Improper exercise regimes may lead to spinal stress fractures
By: Dr Arvind G Kulkarni
Rise in sports injury called Spondylolysis or commonly known as Stress Fracture have raised a need for awareness around the subject with its available treatment modules as well as the risks and prevention methods. Spondylolysis happens due to excessive or repeated stress on the lower back spine area which leads to weakness in one of the vertebrae, the small bones that make up the spinal column.
What is Spondylolysis?
Spondylolysis refers to a crack or stress fracture developed through the pars interarticularis (pars fracture). The weakest point of the vertebra is called Pars Interarticularis which is a small, thin portion of the vertebra to provide stability and connect the upper as well as lower facet joints. The pars interarticularis is the most vulnerable area to injury from repetitive stress and overuse because of its sensitivity. The fracture is known to occur in the fifth vertebrae of the lumbar spine, while it can also occur in the fourth vertebrae due to extreme levels of stress. Fractures can occur on one or both sides of the bone.
Causes of Spondylolysis
The condition is likely to affect younger people who participate in sports and have a higher level of physical activity than usual. Sometimes sports like gymnastics, football, weightlifting and even cricket requires frequent overstretching (hyperextension) of the lumbar spine and overtime repetition of such activities can weaken the pars interarticularis, leading to a fracture and/or slippage of the vertebra. Another cause of stress fracture is genetics. In some cases, children, adolescents and adults who walk upright have a risk of developing stress weakness while reports stating that some people can be born with vertebral bone thinner than normal making them much more vulnerable to stress fractures.
Symptoms of Spondylolysis
While some patients can experience mild to moderate symptoms, some may not discover the stress fracture until an X-ray is taken. But when the symptoms do occur, the most common symptom is pain in the lower back which feels similar to a muscle strain or radiate to the buttocks or back of the thighs and improving with rest and worsening with activity. Some severe symptoms include back stiffness along with tight hamstrings (muscles on the back side of the thighs) and difficulty in standing up or walking.
Preventative methods for Spondylolysis
As the saying goes “prevention is better than cure”, it is better to make smaller changes in one’s life to prevent stress fractures. Make smaller changes like starting a new exercise program and gradually increasing the amount of exercise you get every week rather than going straight for heavy lifting. Using proper footwear which supports the lower back can help prevent excessive stress on the lower back. Keeping the bones strong with a nutrient rich diet including enough calcium, vitamin D and other nutrients is proven to be one of the best forms of preventative methods.
Treatment for Spondylolysis
With a thorough diagnosis with the help of CT Scans and X-rays, the treatment goal is to reduce pain, allow the pars fracture to heal and return the patient to sports and other daily activities. While Non-surgical forms of treatment include rest, Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy and bracing, severe cases of Spondylolysis known as spondylolisthesis are treated through surgery. Patients with severe or high-grade slippage or slippage that is progressively worsening and back pain not having improved even after nonsurgical treatment require surgical treatment in the form of Spinal fusion between the fifth lumbar vertebra and sacrum.
Advanced treatment modules available have made the surgeries for stress fractures easier, minimally invasive with better results and less pain bearing for the patients.
(The author is consultant Spine Surgeon at Mumbai Spine Scoliosis & Disc Replacement Centre Bombay Hospital, Mumbai)