Stress Fracture in Lower Back ?

[mapstangelo]

Hello All!

My 7 year old daughter was recently diagnosed with a stress fracture (Spondylolysis) in her lower back. She is being fitted for a brace tomorrow and will spend 3 months sports free (gymnastics and soccer) Dr says she'll heal up just fine and be back to gymnastics and soccer by spring.

I am just wondering any experience with this type of injury? He says it's quite common in gymnasts. And my DD isn't even a competitive gymnast she takes class once a week but likes to practice at home (no big stuff - back walkovers, front walkovers, handstands) She been doing gymnastics since she was one and a half

I am concerned when she is ready to go back she could injure herself again.

Thanks!

 

[Deleted member D3987]

well, that is about as young as i've heard this condition. she should be fine though as the doctor says. spondylolysis is common and the good one (oxymoron) to have. spondylolisthesis is the bad one and gymnastics must end.

by the way, i would say that she has done way to many back walkovers and backbends...

 

[gym law mom]

As dunno said, this is very young to have this type of fracture. As a parent with a medical background(I'm not playing doctor!) I would be tempted to get a 2nd opinion while she is healing from a pediatric ortho. Typically this fracture is seen in older girls who are competitive gymnasts. Even once she's healed, you may want to limit all the bwo's and fwo's she does---it hyperextends the spine and this can contribute to a fracture.

Best wishes to you and your dd.

 

[gympunkin]

I just want to concur that a second opinion is probably a very good idea. About a year ago, my then 7 year old daughter experienced quite a bit of pain in her lower back after a class that involved many bridges, bridge walks, bridge kick overs and what you call it when a gymnast bends back into a bridge from a standing position and then stands back up. Her pediatrician thought it might be spondylolysis and sent her for an x-ray. THe radiologist said no fracture. When she did not improve in two weeks, she went back to the pediatrician. He still did not see a fracture but referred us to a sports medicine specialist who in turn referred us to a pediatric orthopedist. The orthopedist compared her recent x-ray to one taken when she was 2 years old and decided that her L-5 looked different in the recent x-ray. He thought he saw the Scottie dog collar on the L-5 that is the hallmark of spondylolysis. He sent us to a pediatric spine specialist who has a sub-speciality of gymnasts with spine problems such as spondylolysis. (I live in a very large city but still it was surprising to me that this injury was so common.) The spine specialist did not see the "collar" but because he respected the other ortho he recommended either an MRI or CAT scan (sorry I am always confusing the two) which involved imaging of very fine slices of the spine. There was only one imaging place that he thought could do it accurately. The imaging showed no fracture. So I guess this is a long way of saying that it can be a very tricky injury to accurately diagnosis.

According to the orthopedists we saw, spondylolysis is pretty much a function of repetition over time. Seeing it in a 7 year old is very unusual. So even if you have seen a specialist, a second opinion is really a good idea. If you have had the MRI/CAT scan with slices, your diagnosis is probably solid. I would also consider a second opinion on the brace, because the orthopedist we saw (not the spine specialist) told us that a brace is often not necessary. (Please don't think that I am giving medical advice. All I am suggesting is a second opinion.)

I am not a doctor and have no medical background at all, but what I learned from my daughter's back injury is that lack of shouder flexibility is the main cause of back injuries. Make sure that shoulder stretches are part of her rehab.

Good luck!

 

[emorymom]

While most of the research is on aging people for K2 being a help against fractures, I don't personally see how it isn't a good thing for gymnasts or any child with bone strength or growth challenges (e.g., dental cavities) to be taking since it has been all but removed from the food supply by modern farming (unless you are drinking your milk from grass-fed cows).

My children take 5-10mg K2 per day (Natures Life, sold as 5000mcg wich is 5mg) along with strong D supplementation in the winter as well as a cal/mag/phosphorus tab. You have to take K with fat.

 

[bogwoppit]

MY older DD, now 14 has both spondly's, lolysis and lysthesis. Due to this her future in any "real" sport is pretty much over. We are still waiting to see an ortho surgeon, though xrays and MRI's have been done.

I too have heard that having spondylolysis means that your dd will be able to return to gym. But I would certainly be curtailing the BWO's and FWO's at home, even after she returns. They are brutal on the lower spine., also these stress fractures are very common in kids who have very flexible lower backs.

 

[TumbleBunny]

We were at a gym and it seemed to be a common element that many of the girls were having back issues. I know of at least four that have shown stress fractures. But all of these girls were optionals that did repetitive back walkovers to the point of stupidity. Physical therapy and two months rest seemed to do the trick. Haven"t ever heard of a back brace being used.

 

[bookworm]

I am shocked to hear that a gymnast so young (and not really into the competitive track yet) has this...my daughter also had this but she was a 4th year Level 10 and had been doing gymnastics for 10 years! As gympumpkin said , it is quite tricky to diagnose...my daughter had the Xray and then the CT scan but it wasn't conclusive until she had a bone scan with contrast done...and after that she was sidelined for 12 weeks and she was in a back brace (which she thought helped a lot) ...she didn't do anything but condition for 3 months and I curtailed her schedule to only 4 days a week of that. She healed and (knock on wood) it has been fine but it's not something to fool around with. I would definitely seek out a Sports Medicine Doc (we were fortunate to be in a major medical center and get a doctor who had a lot of experience with gymnasts and was even married to a former collegiate gymnast so he knew exactly what was happening) ...the basic thing he felt was that it came from repetitions and the torque of a lot of the moves at the upper levels..

 

[busymomof4]

HI, my DD who was also 7 at the time of diagnosis has a stress fracture at L5 her is on both sides of the pars which is worse than just having it on one side. She wore a brace 23hrs a day for 3 months. The doctor thought she would heal fine, however, she has not healed and the vertebrae has actually moved slightly out of alignment (spondylolythesis) which she didn't have to start with. We go back to the MD on friday and then make some decisions. I am not trying to scare you. Everyone is different and hopefully your dd will heal quickly. My dd was diagnosed a year ago. MD is still letting her do swim, but no gymnastics or bending of her back. My dd was very flexible in her back and also had some lordosis of the spine (meaning she had more arch to her back) which put her at additional risk for this type of injury. (of course I didn't know that at the time). Good luck to your daughter. Hope everything goes well. We were dreading the brace, but children can adapt easily, and my dd did fine with the brace.

 

[gymgurl]

Well, My mum has Spondylolisthesis and the Physio asked her if she had ever done gymnastics and it didn't have to be at a high level and she had (until level 3) so not a lot at all but the physio is sure that this has helped the condition. I am not sure if this is the same for spondylolysis if she has a predisposition for it due to genetics (have you your family had a history of back problems?)

 

[mapstangelo]

Thanks all for your replies.

We are seeing an pediatric orthro specialist at Children's Hospital Boston

Children's Hospital Boston has been ranked #1 in Orthopedics in the U.S. News Media Group's 2010 edition of America's Best Children's Hospitals featured in the August issue of U.S. News & World Report.

Children's Ranked #1 in Orthopedic Care
Children's has been ranked as the top pediatric hospital in the country for orthopedic care in Parents magazine's Best Children's Hospitals 2009 survey.

I am confident with the care/tests we have received so far. Her initial consult included an x-ray, then a bone scan which confirmed the fracture then a CT scan not 100% why this was done but I think it has something to do with to watch how she heals. My husband was with her at that appt don't have the doctors version of the explanation.

She got her brace today so we'll see how she does Wish us luck!!

Again thanks for all your replies and comments.

 

[Tumblequeensmom]

We were at a gym and it seemed to be a common element that many of the girls were having back issues. I know of at least four that have shown stress fractures. But all of these girls were optionals that did repetitive back walkovers to the point of stupidity. Physical therapy and two months rest seemed to do the trick. Haven"t ever heard of a back brace being used.

There were several girls at an "national training center" gym who wore back braces during their L7 seasons to "help" their back stress fractures while they continued to compete. To me, it makes more sense to take the time off, do the PT and rest that back rather than risk further injury by continuing to compete. I think when this is the situation, it is more of an ego-driven parent rather than concern for the child, that keeps that child competing. There are crazy gym parents everywhere you go.

 

[Deleted member D3987]

absolutely ^^^

 

[virginiacoach]

I have seen back braces. I think it is a dr. opinion. We have had 5 team gymnasts with stress fractures at our gym. Only one has been in a brace. Ironically, they all came from other gyms and within 18 months of being at our gym had stress fractures. We have often discussed what they did differently at the other gym or what we do differently. No one seems to be able to figure it out. None of our gymnasts that grew up in our gym have ever had a stress fracture so we can only attribute it to the fact that we do not do bridges except with their feet elevated up until age 6... after that we do. We do find due to not doing a lot of bridges that our gymasts seem to be weaker at walkovers and do sometimes have shoulder flexibility issues.

 

[emorymom]

After posting above I did look at the K2 research and it is new and very positive with regards to fractures in the elderly, and animal studies on bone healing. No studies on gymnasts but it might be something to propose. I also have wondered how many gymnasts do who are training many hours in the summer (inside, no robust sun exposure) and whose parents do not give them D supplementation. I have seen some very pale gymnasts.

 

[gymgurl]

I have seen back braces. I think it is a dr. opinion. We have had 5 team gymnasts with stress fractures at our gym. Only one has been in a brace. Ironically, they all came from other gyms and within 18 months of being at our gym had stress fractures. We have often discussed what they did differently at the other gym or what we do differently. No one seems to be able to figure it out. None of our gymnasts that grew up in our gym have ever had a stress fracture so we can only attribute it to the fact that we do not do bridges except with their feet elevated up until age 6... after that we do. We do find due to not doing a lot of bridges that our gymasts seem to be weaker at walkovers and do sometimes have shoulder flexibility issues.

One girl at our gym was put in a brace or support type thing for training but because she couldn't tumble or vault properly in it she would compete without it. We don't think it was bridges that caused it as she bailed out of RO-BHS-BT and landed on her neck, however the fracture was in the lumber spine, does this happen often or is it likely that it was caused by something else?

 

[Deleted member D3987]

yes, gymgirl. in fact, that is more common than what you might think having landed up high on the head like that. when you land in that way, the hips and knees continue traveling backward. you end up flexing so far that the vertebrae down there "kiss" each other on the front side of your spine. the front being the stomach side...like if you could stick your finger thru your belly button and continue on until your fingertip touches the front of your spine. hope this helps you with a visual.

 

[Liz Booth]

My dd has been in gymnastics for 12 years she has just been diagnosed with Sponylothesis. I was wondering does anyone have a child who suffers from this condition. We were told she had a fracture to her pars articulars many years ago and it was never diagnosed. This injury came out after a growth spurt.

 

[TumbleBunny]

First, I conduct a biomechanical evaluation of the gymnast to determine what the predisposing risk factors may be that created the stress fracture. I review all of their skills on each event to determine if there is a skill set that contributed to their stress fracture. The goal I set is to correct any of the risk factors found so that when they return to gymnastics they have a better body then what they had prior to the injury. I explain to them that they either need to change their body or change the activity or the back pain may return. If they only rest from activity until the pain resolves and then take the same body and return them to the same activity, chances are the same problem will return.

(just read this from Dr. Larry Nessler)

 

[bogwoppit]

My dd has been in gymnastics for 12 years she has just been diagnosed with Sponylothesis. I was wondering does anyone have a child who suffers from this condition. We were told she had a fracture to her pars articulars many years ago and it was never diagnosed. This injury came out after a growth spurt.

My 14 year old was just diagnosed with spondylolysthesis. It has ended her participation in any gym activity. SHe also has stress fractures at L5, which she probably has had for a while. She sees a physiotherapist weekly and will see an orthopedic surgeon to be assessed.