Key Points:
- Stress fractures in the low back (lumbar spine) are injuries that can result in months off from sport and in some instances can lead to withdrawal from the sport
- Many types of low back pain can be managed early on, before anything serious happens
- Seek qualified medical care for pain that doesn?t improve after a few days of rest and simple treatment, or for pain that is affecting performance
One of the high schools where I?m team physician appears to be having a mini- epidemic 
of low back (lumbar spine) stress fractures. We were going through our fall season injury stats with our athletic trainers this week, and I was surprised to see that low back pain was now the third most common main complaint of the athletes we saw in the training room, and an alarming number of those young athletes turned out to have stress fractures of the lumbar spine.
Stress fractures of the lumbar spine, and stress fractures anywhere in the body are reportedly uncommon. A study published in 2014 by Changstrom and colleagues found that in the high school athlete population, stress fractures accounted for only 0.8% of reported injuries across 8 seasons.
When I first started my orthopedic practice in the early 1990s I?d have to say I didn?t think too much about stress fractures. We simply weren?t trained to put it near the top of our thought processes when evaluating young athletes with pain. Then a series of studies principally focused on military recruits started to raise our suspicions. Furthermore, improved understanding of the role of low bone mineral density, low energy availability, the female athlete triad, and the prevalence of overuse injuries in young athletes has heightened the team physician?s awareness even further.
The result of all those years of improved knowledge means that as an orthopedic team physician I?m much more aware of the possibility of a stress fracture. In the low back I?ve become much more attuned to some signs that would indicate the need for proper imaging studies. A sudden start of pain, possibly associated with a ?pop? is a red flag. Pain that doesn?t improve in spite of several days of rest is another red flag. Localized tenderness on one side of the spine can be a sign of an underlying stress fracture. And a young athlete who feels she/he simply can?t play is a big red flag.
Still in spite of improved awareness I have the feeling we?re not doing enough in the earliest phases of the problem. A stress fracture is one of those classically preventable problems, where rest and treatment early on might result in a short time off from play, but playing through and then treating at the stress fracture phase can result in months off from play, and sometimes withdrawal from the sport. For me it means that our trainers, physicians, and strength coaches are going to have a very close look at all athletes with low back pain and be very cautious about return to play. We may end up sitting more kids out early but I?d rather do that than lose them for months.
If you?re a parent of a young athlete with low back pain I?d urge a cautious approach for you too. If you hear complaints of low back pain from your son or daughter, if it lasts more than a few days, or if it?s affecting their play I?d strongly recommend early evaluation from a qualified physician. Don?t let this injury become a game-ender.
Click here for full podcast playlist.
