Understanding Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. This low back injury is typically found unilateral and if it becomes bilateral, it can easily progress into spondylolysthesis, characterized as having bilateral fractures and a forward “slippage” of the body of the vertebral spine.  An injury to the pars interarticularis is often referred to as a pars defect.

Young athletes participating in sports which involve contact, backward bending and aggressive rotation such as football, wrestling, martial arts and gymnasts are more succesptable to suffering this type of a back injury.  A comprehensive history is needed to determine if past activities contributed to the current low back pain. Obtaining lumbar spine x-ray, CT scans or even MRI may be required to confirm the diagnosis.

Signs & Symptoms of Spondylolysis

  • Pain and stiffness located at the center of the lower back.
  • An increase in symptoms with backwards bending or lumbar extension.
  • Patient notices an increase in symptoms with an increase in activities and an decrease in symptoms with rest.
  • With more severe cases of spondylolysis, the patients can experience pain radiating down one or both legs which is referred to as neurogenic pain.
  • A localized ache or stabbing pain involving the central low back region following prolonged standing or sitting.
  • If nerves are involved, there may be a decrease in lower extremity reflexes and/or the sensation of pins and needles in the low back, hips or legs.

Professional Treatment for Spondylolysis

Treatment of symptoms from these stress fractures are often accomplished in 3 general steps.  Initially, the low back is “quieted down” followed by efforts to improve both the core strength and core flexibility and lastly, returning to normal activities with a comprehensive education of the “Do’s and Don’t’s” to avoid any setbacks.

  • Implement an aggressive flexibility plan focusing on the low back, hamstrings, quads, groins and hip flexors.
  • Using a low back brace if needed to stabilize the lower back and pelvis during functional activities.
  • Initiate a progressive core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid excessive lumbar extension.
  • Continue to apply ice to the entire low back while resting on a firm surface with a pillow under your abdomen.  Only when the main symptom is “stiffness” should heat  be used.  The heating can be utilized via a hot tub, heating pad or hot packs.
  • Postural training to promote a painfree posture involving the pelvis, low back, upper back, shoulders, neck and head.  All of these areas have a direct impact to the lumbar spine and the pars defect.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Avoid all activities and positions that promote hyper-extension of the lower lumbar spine.  This “sway back” or lordotic curve is normal and necessary but when it becomes excessive and the pelvis rolls too far forward, that’s when spondylolysis becomes painful.
  • Slowly progress with low back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises.
  • In extreme cases where non-surgical treatments becomes ineffective, a surgical laminectomy or posterior lumbar fusion is considered.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. How bad is my back injury and do I have spondylolysis or spondylolysthesis?
  2. Can you show me the “Scotty Dog” view on my x-ray?  This is a key view on an x-ray of the lumbar spine used to confirm the diagnosis for and the difference between spondylolysis and spondylolysthesis.
  3. How can I alleviate the pain I’m currently experiencing without causing further injury to my back?
  4. What activities and exercises do I need to avoid while I rehab my back to significantly improve my back function?

Elite Sports Medicine Tips from Mike Ryan

  • Stick to the Plan – Your specific physical therapy program is individually planned for you. The program may take weeks or months but stick to the plan to ensure an optimum recovery.
  • Balance is the Best –  Your goal is to attain the perfect combination between strength and flexibility of your paraspinal and abdominal muscle groups.
  • The Nasty S Word – Sitting may be easy to do but it can destroy your low back.  Learn to sitting properly and do as little of it as possible.
  • Body Mechanics is Key – As with sitting, poor body mechanics with standing and lifting will hurt your back very quickly.  Become a believer in that and you will quickly get back to an active lifestyle.
  • Become The Ab King – Flexible low back muscles with strong Abs is the winning combo with spondylo.
  • Know the Good C Curve – With standing and walking, the “C” curve of your low back has it’s opening facing backwards.  Strive to maintain the “Good C Curve” and your back will thank you.