Bone stress injuries can be debilitating, usually worsening over time and preventing us from doing the sport and activities that we love.
But how do you know if what you’re experiencing is just a minor muscle strain and tightness or something more serious like a bone stress injury?
In this article, we’ll explore the signs and symptoms that may indicate a lower back bone stress injury, empowering you with the knowledge to seek appropriate medical attention and get on the path to recovery.
What is a lower back stress fracture/bone stress injury?
A lower back stress fracture is an overuse injury that results in microscopic fractures in the bones of the lumbar spine. Unlike fractures (breaks) in bones, which usually occur following a traumatic event, stress fractures are caused by the cumulative effect of many small traumas.
Usually, stress fractures occur in the part of the vertebra known as the pars interarticular, the weakest portion of the vertebra and, hence, the most common spot for an injury. Stress fractures most frequently occur at the bottom two lumbar spine vertebrae, levels L4 and more often,L5.
What are the signs of a lower back stress fracture/ bone stress injury?
Here are some signs of a fracture or stress injury in the lower back region.
- Spontaneous or gradual increase in low back pain, usually combined with a period of high activity
- Commonly, night pain is reported, including difficulty sleeping or waking
- Most often unilateral (one-sided)
- Pain with extension-based activities such as bending backward
- Pain with prolonged standing or running
- Early morning stiffness
- Pain eases with rest
If you are experiencing any of these symptoms and believe you may have sustained a stress fracture in your lower back, it is advised that you schedule an appointment with an expert sports doctor, orthopaedic specialist or physio for sports injuries.
Who do lower back stress injuries mainly affect, and why?
Stress fractures are most prevalent in children and adolescents. Sports that involve repeated lumbar spine rotation and/or extension are most vulnerable to stress fractures. The most common sports for lower back stress fractures are cricket, running, football (soccer), gymnastics and dancing.
In cricket, fast bowling, rapid side flexion, rotation and extension during the delivery stride have been identified as the main mechanisms that cause lower back bone stress injury.
In footballers, it may result from many hours of running, change of direction at speed and striking the ball, causing cumulative stress on the lower spine.
Injury prevention strategy: lower back stress fractures
Although there is always a risk of bone stress injuries in sporting populations, some strategies exist to manage this risk. These include:
- Managing training and sport loading, preventing rapid increases
- Gym-based strength programs that target the lower body, glutes and core
- Reducing tightness in the hamstrings and hip flexors
- Having good biomechanics to move correctly and protect the back from excess loading.
Lower back bone stress injury recovery
Usually, managing a lower back bone stress injury will include a consultation with a sports doctor or orthopaedic specialist in combination with your physiotherapist to assess whether a supportive brace will be indicated to assist with bone healing. Your Physio will then help to manage a period of offloading or rest from sport and high-level exercise, which is key in allowing bone healing.
Rehab exercises following a lower back stress fracture
Following this, a graded rehab program to build strength around the lower back is key in preventing ongoing and future bone stress injuries. Usually, this will target the abdominal and oblique muscles and the muscles of the lower back, the glutes and the major lower limb muscle groups.
Additionally, biomechanical factors may be addressed to modify the movement patterns within a sport or activity to reduce the load on the lower back vertebrae. Finally, a gradual return to training is key in gently returning load to the vertebrae.
Lower back fractures: stress injuries you shouldn’t ignore
If you are experiencing symptoms that might suggest a lower back bone stress injury, seek proper medical care.