Spondylolysis

Spondylolysis

Hereditary and Acquired Back Pain

Spondylolysis is basically a fracture in one of the vertebra of the lower back. Most commonly, it is seen in the 4th or 5th lumbar vertebra. Clinically it is defined as a defect in the pars interarticularis of a vertebra. The pars is a narrow strip of bone that connects the facet to the vertebral body. The facet is the area of articulation (joint) between two vertebra. In the picture above, the shaded area resembles a Scotty dog. It is in the area of the dog’s collar that the fracture occurs. When the fracture is present it allows the vertebra above to slip forward on the vertebra below. This results in a condition called spondylolisthesis.

Spondylolisthesis can be a potentially dangerous condition. It is imperative for the physician treating the athlete to determine if there is vertebral slippage as well as how far it has slipped.

If the bones slip too far spinal nerve compression can occur. If the athlete is exhibiting pain radiating down the leg, leg weakness, or loss of sensation in the leg, it is a medical emergency. This represents spinal nerve compression. If the compression continues unchecked, permanent nerve damage can occur.

Causes

Both spondylolysis and spondylolisthesis are most common in football linemen and gymnasts. These two sports involve weight-loading, rotation, and hyperextension (back-arching). These actions are an integral part of sport-specific activities for these two sports as well as divers, weight lifters, wrestlers, and some track & field athletes. Many back specialists believe that this condition is hereditary. Research has shown that more than 50% of these “fractures” are actually genetic abnormalities.

Symptoms

Generally, the athlete will have pain across the low back that may radiate down to the buttocks. The paraspinal muscles will be in spasm, giving a flat appearance to the normally curved lower back. This is mechanical pain. Mechanical pain is due to the actual injury, bony fracture and the related muscle spasms.

Compressive pain can be characterized as radiating. Any pain due to spinal nerve compression will present itself as pain that radiates down the leg. This may be electrical in nature. It may also present itself as numbness or heaviness in the leg. This pain necessitates medical intervention.

Asymptomatic athletes may participate fully in athletics. Activities should be restricted if pain is present, especially if the activity requires extension and hyperextension of the spine. These activities will cause the slippage of the vertebra to become more pronounced. Asymptomatic athletes may have grade 1 (25%) slippage and should be able to participate fully in athletics. Symptomatic athletes who have grade 1 spondylolisthesis should be restricted from vigorous activities until pain and muscle spasm subside. Athletes with grade 2 (50% slippage) or higher should avoid high-risk sports. Other grades of slippage that preclude athletic participation are grade 3 (75% slippage) and grade 4 (100% slippage).

Treatment

Initially, the athlete should be removed from athletic activities. The physician will probably prescribe muscle relaxants and anti-inflammatory medications. A corset or back brace may be used to alleviate symptoms as well.

Rehabilitation exercises should also be instituted. These should include flexibility exercises to stretch the paraspinal muscles that are in spasm, hamstrings, and gluteals.

Exercises to strengthen the back and abdominal muscles should also be performed. This is necessary to restore the spine to its proper neutral position.

General Back Rehabilitation Sheet In PDF Format

Your personal physician should be consulted to determine which exercises are applicable for your particular condition.

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM