Recent research has shown that stress fractures in the lower backs of athletic children are much more common than we used to think and are often missed by X-rays.
In some children, repetitive spinal stress in sport can lead to a gradual fracture of the bony arch of the vertebrae in their low back. This condition, called spondylo-lysis, is very often undetected, untreated and the fracture remains unhealed for the rest of their lives. This can result in instability, recurring back pain and slippage of the vertebra. (see diagrams)
These stress fractures occur only in children. Usually the problem isn’t discovered until adulthood when X-rays eventually reveal that something occurred when they were younger. The question has often been asked, “Why are we missing them in children?”
How common are spinal stress fractures in children?
A study in 2012 in the American Journal of Sports Medicine studied 200 young athletes (aged 12-16) who were experiencing lower back pain while playing their sport. X-rays were normal (did not show fracture) for 94% of the children. When MRI was performed on the same group of children, 48.5% were shown to have active stress fractures occurring in their spine.
Almost HALF of the children who went to the clinic complaining of back pain while participating in sport were shown to have the beginnings of stress fractures in their spines which were not detected by X-ray!
The types of sports which have been associated with spinal stress fractures vary widely to include baseball, soccer, basketball, football, hockey, track and field, tennis, volleyball, gymnastics, swimming to name a few. These injuries can heal if they are detected and managed early but it is not clear at what point the damage is irreversible.
The key messages are:
- Spinal stress fractures are a common cause of low back pain in children.
- Low back pain in a young athlete should not be ignored! Don’t “play through it”.
- Early treatment and rest is crucial to increase chance of healing.
- X-rays do not reliably rule-out early stress fractures.
What should you do if your child has back pain during sports?
If your child is experiencing back pain while playing their sport, bring them to one of our MSK clinics to be assessed by a physiotherapist or chiropractor. A history and physical exam will help to determine whether they have contributing mechanical and muscular problems which need to be treated.
An X-ray may be ordered. We can assist in obtaining an MRI to screen for active stress fracture in those children for whom it is indicated.
Depending on the imaging results, we can help communicate with your family physician and guide you and your child through an appropriate period of rest, rehabilitation and gradual, safe return to sport.