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).
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.12 thoughts on “Lower Back Stress Reaction/Stress Fracture Treatment ”
Hi Dennis, yes it is safe but I would recommend 20-30 minute intervals to allow a change of posture. Prolonged postures often cause pain and stiffness. Always use pain/discomfort as a guide and assess pain levels after the many exercise to guage the reaction to the exercise. If the pain is worse a few hours later or the next day, that is a sign of overload.
My 16 year old son was diagnosed with a dress fracture on the Left side of his L3 in August of 2021. He was placed on rest and later a back brace. He wore the brace for 8 was. Still had pain and we sent to another orthopedic doctor. He did a CT and started PT. The pain is still there. They did another MRI in January. 6 months after the first and initial diagnosis. The second MRI was with contrast and came back good. No fracture or other alarming deformities. Why is he still having pain in the same spot? NSAIDS don’t not and have never eased the pain. Ice or heat stretching PT. Nothing has helped. Any suggestions to ask the doctor would be great. He just wants to be able to play baseball and not hurt. Thank you.
My son soccer player he’s playing u16 and he’s got lower back stress fracture 12mm ( MRI result )
It’s been under treatment with out physio area for 5 weeks now but he feels no pain .
At the beginning he couldn’t move he’s right leg forward too much but now he can
When do u think he can go back to play ( very important stage of games now )
Hi Tracy We would usually recommend 6-12 weeks of rehabilitation before return to sport. Unfortunately I can’t be more specific than that without assessing your son. I’m sure your physio will be doing everything they can to get him back safely and as soon as possible. It really is t worth rushing back to soon as that could cause a delay in the bone healing.
Sorry Evin, not Tracy!
15 year old daughter has a stress reaction at T12/L1 she is a high level basketball and soccer player and has been wearing a brace for 2 weeks – is there any movement/excercises she can do to keep ball skills up? was thinking she could lay on her back on floor and toss ball up in the air
We would usually recommend 6-12 weeks of rehabilitation before return to sport. Unfortunately I can’t be more specific than that without assessing your son. I’m sure your physio will be doing everything they can to get him back safely and as soon as possible. It really is t worth rushing back to soon as that could cause a delay in the bone healing.
My daughter was diagnose with a stress reaction on the L5. she is taking a month off of sports> can she still do the elpital to stay in shape??
What are your thoughts on the use of the BOB (Boston brace) overkill or on point for a L4 fracture?
My son has just been diagnosed with a stress reaction of the L5 lumber. He is 15yrs old and plays a lot of sport. He hasnt had his full growth spurt yet. Is this something that could impact his growth?
My son had a stress reaction in L4. He took full 12+ weeks off. Was cleared with no pain for all activity. Pain has since come and gone. Sometimes the paninis sharp but relatively quickly the pain subsides, even when hyperextending, bending, jumping. Is it possible the stress reaction returned? What is the probability this is muscular related? We were never told about manual therapy but started a week ago.
Is it safe for a 14 year old boy to ride a stationary bike after being diagnosed with a back stress fracture.