It seems to be happening more and more these days. I’m talking about young athletes who are suffering from back stress fractures.

We’ve received multiple referrals from local clinicians in the last year to help athletes with their rehabilitation process after being diagnosed with a stress fracture in their lower back. I’m feeling pretty sure these numbers are rising yearly, but I have yet to find actual research on this.

When I’ve spoken with physical therapists on this, they’ve let me know that part of the issue is the coding therapists use for insurance purposes. In some cases, clinicians will code the condition as a stress fracture while others code it as low back pain. Regardless, I don’t see this upward trend in what we’re seeing changing any time soon.

Pars Fractures / Spondylolysis

When I talk about young athletes coming in with stress fractures in their back, I’m referring to a Pars fracture or spondylolyis. This is a fracture of the pars interarticularis, also known as a pars fracture or spondylolysis. The pars interarticularis is a part of the vertebra that is located between the articular processes of the facet joint.

Back Stress Fractures

This type of stress fracture usually occurs during adolescence. The pars bone is very thin and weak and during periods of rapid growth, thus is more susceptible to injury during adolescence.

Common Causes of Back Stress Fractures

Back stress fractures are usually multi-factorial and there are several things that contribute to this condition. Rapid training volume increases & repetitive movements are the most likely culprits of back stress fractures.

That’s right, the same movements {running, sprinting, jumping etc.} that can get an athlete most prepared to thrive in a sport can also contribute to a young athletes developing stress fractures in their back. In most cases, it’s repetitive hyperextension of the lumbar spine that actually causes the damage to the pars interarticularis.

It’s imperative that once a pars fracture is diagnosed, the client/patient avoids lumbar hyper extension until the fracture heals. The key is to avoid the mechanism of injury. For best results, the treatment and rehab process should be determined by a physical therapist in combination with a strength coach.

Two Example Athletes with Back Stress Fractures

Here are two scenarios we’ve actually seen here at the gym.

Scenario #1: The Soccer Player

A youth athlete was looking to improve his “sports specific conditioning” so he signed up for a conditioning camp. The camp included lots of time playing soccer combined with a tough conditioning program. The coaches of this particular camp are notorious for “crushing ” their athletes with conditioning programs that include various plyometric jumps, burpees and hours on end of of sprinting.

This young athlete had zero background in strength training or jumping, but he wants to keep up. Oh, and keep in mind, his team hadn’t been conditioning much either so he was not in the best shape.

After a couple weeks of, let’s call it, surviving, the young athlete noticed some lower back pain during a sprint. He pushed through because who wants to quit? Eventually, the pain became too much to bare and he saw a physician. He was referred to a specialist for imaging and was diagnosed with a stress fracture in his back.

Here’s what likely happened:

  • Lack of proper mechanics/training. Despite all of the jumping and sprinting drills the team performed, the young athlete was never taught how to properly jump and land. In addition to that, he was never taught about spine positioning or basic mechanics.
  • Repetitive stress and lumber hyperextension. When he performed burpee’s, every repetition jammed his lumbar spine into hyperextension, slowly damaging the vertebrae through repetitive stress.
  • Poor pelvic and lumbar control. When he was sprinting, he had poor pelvic and lumbar control. Essentially, there was no stability in his lumbo pelvic region and the repetitive stress to the spine paired with poor force absorption irritated the back.

When you combine these poor movement patterns with someone who is not accustomed to this type of volume,  it’s not all that shocking that the result was a stress fracture in his back.

Let’s say he trained 2 to 4 hours a week most of the time. During these camps, the total training volume was drastically increased to something like 12 to 16 hours a week. That is four times the workload without any smart and adequate progression leading up to it.

A rapid increase in exercise paired with poor mechanics is a recipe for low back injuries. Click To Tweet

Here’s my advice. If your young athlete decides to attend any type of camp like this, reach out to the coach and ask to see the outline of the program. Don’t worry, you don’t have to be the crazy, neurotic parent, but arming yourself with some basic information about the camp never hurts.

Causes of Back Stress Fractures

Scenario #2: The Inexperienced Runner

A young athlete decided to give cross-country a try one fall. This specific athlete is 90 pounds soaking wet, hyper mobile and a heel striker.

After some research on Google University, this girl dove into a running program. She knew it was a running program designed for collegiate athletes, but it seemed okay.

After a few weeks, this poor young athlete started to develop lower back pain on the right side of her back. As the mileage increased, so did the pain. After her initial visit to her general practitioner, she was referred out to a spine specialist and the MRI confirmed a pars fracture.

Here’s what likely happened:

  • Too Much Stretching. To start, hypermobile athletes do not need stretching. It will actually make their condition worse. Runners are supposed to stretch (right?), so this young athlete did all of the stretching drills after searching for (stretches for running)
  • Too Little Stability. So now we have a hypermobile athlete creating more laxity in the joints and ligaments that desperately need stability. Now, don’t get me wrong, I don’t have any issues with stretching but young, hypermobile athletes need strength training and stability work far more than a generic, ineffective stretching routine.
  • Lack of Individualized Programming. Pair this with a generic cross country running program and things aren’t looking great.
  • Poor Running Mechanics. We also need to look at how young athletes run. Running is a skill, but rarely gets treated that way. One of the biggest mistakes I see with running, is a heel strike. This is far from optimal and can potentially have negative benefits down. I’m not going to dive into running mechanics in this blog but imagine jumping rope and landing on your heels instead of your midfoot. Yes, it would hurt and eventually your lower back will lay the price.

How Can You Avoid a Stress Fracture?

  • Implement strength training at an early age. I’m not saying you should be putting a barbell on the 10-year-olds back, but teaching them about the basics of squatting, lunging and deadlifting will go along way.
  • Don’t specialize too early. Listen, I understand your nine-year-old is going to be the best soccer player in the world, but from a developmental standpoint, please have them play various sports where they can develop different skill sets, practice and learn various movement patterns, and enjoy playing other sports.
  • Avoid sudden increases in training volume. This seems like common sense, but is probably the biggest culprit when it to comes to stress fractures. If you decide to play in tournaments, camps and other intensive athletic events, gradually increase volume and don’t go from 0 to 60. You don’t need to play six games on the weekend when you haven’t trained in the last 3 months at all. Here’s a question I always ask my young athletes to put things into perspective.“Are you a professional athlete and are you currently getting paid to the play sports?”… you know the answer.
  • Stop cramming! I see this all the time. Parents frantically reaching out to coaches to prepare their kids for preseason when they’ve got three weeks before tryouts. Their young athlete has done nothing but hang out at the beach all summer and now realized it’s time to get serious a few weeks before tryouts. Cramming doesn’t work and can often lead to injuries. If you’re going to play a sport in the fall, start training in the winter or spring.
    Related: 8 Weeks Until Fall
  • Clean up glaring asymmetries and imbalances. If you move like absolute rubbish, compensations will occur and can have a negative impact on the musculoskeletal system. I highly recommend working with a strength and conditioning coach or physical therapist who specializes in the FMS or SFMA.
    For more information, check out Function Movement Screen.

I believe the majority of back stress fractures are avoidable with proper training, planning and some good all around common sense.

Avoiding Back Stress Fractures

Train smart, surround yourself with good coaches and hopefully you will enjoy a healthy athletic career!