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Answer to your Health Question

Question :

I have stopped playing hockey for five weeks due to spondylolysis and I have no pain in my back.

Does this mean I can return to practice?

Also I do get shooting pains down my leg once in a while but that's because I have grade 1 spondylolisthesis.

Can I return to hockey or should I wait a little longer?

Matthew

Answer:

Dear Matthew,

The most common cause of low back pain in adolescent athletes that can be seen on X-ray is a stress fracture in one of the bones (vertebrae) that make up the spinal column.

Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects the fifth lumbar vertebra in the lower back and, much less commonly, the fourth lumbar vertebra.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).

If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

Spondylolysis is the commonest cause of spondylolisthesis, and is sometimes referred to as isthmic spondylolisthesis, since the defect is in the isthmus.

If you have spondylolisthesis (slip), care needs to be exercised.

Up to the age of 14 or 15, the risk of further slip is the highest and regular follow-up is needed.

Sports participation is allowed, but strenuous sports like hockey, gymnastics, weight-lifting and football should be avoided.

Participation in activities such as swimming, biking and limited weight lifting is permissible as long as it is pain-free.

When moderate symptoms are present, immobilization of the spine in a flexed position - by means of a plaster cast extending from the lower part of the thighs to above the costal margins - will relieve most of the acute pain.

The cast should be followed by a back brace. In the milder cases an ambulatory plaster jacket or brace, together with exercises to decrease pelvic tilt and lumbar lordosis may be adequate treatment.

The majority of cases of spondylolisthesis can be treated by conservative means of this type.

Treatment for spondylolysis and spondylolisthesis is not much different than for other causes of mechanical and/or compressive back pain. In most cases, surgery will not be necessary.

Strengthening the back muscles can reduce the mechanical symptoms resulting from the segmental instability.

A physical therapist will probably be recommended to help you with a series of exercises designed to help stabilize the spine by strengthening the back and abdominal muscles.

For cases of spondylolysis complete bed rest is helpful. For spondylolisthesis however, complete bed rest may not really be effective.

After pain relief, you would be prescribed active physiotherapy i.e., spinal flexion exercises. This exercise protocol is the most effective tool in the nonoperative treatment of this problem.

The goal of physical therapy is to help you return to full activity as soon as possible.

Exercise is very helpful for pain and it can help you heal faster Physical therapists can instruct you on proper lifting and walking techniques, and they'll work with you to strengthen your abdominal muscles and lower back They'll also encourage you to increase the flexibility of your spine and legs.

Some patients want to try holistic therapies such as acupuncture, acupressure, nutritional supplements, and biofeedback.

The effectiveness of these treatments for spondylolysis and spondylolisthesis may aid you in learning coping mechanisms for managing pain as well as improving your overall health.

Left untreated, spondylolysis can develop an existent spondylolisthesis into a higher grade and sideline an athlete for more than just a sporting season.

Grades I of spondylolisthesis: < 25% slippage of one vertebra on top of another vertebra.
Grade II - 25-50% slippage
Grade III - 50-75% slippage
Grade IV - > 75% slippage

Return to play hokey will be determined by how soon you back recovers, not by how many days or weeks it has been since your injure occurred .

It is important that you have fully recovered from your low back pain before you return to play hockey.

You must be able to have the same range of motion that you had before your injury.

You must be able to run, jump and twist without pain.



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