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.
