
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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