Stress Fractures

How Does It Occur?

The wing-shaped parts of the vertebra may become damaged from strenuous exercise. Certain athletes are at increased risk of developing this condition. It usually starts as a stress fracture and never completely heals.

Common sports that cause this injury include football, gymnastics, weight-lifting and javelin throwing.

Treatment

Most people can manage spondylolysis by:

• Resting from strenuous activity.
• Doing stretches and strengthening exercises.
• Taking pain relief medication, such as ibuprofen.

Surgery is rarely needed, although it may be considered for people who don’t respond to other treatment.

From an Athlete: Hilary Braun’s Story

I played ice hockey from age 8 to 19. It was demanding both in and out of the rink. On the ice, I was required to be very physical in a specific pushing motion that required a lot of extension, especially from my lumbar spine. Off the ice, we had intense weight-lifting regimens that involved a lot of squatting, lunging and other movements that compressed the lumbar spine.

Around age 13, I fell. I had intense pain in my lower back and had to crawl off the ice. I was unable to sit up straight without pain for several weeks, but I thought I was just experiencing severe muscle cramps.

The pain eventually subsided to a tolerable level. I saw a physical therapist and had to make changes in my daily life to manage the pain. For example, I slept with a pillow between my legs, sat with a rolled-up sweatshirt between my lower back and the chair and did back exercises.

Ever since that game, lower back pain has plagued me throughout my athletic career. I feel it with everyday motions, such as lying flat, and with movements required by sports, including ice hockey, field hockey and golf.

When I came to Stanford, I played field hockey. After my freshman year, my back pain returned in full force.

I had an MRI, X-rays and a bone scan and was finally diagnosed with inactive fractures in my L4 and L5 vertebrae. These stress fractures were not currently healing but might eventually go away with a lot of rest.

That winter, I stopped field hockey and impact activities and did a lot of physical therapy. I had small improvements but nothing remarkable.

In the summer and fall, I had two rounds of six cortisone injections in the L4/L5/SI region of my back. The injections provided an incredible amount of relief after the first four or five days that lasted for three to five weeks. However, after adding my field hockey training back into my activities, the relief dissipated rather quickly.

I’m thankful that I’ve had access to outstanding medical care thus far and hope to manage my back pain more practically and effectively when finished with my field hockey career.

Interview with Kenneth Vereschagin, M.D.

What causes lower lumbar spinal fractures?

Some people think that it has mostly to do with posture, while others blame early specialization in sports for the higher incidence of these fractures. Frankly, it’s a combination of both.

Spinal bones have discs between them that allow your back to move forward, bend backward and twist. Another part of the spine that’s important for movement are the facet joints. These joints are about the size of a knuckle. They are the most common source of pain from either overuse or one hard hit.

When you’ve overused or overstressed your facet joints, they get hard and move less. If you keep overusing your joints, your body can’t adjust and compensate for the stress, which leads to spine fractures.

These fractures are most common in women and are seen a lot in female college athletes.

How are the fractures diagnosed?

The official diagnosis of spondylolysis is not very common. Back pain, however, is common. Because everyone is different, each case of back pain is treated differently.

Usually an X-ray comes back normal. In these common cases, the back pain is probably mechanical. This means that it’s not a disease but can be fixed with changes in posture.

If pain persists, a bone scan or an MRI may be done to see whether there are fractures in spine.

What is the common treatment?

Typically, back pain is treated with decreased activity, ibuprofen and ice. But if you have fractures, you’ll need to:

• Stop playing your sport or modify your activity while you recover.
• Change your anatomy and posture so that when you start playing your sport again, there’s less stress on your lower back.

One way to change your posture and to protect your back is to have stronger abs, which allow you to have a flatter back. In addition, ice and physical therapy can reduce facet joint stress and damage from overuse.

How can these fractures be prevented?

Three main aspects of fitness can help protect your back from damage:

• Flexibility – Flexible joints around your back will prevent your back from having to compensate when you move. Stretching hamstrings and hip flexors is especially important.
• Good posture – Strong abs allow you to maintain a neutral spine and offloads stress from the facet joints onto other discs, decreasing fracture risk.
• Good body mechanics – Learning how to move correctly and protect your back in your sport is crucial to avoiding these injuries.

Last reviewed: August 2019