weaken. This is when your symptoms may start to occur.
Quite frequently the fracture occurs on the side opposite to that the activity is preformed. So a right armed javelin thrower may develop a left sided fracture. In fast bowlers the fracture is caused by using a mixed action where a rotational twist is provided through the body to produce extra speed. To eliminate the risk of a stress fracture the technique has to be modified slightly to reduce the amount of twisting. Unfortunately this often corresponds to a reduction in bowling speed.
Continued aggravation will cause this condition and may lead to the development of a spondylolisthesis.
Symptoms of lower back stress fractures include:
- Pain on one side of the lower back in the case of a unilateral stress fracture or both sides in the case of a bilateral stress fracture.
- Pain in the lower back is aggravated by lumbar extension, especially if rotation is added.
- Sometimes these stress fractures can be asymptomatic.
- Quite often an x-ray will not show the fracture and a bone scan is required.
Treatment consists of:
- Rest from the aggravating activity.
- Decreasing any associated muscle spasm is important to deload the spine through appropriate massage or mobilisation techniques.
- Improving the posture is important, reducing the amount of lordosis/extension will take pressure off the stress fracture allowing it to heal adequately.
- Strengthening of the core stabilisers to ensure the correct posture is maintained.
- Review of exercise technique to ensure the stress fracture won’t return.