Spondylolysis (stress fracture) Injury Explained

A Stress fracture or Spondylolysis occurs due to over use of the lower back. Spondylolysis happens when a crack forms in the bony ring on the back of the spinal column. Most commonly, this occurs in the lower back. In this condition, the bone that protects the spinal cord fractures as a result of excessive or repeated strain. The area affected is called the pars interarticularis, so doctors sometimes refer to this condition as a pars defect. Rugby players are at risk of this condition due to the amount of stress that is placed on the lower back during a game.

Spondylolysis is a stress fracture of the narrow bridge between the upper and lower pars interarticularis. It can occur on one side (unilateral) or both sides (bilateral) and at any level of the spine, but most often at the lower lumbar levels L4-L5 or L5-S1.

Computed tomography (a CT scan) may be ordered. This is a detailed X-ray that lets doctors see slices of the body's tissue. The image can show if the edges of the fractured bone have begun growing together. The scan shows whether the fracture is new or old, so doctors can decide which treatments will help the most.

When more information is needed, your doctor may order a magnetic resonance imaging (MRI) scan. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It can help in the diagnosis of spondylolysis. It can also provide information about the health of nearby inter vertebral discs and other soft tissues that don't appear on X-rays.

Spondylolysis Signs & Symptoms

Younger rugby players may be at a higher risk of developing this condition. Lower back pain may be severe, slight, or entirely absent. It is often well localized in the lumbosacral joint region but may radiate down one or both legs along the course of the sciatic nerves and especially into the distribution of the peroneal nerves. There is often complaint of stiffness of the back and all of the symptoms become worse with exercise and subside with rest.

Spondylolysis Treatment

When moderate symptoms are present, immobilization of the spine in a flexed position - by means of a rigid back brace from the lower part of the thighs to above the costal margins - will relieve most of the acute pain. The cast should be followed by a back brace. In the milder cases a back support, together with exercises to decrease pelvic tilt and lumbar lordosis may be adequate treatment. The majority of cases of spondylolisthesis can be treated by conservative means of this type.

• 6-8 weeks complete rest is usually enough . Rugby should be curtailed for 3-4 months to allow time for healing.
• After the initial acute stage (6-8 weeks) a swiss ball can be used to build strength
• Pool running and water exercise using a buoyancy aid will develop the lower back muscular strength.

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• After 4 months, healing is again assessed, this time by means of an exam and a CT scan. Here doctors are looking to see if and how well the bone at the pars has healed. If the test results show a bony union of the pars, and/or if the athlete is pain-free, the athlete is then allowed to fully return to rugby. She or he can also start gradually letting go of the brace.

Most patients with spondylolysis do not require surgery. When symptoms are not relieved with non surgical treatments, however, patients may require surgery. The main types of surgery for spondylolysis include:

• Laminectomy- A section of the bony ring is removed to take pressure off the nerve which may be compressed causing pain.
• Posterior lumbar fusion - A spinal fusion allows two or more bones to grow together, or fuse, into one solid bone. A fusion is usually only recommended when a spinal segment (a set of vertebrae) has become too loose or unstable

Spondylolysis Prevention

Although spondylolysis might not be preventable, there are steps you can take to reduce the risk of fractures. Seek medical attention if you suffer a back injury or have significant low-back pain. Early treatment of spondylolysis often results in the best outcomes. Keeping your back and abdominal muscles strong can help support the lower back and prevent future stress fractures. Focusing on core stability exercises will help strengthen the back and prevent stress fractures of the lower back. If you have spondylolysis, it is important to choose activities and sports that do not place your lower back at risk for injury. Swimming and biking are possible options.

Try and practice your rugby on grass and not Astroturf as grass has some give which reduces the force through the spine. Try and avoid over training and the intensity of training sessions should be increased gradually.

Good posture must also be observed. Slouching prevents the back muscles from effectively preventing back injuries. Also, sitting in front of the computer for extended periods of time must also be avoided. In such an instance, the person must take regular breaks. The use of a seating support is highly recommended.

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