January 2007

Spinal stress fractures can afflict young athletes needlessly

By Ira Dreyfuss

The Associated Press

Exercise by young athletes – especially by those who train in one sport – can cause fractures of the back, doctors say.


Spondylolysis, often-painful tiny cracks in spinal bones, may account for almost half of low back pain cases, among active teenagers who seek medical attention for their pain, according to a report in the January issue of the medical journal The Physician and Sports Medicine.


Spondylolysis is more common than doctors visits indicate, the article said teens “often cope with the condition by hoping it will just go away,” the journal reported.


In many cases, it does go away, or teens play despite the pain. But treatment can reduce the pain and possibly head off a recurrence.


Spondylolysis typically happens to young athletes who specialize early in a sport such as gymnastics which can require the athletes to bend repeatedly far backward, putting pressure on bones in the lower spine, said Dr. James Moeller, chairman of sports medicine at William Beaumont Hospital in Troy, Mich., Moeller was co-author of the journal article.


Risk of injury rises with the level of competition and time spent in a sport, Moeller said. The risk is greater in college or pro activity than in middle or high schools, he said, but young athletes who specialize early in one sport face similar dangers.


It would be better if kids varied their sports while they were young and didn’t decide on a favorite until they were in their early teens, Moeller said. This would reduce the risk of overuse injury, he said.


Young athletes also can reduce their risk by strengthening muscles in the abdomen, as well as hip flexors and other muscles that support the back, Moeller said. Typically, however, coaches prefer to focus their limited training time on muscles needed for the sport instead of on prevention of injury, he said.


“I think if they work in this prior to any problems, they might be able to avoid the problems altogether,” Moeller said.


Doctors look for the condition by having the patient bend backward. If it hurts, that’s a sign of spondylolysis. The tiny cracks also can show up on x-rays, but more sophisticated imaging may be needed to make a diagnosis, the journal article said. 


The cracks can heal in two ways – the bone fuses back together or a softer material called collagen fills in the crack.  Collagen self-repair is less stable, however and increases the possibility of a recurrence of spondylolysis, said Dr. John Sarwark, a professor of orthopedic surgery at Children’s Memorial Hospital in Chicago.