I see a lot of athletic teens, and while many of them participate in several sports more and more tweens and teens are “specializing” in one sport. In other words, they may only play soccer or basketball, or be a gymnast or a dancer. In some cases they practice or compete almost 365 days a year. (I think they often are only off on the 6 holidays/year that our office is closed!). They too work really hard.
I have recently had more than a handful of elite athletes, especially girls who are gymnasts, cheerleaders and dancers, who have come to me complaining of back pain. In most cases lower back pain is musculoskeletal in nature and will resolve with some anti-inflammatories (like ibuprofen), alternating ice and heat to the back and a few days of rest. But in some cases the back pain worsens, especially with activity and further work up is required.
In several cases the ongoing back pain is due to a spondylolysis, which is a fracture of the pars interarticularis of the vertebrae. It is akin to a stress fracture in other areas. It is most commonly found in the pediatric population and is thought to be due to mechanical stress of the trunk with repetitive flexion, hyperextension and trunk rotation. All of those maneuvers are the “usual” for a cheerleader doing back flips or a gymnast doing exercises with hyperextension. Athletes who are into weight lifting (seems they all do this now) and even children who carry heavy backpacks may be at risk for a “spondy”.
The spondylolysis may show up on a plain X-ray of the back or may require a CT scan to see the fracture.
In our community there is some difference of opinion on how best to treat the condition. Unfortunately, it seems that the best treatment is rest which may be for weeks-months. This is NOT what they competitive gymnast or star football player wants to hear.
Once the pain has resolved a structured physical therapy program seems to be of benefit as well. If conservative management for over a year does not help some orthopedists would recommend surgery. Again, there are several different views as to the benefits of surgery in this age group.
But if your child has persistent lower back pain that worsens with activity and hyperextension you should think about this condition and talk to your doctor. It is becoming more prevalent as our kids compete at higher and higher levels.