Defects of a vertebra’s pars interarticularis (spondylolysis) and the slippage of one vertebra in relation to another vertebra (spondylolithesis) are common causes of back pain in the young athlete. These injuries are often seen in athletes who participate in sports that require twisting and hyperextension of the spine, such as in gymnastics. The athlete usually complains of pain that worsens when arching the back. The physician must be alert because these injuries often appear to be a sprain or strain. X-ray images are often normal and special imaging studies such as bone scan and CT scan may be required to confirm the diagnosis.

Recovery requires a period of relative rest, ice, medication and specific exercises. It is important that inflexible muscles are stretched and the trunk muscles strengthened. In some cases, bracing may be necessary to allow for proper healing. Progression back to sports is similar to that for sprains and strains.

A few special considerations are important in an athlete who has developed a spondylolisthesis. Athletes with 50% or less forward slippage can usually return to all sporting activities after pain resolves and appropriate rehabilitation has been completed. Athletes with 50% or greater forward slippage are encouraged to participate in less aggravating sports. Also, athletes with a spondylolithesis should be monitored every six months for progressive slippage as they go through any adolescent growth spurt.

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