Sporty kid with back pain? Recently started after increase in sport? What could it be…?

Low back pain can be a problem in all age groups. There can be a variety of reasons for it but fortunately most are not serious and are easily sorted with the right management. But in children and young adults there is a specific condition that needs to be assessed for and that is spondylolysis.

What is it?

Spondylolysis is a bony injury caused by an overload of the pars interarticularis a specific part of the vertebrae. Research has shown most of the these injuries occur at the bottom level (L5). L5 is located at the base of your back where it attaches to your sacrum.

Sport often involves quick rotational movements such as throwing, serving in tennis and bowling in cricket. In this blog we will focus on cricket, where there is a high incidence of spondylolysis injuries. Bowling especially, which combines a rotational movement (twisting) of the back with extension (leaning backwards) can be particularly provocative and it is reported that 47% of cricketers presenting with low back pain were diagnosed with a spondylolysis. This has been hypothesised to be as a result of more intense training sessions, relatively poor preparation and longer spells of bowling.

After the Christmas break, winter cricket nets start in most age groups in preparation for the start of the new season. The increase in sport and activities can be a common time to pick up injuries and children and young adults are no different.

What are the symptoms?

In most cases there may not be any symptoms! Normally diagnosis is made between 15 and 16 years old with pain worse after repetitive athletic activities that combination in extension and rotation movements (think bowling and throwing and even gymnastics).

Specific symptoms could include low back pain, worse with exercise and a feeling of ‘tight’ hamstrings. It may also be painful to feel parts of the back around the back and back muscles.

A period of rest can make the pain better, but it often returns when sport is replayed. It also can influence walking patterns and changes in standing positions.

How is a diagnosis made?

There is no gold standard way of diagnosing spondylolysis. A combination of methods have been found to be the most reliable. Imaging forms a part of this diagnosis, x-rays, CT scans and MRI scans are all used, but are they useful?

Research has shown only 30-38% of this type of spinal bony injury can be seen on an x-ray. Although they can be used to examine for any other bony injury such as a spondylolisthesis (a forward movement of one vertebra on another). 

xA CT scan has been found to be more sensitive than an x-ray and enable an assessment to see if the bony injury is acute or longer standing in appearance. This can therefore influence treatment and management of the injury.

An MRI scan enables a review of associated soft tissues and therefore identify varying pathologies with similar symptoms. You can see the defect on the MRI image.

MRI Scan showing a pars defect

How can it be treated?

Conservative treatment is, in most cases sufficient to treat spondylolysis. This can include relative rest, promoting normal movements with increasing strength and flexibility with a graded return to sport.

To help guide this rehabilitation process we will use your history of the injury, exercise history amongst other things as well as a clinical assessment to diagnose the problem and recommend any further medical intervention. We will then tailor rehabilitation programs for your needs. Getting you back to sport stronger!

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