Is Your Low Back Pain a Stress Fracture?

Working with fitness athletes, CrossFitters, and weightlifters, many of our members first find us while dealing with low back pain. With low back pain there are many different diagnoses to differentiate between, which is why seeing a health professional skilled in diagnosis and treatment of low back pain is so critical. In this article we discuss one specific cause of low back pain that is surprisingly prevalent in the weightlifting and gymnastics athletes, called spondylolysis.

What is Spondylolysis?

Spondylolysis occurs when there is a fracture, found in a region of the vertebrae called the pars interarticularis. For a little anatomy 101, the vertebra are the bones that stack upon each other to create your spine, and surround your spinal cord.

The fracture generally occurs in the lowest vertebra of your low back, and generally on one side of the vertebra; however, it can occasionally occur on both sides, which leads to the potential for the vertebra to slip forward, which is then known as spondylolisthesis.

What Causes the Spondylolysis Stress Fracture?

The guilty culprit leading to spondylolysis is from repetitive spinal hyperextension (hyperextension = extension of the lumbar spine beyond the anatomical limits), especially when loaded. To clarify, spinal extension occurs when we lean or bend backwards. When we get into a hyperextended position, we place increased stress through the pars interarticularis, which over time can lead to a spondylolysis.

Who is Most at Risk?

Spondylolysis occurs at a surprisingly high rate in the general population, estimated at 6-10% of the entire population having it. This rate unfortunately jumps significantly when we look at the athletic population, with studies ranging from 20% all the way up to 60% of the athletic population having spondylolysis.

Of those in the athletic population, the highest risk follows those who participate in sports where they often find themselves in a loaded and hyperextended spinal position. The big 3 sports this includes is gymnastics, weightlifting, and football (specifically lineman). With the fitness industry moving towards integration of more weightlifting movements (snatches and clean & jerks) as well as higher level gymnastic movements, we face the risk of increased rate of spondylolysis in this athletic population.

Interestingly, another population that spondylolysis is quite common in is the post-partum mama's. Unfortunately this group is often not studied as much. And with more mama's looking top participate in higher intensity strength training or weightlifting workouts following pregnancy, I would argue that they are at the highest risk of developing spondylolysis.

How do I Know if I Have a Spondylolysis?

Common reports that go along with someone who has spondylolysis include:

• The athlete’s history leading to injury is often inclusive of repetitive loading into extension, flexion, twisting, or a combination of movements

• Atraumatic, insidious onset (which means there isn't a specific event or moment you remember that started the pain)

• Focal low back pain which worsens with activity, especially lumbar extension movements

• No symptoms radiating/referring down the legs

As we mentioned there can be so many different causes of low back pain, and in many cases the diagnosis itself is of less importance for determining a plan of action than the specific impairments you present with themselves. Nevertheless, finding a health professional skilled in the diagnosis of musculoskeletal diagnoses can be ideal for ensuring you are addressing the appropriate things. In the case of spondylolysis, this is likely even more important, as additional activity modification will likely be required early on.

What Should I do if I have Spondylolysis?

If you are diagnosed with spondylolysis, at Thrive HQ, we follow a detailed and comprehensive protocol to help you return to participating in the sports or activities you love. The first phase of the rehab protocol includes a period of relative rest with a heavy focus on pain management. Additionally, the hope is to allow for the fracture to heal.

Progressing forward in the protocol, "core bracing" becomes the primary theme. This is often times surprisingly difficult for members, but is absolutely essential and is the foundation for all that is to come (watch for a future post on "How to Engage your Core" as we discuss core bracing in more depth...)!

As you begin to master core bracing we gradually and progressively begin to incorporate more and more movement, all while maintaining the new core bracing skill that you have developed.

Working with many fitness athletes, CrossFitters, and weightlifters, it is at this stage that they are often left on their own with no protocol or plan to get them back to the activities they need to do in their sports. At Thrive HQ, our protocol does NOT stop here! This is where the real fun begins and you get to progress through more functional movements that will help you safely return to your sport!

What's the Outlook?

Do not fear - Enough of the doom and gloom already, right! Our bodies our amazingly resilient and capable of healing and restoring in miraculous ways. In fact, in the case of spondylolysis, 85% of athletes report good/excellent clinical outcomes by year one, regardless of their fracture healing or not. Yes, you read that correctly... You can still have the fracture in your spine while receiving an excellent functional outcome and continuing to do the activities you love.

Interested in Having Thrive HQ Help you on Your Journey?

You don't have to be alone on this journey and we would love to help guide you back to the activities you love to do while avoiding pain meds, injections, and surgeries! Reach out to us for a free consult about your back pain at (651) 383-2626 or matt@thrive-mn.com.

Thrive On!

Dr. Matt