Back Pain Hitting Younger Athletes

New York Post—July 3, 2007

Most people associate the term "stress fracture" with injuries that involve the foot, ankle and lower legs. But sports medicine specialists around the country are seeing an increase in stress fractures involving other areas—specifically the spine and low back.

Low back pain is a common complaint among athletes. Causes range from a strain or "overuse" of the muscles to a more ominous condition such as a herniated disc.

"What has emerged in much greater numbers recently is pain in the low back of our younger athletes in high school and college, especially in sports like baseball, tennis and gymnastics," says Brian Halpern, MD, a sports medicine specialist at Hospital for Special Surgery in New York City. "These activities generate tremendous rotational forces around areas in the lumbar spine, often resulting in overload of these structures."

This increased structural stress leads to a stress fracture in the spine called a spondylolysis.

Dr. Halpern notes that pain resulting from the spine stress fracture can be acute or chronic in nature. Yet "some athletes will often try to play through the pain, and this often leads to prolonged healing time and disability."

The diagnosis of this condition is difficult and often needs more precise imaging than X-rays to identify the problem. Bone scans and MRI are the best imaging modalities to identify stress fractures of the spine. In addition, the MRI can also distinguish a herniated disc from a stress fracture, thereby using one study to rule out all possibilities.

Treatment of these lesions is not always easy. "Relative rest can be effective, but sometimes bracing is indicated and proper rehabilitation is always important," Dr. Halpern says.

Preemptively, know that most sports injuries can be avoided with the proper stretching and strengthening regimen.

And if identified at an early stage, spondylolysis need not be a major concern for future disability, as these spinal stress fractures generally heal without any great consequence.

The author of this piece, Rock Positano, DPM, M.Sc., MPH, is the director of the Non-surgical Foot and Ankle Service at Hospital for Special Surgery in New York. His column appears every Tuesday in the New York Post.