Low back pain is common in adults. With various factors such as age, work, stress levels, sleep, exercise, and previous injuries all playing a role. However, when looking at active teenagers, low back pain shouldn’t be seen as ‘normal’. With their rapidly growing body, and immature bone density, it is important to rule out a bone stress injury, which can progress to a stress fracture.

Understanding the unique challenges

While we know approximately 90-95% of low back pain in adults can be classified as ‘non-specific’, it’s different for youth athletes – approximately 73% of low back pain in youth athletes can be classified as having a specific cause. That’s a huge difference. So while we may not diagnose and scan many backs we see in the clinic, our perspective may need to shift when assessing youth athletes with low back pain.

Other considerations for youth athletes is that their backs are a little different; their intervertebral discs are more elastic, while this may help to reduce the risk of disc injuries, it can result in more stress on the neural arch and potentially contribute to a higher risk of bone stress injuries. Interestingly, the pars interarticularis does not mature until approximately 25 years old – so our understanding of a ‘youth athlete’ needs to consider people up until this age.

Identifying bone stress injuries

It’s estimated that in extension-based sports, for adolescents who have had more than two weeks of low back pain, approximately 40% will exhibit spondylolysis on scans (1). This is a high number and needs to be in the back of our minds when managing young athletes. Spondylolysis can be considered as a spectrum of bone stress injuries from bone marrow edema to spondylolisthesis. For kids, it most commonly occurs at L5, due to the anatomy of the sacral angle and the inferior facet of L5 causing a large anterior shear on the pars. But how do we know when we are dealing with a bone stress injury, versus non-specific low back pain? The management can be quite different, and it’s often a balancing act of appropriately managing back pain while avoiding catastrophisation.

For bone stress injuries you are looking for localised, unilateral pain which is worse in extension or lateral flexion activities and eased with rest. While in non-specific low back pain, iit is more likely the patient will complain of pain aggravated with flexion-based activities or sitting, and they are more likely to have pain at rest.

Wrapping Up

Early identification of low back bone stress injuries in youth athletes can be the key to reducing time on the sidelines. Optimising your assessment and knowing what you’re looking for can put you in the best position to help your patient get back to sport as soon as possible, and continue a long career into the future.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.