Lower Back Stress Reaction / Stress Fracture Treatment
What is Lumbar Stress Reaction / Stress Fracture?
Lumbar stress reaction or stress fracture is a condition we see regularly at Newcastle Physiotherapy. It occurs most commonly in adolescent athletes 12-19 year olds when starting a new sport, changing surface or when increasing frequency, intensity or duration of sporting activity. It often corresponds with a growth spurt. Medically it is known as spondylolysis affecting the pars interarticularis of the spine and most commonly occurs at L4 and L5 levels.
Where are stress reactions / fractures located?
How is Lumbar Stress reaction / Stress Fracture caused?
Stress reaction starts when bone micro failure occurs through repetitive load and inadequate recovery. This causes bone recovery to lag behind natural bone breakdown which occurs during activity. This leads to a stress reaction. If this process continues the stress reaction can progress to a stress fracture and may lead to a vertebral slippage (spondylolisthesis).
Bone stress Reaction Continuum
What are the Symptoms?
Symptoms usually occur gradually, manifesting as dull lower back pain and may have some pain radiating to the buttock region. Spinal movements including leaning backwards (hyperextension) and rotation of the spine usually increase pain which are movements common to many sports such as cricket, gymnastics, football and tennis. Pain can intensify during activity often becoming sharp then easing with rest.
How do we treat reaction / stress fracture?
Physiotherapy has been highlighted to be an effective treatment for lower back stress reaction / fracture. Treatment aims to reduce pain, restore range of movement, develop core stability and functional strength.
Therefore, we utilise a combination of the following treatment methods:
- Initial period of rest to offload structures which varies for severity and sporting type.
- Bracing / Taping to limit lower back extension and offload the painful structures.
- Manual therapy to improve soft tissue flexibility for example hip flexors/hamstrings and spinal mobility of the mid back aiming to reduce stiffness.
- Exercise rehabilitation including range of motion, flexibility, core stability, strength and kinetic chain control training.
- Cardiovascular exercise using an individualised gradual progressive return to play programme including aerobic conditioning and functional sports specific rehabilitation.
- Advice on pain management, sporting technique, and posture.
It must be noted that treatment duration will vary for different sports and severity of injury to prevent overload. Usually athletes will return to sport between 4-6 months but may be longer in more severe cases.
If you feel your child may have lumbar stress reaction / fracture and would like one of our Chartered Physiotherapists to help you please call us or use the button below.