Spondylolysis, a stress fracture of the pars interarticularis, is a common cause of low back pain (LBP) in athletes and is the most common cause of athletic LBP in adolescents (Standaert and Herring, 2000; Standaert et al., 2000). Athletes who participate in sports involving repeated and forceful hyperextension of the spine (e.g., gymnastics, American football) are more likely to develop spondylolysis from the cumulative effect of repetitive loading of the bone imposed by physical activity. Athletes generally have an insidious history of increasing focal back pain reproduced by lumbar extension.

Spondylolysis can be identified by plain radiography in approximately 5% of the general population, but the vast majority of these lesions occur without associated symptoms. Identification of spondylolysis on radiographs in an athlete with LBP must be correlated with the clinical presentation and advanced imaging. Single-photon emission computed tomography (SPECT), high-resolution (thin-slice) computed tomography (HRCT), and MRI are helpful to determine the metabolic activity of the stress fracture, the acuity of the lesion, and potential for fracture healing, and to exclude other spinal pathology that may be present.

Conservative treatment is usually successful in controlling symptoms and restoring function. Treatment requires activity restriction and temporary discontinuation of the aggravating sport or activity. Some patients may require lum-bosacral bracing to achieve treatment goals, and only a small percentage of patients require surgical intervention for pain or progressive spondylolisthesis (Standaert and Herring, 2000; Standaert et al., 2000).

Back Pain Relief

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