Low back (lumbar) stress fractures
Low back pain in children and adolescents should not be ignored, especially in athletes. Growing bones are susceptible to repetitive stress that occurs when playing sports like football, soccer, and gymnastics, and other activities like weightlifting. As a result, small cracks, known as stress fractures (medical term – spondylolysis), can occur in a bone. The area of the spinal bone (vertebrae) that is usually the most impacted is a part called the pars interarticularis and it is usually at the L5 level (the lowest level of the low back).
Stress fractures in the lumbar spine (low back) typically present with localized low back pain, which can be dismissed as a muscle strain. When seeking evaluation, Dr. Garala will obtain a complete medical history, perform a physical exam, and will usually order an imaging study. X-rays, CT scans, bone scans with SPECT, and MRIs are various imaging studies that can potentially help confirm the diagnosis.
The majority of patients who are diagnosed with stress fractures improve over time with conservative treatment. This includes a period of rest from sports and other strenuous activities to allow the fracture to heal. Pain can be controlled with medications and/or a back brace if necessary. However, the patient is also placed in a specific physical therapy (P.T.) program to strengthen the low back and pelvic muscles. The goal is to optimize the health of the muscles surrounding the spine so when the patient returns to activities, the spine itself sees less force due to stronger and less fatigable muscles. The total length of recovery can span from six weeks to 12 weeks, or possibly longer.
A determination to return to activities is a clinical decision. The patient should be pain free, have no provocative discomfort with physical exam maneuvers, and should have met all their P.T. goals for lumbar/pelvic muscle strengthening and endurance.
If you have any questions about your child’s low back pain, please feel free to call Dr. Garala’s office.