- Usually childhood fracture
- Usually in Lumber spine
- In sports that require episodes of Hyperextension, especially if combined with rotation. Eg; of common sports - Gymnastics, fast bowling (cricket), Tennis, rowing, dance, weightlifting, wrestling, pole vaulting and high jump and throwing activites
- Usually at opposite side of activity (that is; In right handed person, fracture is common seen in Left).
Clinical Features
- Unilateral low back pain, occasionally associated with somatic buttock pain
- Aggravated by movements involving hyperextension of lumber spine
- Occasionally asymptomatic
O/E
- Pain maybe reproduced by hyperextension with rotation of Lumber spine
- And on extension while standing on the affected leg.
- Associated hamstrings spasm may present
- Tender over fracture site
Diagnosis
- Xray - maybe normal (or) may showScotty dog appearance of a pars defect in Long stranding fracture
- If Xray Normal, SPECT scan to detect active stress fracture or stress reaction (Increase bone uptake)
- If SPECT positive - CT (reverse gantry) - to detect fracture line
- Alternatively - MRI can be used (not as sensitive as combined use of SPECT and CT)
Stages (by Radiology images)
- Early - Focal bone absorption or Hairline defect
- Progressive - Wide defect and small fragments
- Terminal - Sclerotic changes
Prognosis of healing
- Early and half of progressive type achieved radiological healing
- Terminal cases - will not heal
- L4 fracture is better change of healing than in L5
Management
- Initially - rest and avoid aggravating movment (ie; lumber extension and rotatoin)
- There is no definitely time set period for rest, use PAIN as a guide
- Rehab program - painfree progressive exercises
- When no tender locally and aggravating activity is not tender, Gradual resumptoin of the aggravating activity over 4 - 6 weeks.
- Specific exercise program training on Transverse abdominus and Multifundus (O'Sullivan et.al.)
- Core stability exercise
- Assessment and modification of biomechanics and technique
Reference: Brukner and Khan's clinical Sport and Exercise medicine