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I have a 15 year old with low back pain. She is a soccer player and has tried rest. Why isn’t she getting better?


Yes, children with injuries typically heal. When they don’t heal, we have to suspect something more serious. The same is true for children with low back pain. Some research data supports that 1/2 of all pediatric back pain in athletic patients is related to disturbances of the spine including spondylolysis, a common diagnosis with pre-adolescents and adolescents. “Spondylo” means spine/vertebral segment, “lysis” means fracture. Failure to pick up a spondylolysis can lead to a more aggravated condition where the fracture leads to instability and a vertebra can slip forward. Gymnastics, dance, soccer, football, track and field, weightlifting, rowing and wrestling are sports that may result in this injury. Basically, the body repeatedly extends and rotates, compressing the spinal segment resulting in a stress response and eventual fracture. These are typically identified by a medical physician who is trained to order the proper imaging to diagnose this condition. A physical therapist may see these as typical low back pain, but a high level of suspicion needs to be had with this population due to its high prevalence. Once diagnosed, a patient with spondylolysis is often placed in a brace to avoid hyperextension forces to allow the bony segment to heal. However, some fractures don’t heal with bracing and at this time, it is not known why. After a period of immobilization, a physical therapist will teach the patient how to move their bodies. Most athletes are able to return to their regular level of activity and many do not progress into instability and slippage of vertebral segments. Although many of these athletes are very strong, they can have imbalances in movement that are difficult to assess without a trained eye. A physical therapist is trained to identify potential risk factors such as muscle imbalance and movement dysfunctions that may predispose this population to this injury. If diagnosed, a physical therapist should rehabilitate these children to ensure a safe return to their mode of physical activity.
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