Often lower back pain comes and goes like the common cold. Sometimes though, it can long outlive its welcome. This is frustrating for anybody, and absolutely so for an athlete that is sidelined from lower back pain. Here we will discuss a diagnosis that is sometimes missed in the realm of youth sports - Spondylolysis.

If this condition goes undiagnosed and is improperly managed, symptoms can persist and worsen over time.

In this blog we will answer the big questions:

• What is spondylolysis?

• Can spondylolysis heal on its own?

• How is spondylolysis diagnosed?

• How is spondylolysis managed?

What is Spondylolysis?

Spondylolysis is a type of fracture of the spine.

It usually starts as a stress fracture, which can progress to a complete fracture. It can occur on one or both sides of the spine.

If the fracture is on one side, it will be more stable.

If it is on both sides, there is a chance that part of the spine can shift forwards relative to the segment below. When this happens, it is called Spondylolisthesis (pictured on the right).

It is important to diagnose spondylolysis as soon as possible, in order to prevent progression to spondylolisthesis and further injury to the area. The sooner it is diagnosed, the sooner treatment can occur.

How to Know if You Have Spondylolysis?

Lower back pain alone isn’t enough information to indicate spondylolysis. We need other signs and symptoms to guide us toward a diagnosis.

You should consult a medial professional if you have low back pain and the following are true:

• You are a youth athlete playing a sport(s) that requires repeated extension and rotation of the spine

  • Examples include: Baseball, gymnastics, tennis, swimming, lacrosse, football, etc.

• You have pain bending backwards

• Your pain has lasted more than 3 weeks

It is rare, but occasionally spondylolisthesis can compress the spinal cord or peripheral nerve. You should consult a medical professional ASAP if you have low back pain with any of the following symptoms:

• Pain radiating to your legs

• Weakness in your legs

• Numbness/tingling in your saddle region and/or legs

• Changes in your bowel/bladder habits, such as incontinence

• Fevers, night pain, night sweats, or unexplained weight loss

• Pain that never goes away

How is Spondylolysis Diagnosed?

Often, an X-ray is the first choice of imaging to evaluate back pain. The downside is that it only picks up spondylolysis about 50% of the time. This percentage is even lower in the early stages of the condition.

The gold standard to diagnose spondylolysis is with a CT scan of your spine. MRIs are often preferred due to low radiation exposure. Each has advantages for detecting spondylolysis at different stages and classification of the injury. A radiologist or orthopedist will be the best at determining which is most appropriate for you in terms of spondylolysis diagnosis and treatment.

In most cases, I am not an advocate for rushing to imaging. Many times low back pain will go away on its own, and there is no reason to panic. But if it persists for a few weeks, consider further evaluation from a physical therapist or orthopedist to help you navigate the situation.

How to Manage Spondylolysis

Physical therapy is your best first option to manage a confirmed diagnosis of spondylolysis. Treatment is based around rest, core stabilization, and gradual ramping up of activity. The idea is to temporarily reduce stress to the bone to allow it to heal, and then build up strength in the surrounding tissues. Without resting from your sport or physical activity of choice, you may prolong the recovery process, and potentially make the injury worse. Research currently points at 5.5 months as the average time for return to sport from spondylolysis.

Some healthcare providers will recommend a low back brace to reduce movement and allow the bones to heal. Recent studies have shown no difference in recovery outcomes with or without bracing.

If you suspect that you have spondylolysis, consider consulting with an orthopedist or physical therapist that specializes in youth athletics.

This blog is not a substitute for medical advice. If you are experiencing symptoms, consult a license healthcare provider.