Adolescents with low back pain and spondylolysis.

Adolescents are specialising in their sport of choice earlier in life than ever before. Sporting organisations are getting more professional at younger ages. Rep teams, development squads and sports academies are popping up for increasingly younger athletes. This shift in the sporting landscape is leading to an increased exposure of adolescents to strength and conditioning coaches and programs. It is important to understand the nuances of training young athletes, they do not just function like mini adults, they are physiologically different on many levels.

One common issue that must be approached very differently in adolescent athletes vs musculoskeletally mature athletes is low back pain. Low back pain is common and nothing new to strength and conditioning coaches. In adults; the overwhelming majority of low back pain is musculoskeletal in nature. Very rarely is a scan advisable in these cases and, with appropriate programming and rehab, these athletes can continue through their training regime.

In adolescent athletes, however, close to 50% of low back pain is the result of spondylolysis1; a stress reaction in the pars interarticularis structure of the vertebrae. These must be picked up and managed appropriately early otherwise the stress reaction may progress towards a full, bilateral, displaced fracture (spondylolisthesis). The athletes most at risk are those in sports that require lumbar spine hyperextension or combined extension and rotation (diving, gymnastics, butterfly swimming etc) or activities that produce load bearing extension forces on the lumbar spine (jumping, sprinting, weight lifting etc)2,3.

Signs of symptoms of spondylolysis include2,3:

· Pain with load bearing activity (running, jumping, weight lifting) that eases with rest.

· Painful lumbar spine extension

· Painful lumbar spine rotation

· Painful single leg extension test

Risk factors that can be associated with spondylolysis and should be monitored as part of any adolescents programme include2,3:

· Rapid spikes in load (aim to gradually build and taper loads through the various season cycles appropriately)

· Growth spurts (load may need to be decreased or more closely monitored during periods of growth)

· Hyperlordotic posture (this may be habitual or affected by the factors below)

· Hamstring and/or hip flexor tightness (this is where regular flexibility testing may be appropriate especially around period of growth)

· Poor core and/or glute strength and control (this should be the bread and butter of any exercise professional!)

· Poor lower limb biomechanics (assess and address biomechanics of meaningful tasks for the athlete e.g jump and land technique in a volleyballer or front squat technique in a weightlifter)

If any suspicion of a spondylolysis exists; action must be taken immediately. Consult with a trusted health care practitioner and ensure that an accurate diagnosis is made early. If discovered early, these injuries may only require symptom limited rest periods followed by gradual reloading taking all the factors mentioned above in to consideration. In worst case scenarios, surgical fixation can be warranted.


1. Micheli, L., & Wood, R. (1995). Back pain in young athletes: Significant differences from adults in causes and patterns. Archives of Pediatrics & Adolescent Medicine, 149(1), 15.doi:10.1001/archpedi.1995.02170130017004

2. Kim, J. H., & Green, W. D. (2011). Spondylolysis in the adolescent athlete. Current Opinion in Pediatrics, 23(1), 68-72. doi:10.1097/MOP.0b013e32834255c2

3. Lawrence, K., Elser, T.,& Stromberg, R. (2016). Lumbar spondylolysis in the adolescent athlete. Physical Therapy in Sport, 20, 56-60. doi:10.1016/j.ptsp.2016.04.003


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