Lumbar stress fracture treatment

[Danny]

Interesting looking at the varied treatment of Lumbar Stress fractures (particularly cricketers) in Australia. Michael Clark from the Western Australia Warriors underwent surgery with screws put in place to 'stabilise' the fracture. Where as in NSW the treatment is very much in favour of Physio rehab with core stability and bowling action review and modification. Any thoughts...

[hhh]

One important issue is to determine if it is a stable v unstable spondylolisthesis. If there is instability, conservative treatment and core stability isn't going to do a lot for it and if you want to continue an elite sporting career, surgery may be a better option.

[injuryupdate]

Hard to say that a state has a policy of using surgery or not because we don't know how bad each individual case is.

I would imagine that if possible, all stress fractures of lumbar spine should be treated conservatively to avoid complications of metal in the spine, but there will be occasional cases where the fracture just won't heal and keeps re-opening or extending and slipping and surgery then becomes a sports career-saving option.

Phil Alley was a NSW quick who had a stabilisation and was able to return to first class cricket briefly, but didn't quite reach his previous level.

Shane Bond, who is NZ's top quick, is currently recovering from surgery to a displaced stress fracture. I read an article in NZ Sunday Times on Oct 31, which stated that Bond had surgery on August 19 which included a bone graft from his hip.

The article quoted Glenn Howard, who had successful surgery for lumbar stress fractures in 1998 and then came back to compete at the Sydney Olympics in high jump.

Both athletes had surgery with Graham Inglis in Christchurch. However, despite their similar histories, it might not be a guarantee that Bond will have a 100% recovery, as fast bowling loads the lumbar spine even more than Olympic high jumping.

[vijairanawat]

I read your comments with interest. I would like to draw your interest to the work we have done in the UK. Over the past 20 years we have diagnosed these fractures in 19 professional cricketers. 8 were managed conservatively with physio etc and the remaining 11 were operated on by a direct screw repair of the lesion with bone graft but only after failure of the conservative measures.
All of these players got back to 1st class cricket with 2 of the fast bowlers playing internationals and opening the bowling for over 10 years.
If anyone is interested in the article i can send you a copy. Please email me on vijairanawat@hotmail.com

[Arthur Phat]

Also need to consider physios would treat an ingrown toe-nail with core stability exercises

[Unregistered]

Also need to consider physios would treat an ingrown toe-nail with core stability exercises
Agreed that ingrown toenails are a due to core weakness.

[JRU]

I'm a competitive weightlifter and have just beein diagnosed with a lumbar stress fracture. I'm curious exactly what physio treatment has been used for this injury in athletes. Right now, my ortho has told me "no exercise" which isn't going over very well.

[Unregistered]

I have also been diagnosed with a lumbar stress fracture. Although I am not a weightlifter, I am a dancer, and I have been told to take 12 weeks off, of everything active... do you have any suggestions on how to stay fit?

[injuryupdate]

Most lumbar stress fractures will end up with a fibrous semi-union (pars defect) irrespective of treatment. In sports like gymnastics, or fast bowling in cricket, this can be bad news and lead to recurrences. In the majority of sports a fibrous union will be OK. In sports where recurrence is possible or likely, it is best to be very conservative with these injuries early. In sports where a fibrous union of the stress fracture is no big deal, then IMO the athlete can play through the pain if they like.

[Mark4]

I suffered a stress fracture 14 years ago. No doubt treatments have changed a hell of a lot since then. The fracture was L3/4 and troubled me for 6 months before it was finally diagnosed. The only way it was found was after a bone scan.

It was treated by putting me in a brace that covered just below my chest down below my pants line. Very annoying, and it had to be worn for 6 weeks fulltime and then be reassesed.

To cut a long story short, i ended up in the brace for about 3 months, had plenty of physio for core strength and to be honest, at the end of the day it had merely settled down, not healed. My budding Rugby League career was over. I see most people these days make a full recovery, which is the way something so trivial should end up.

[Cail]

9 months ago I was diagnosed with an L5 stress fracture. It's still hurts. So instead of getting yet another bone scan or x-ray, I'm going for an MRI. For people who had a severe lumbar stress fracture, how long did it take you to recover? and are there suppliments that can quicken the process? (i.e taking shark cartalige pills)

[injuryupdate]

Unfortunately the vast majority of L5 stress fractures don't heal, but they do become less painful. If you do gymnastics or bowl in cricket etc. the recurrence rate is very high. Non-symptomatic non-union (or fibrous union) is very common in other sports.

[fuelinjected]

can anyone explain what a stress reaction is?

[fuelinjected]

sorry, what I mean is, it would be great if anyone knew what it is, and any other information you know about it. It would be extremly appreciated. Thank you

[Unregistered]

sorry, what I mean is, it would be great if anyone knew what it is, and any other information you know about it. It would be extremly appreciated. Thank you

A stress reaction is a precursor to a stress fracture. The bone is undergoing remodeling and the osteoclasts have taken a lot of the bone away. There's usually a bony edema that shows up on an MRI and there's uptake on a bone scan but there isn't a fracture line like there would be in a stress fracture. Typical treatment for a stress reaction for Spondylolysis is 4 to 6 weeks in a rigid brace followed by resumption of athletic activities in the brace for another 2 months assuming there was no pain on provocative exam at 4 to 6 weeks.

For a fresh stress fracture with a chance of achieving union the treatment would be 4 to 6 months in the brace although activity in the brace may still be resumed at 4 to 6 weeks. There are a lot of other treatment approaches but that one is the most accepted in the literature.

It is interesting for me to read this forum as my son who has been diagnosed with spondylolysis is a baseball player and the injury seems to be even more common in cricket.

[gymnast922002]

I was diagnosed with a L5 stress fracture two years ago at 13. I think it occured because of intense gymnastics workouts and running in Track and Field. I was in a soft brace and physical therapy for 6 weeks. two times. Neither of which helped my back. Then i had a hard plastic brace from my collar bone to my hips which just made my back hurt more. I have mostly been out of sports since then and it still hurts. Now I'm thinking of getting surgery. The doctor said he would put cadaver or cow bone on my spine and wrap it in "duct tape" is how he explained it.

Any Ideas. Help. Comments?

[vijairanawat]

hi; there are several ways to operate on these fractures; if you scroll up the page have a look at the message i posted about work done on fast bowlers essentially using a screw with your own bone as graft rather than tape and cadaveric bone
i can send you the paper if you want

[Caroline98853]

I was diagnosed with a lumbar stress fracture about 5 months ago. I am a year-around swimmer and training is very intense. I also have Scoloisis. The pain has not gone away and even though I still swam through the 5 months, I was wondering if it is abnormal that the pain has not gotten better. I do have a bendable back brace that I wear 24/7, expect when I am swimming which is 2 hours 9 times a week. Did I make things worse by not resting and should I rest now? For how long?