Understanding Lumbar Stress Fractures

Lumbar stress fractures can occur when the demands placed upon the lumbar spine are greater than its ability to recover and generate healthy bone tissue. There is typically a gradual onset of overload before fracture occurs. The fracture can occur on one or both sides of the vertebra. In the image above, you can see that on the oblique x-ray, a ‘scotty dog’ can be seen. Note the NECK of ‘Scotty’. The top two ‘Scotty’s’ have a normal neck. The bottom Scotty has a collar (black line), displaying a complete stress fracture. This is the fracture of the ‘pars interarticularis,’ an aspect of the vertebra which goes towards creating the vertebral foramen (the hole through which the spinal cord passes).
These stress fractures are often associated with sports involving repetitive lumbar extension and rotation, such as cricket, athletic field events and gymnastics. Adolescents involved in these kinds of sports appear to be the main demographic this injury is diagnosed in.The early phase of the injury involves inflammation around the bone. As the demands on the spine continue to exceed the capacity for recovery, a ‘stress reaction’ may progress, before an actual fracture occurs. If the fracture occurs on both sides of the foramen (hole), then forward slippage of one vertebra on another may gradually occur in the coming months and years. The good news is that these fractures can be managed with education and optimised loading through exercise and possible bio-mechanical alterations. They can sometimes be symptom free, and may have a capacity to heal non-surgically if diagnosed early and managed well. Surgery for this fracture is typically not indicated, especially in the earlier phases. However, it may be indicated in chronic and severe circumstances. Please listen to back pain. This is more of an intense example and there may be several causes of lumbar symptoms, but there is usually a diagnosis of some kind or another and a management plan from your trusted clinician / physician. Children and adolescent bodies are growing so quickly. They require frequent rest and moderated changes to their exercise loads / volumes over time. A properly prescribed strength and motor control program may reduce the risk of injury across a range of sports. Please reach out to discuss any adolescent back pain.
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