Back strain injuries in children and adolescents: Stress fracture and stress osteopathy
Back pain in growing children and adolescents is a symptom that should always be taken seriously. Especially in young people who play sports with a goal in mind, back pain can sometimes be caused by a strain injury to the posterior arch of the vertebra.
This injury is divided into two stages: stress osteopathy (stress state of the bone precursor) and the actual to stress fracture (spondylolysis).
What is stress osteopathy and stress fracture?
Stress osteopathy: This is the precursor to a fracture. The bone is overloaded and there is swelling, but the actual fracture line has not yet formed. At this stage, the injury usually heals quickly with rest.
Stress fracture (Spondylolysis): If the strain is continued despite the symptoms, a fracture may occur in the posterior arch of the vertebra. In children and adolescents, the posterior arch of the vertebra is still in the growth phase and is therefore more sensitive to mechanical stress.
Risky species?
The injury typically occurs in sports that involve repetitive stress on the back. strong backward bending (extension) and rotations. Such species include, for example:
Gymnastics and figure skating
Athletics (e.g. javelin throw, high jump)
Ball sports (e.g. football, floorball, tennis)
Identify the symptoms
A typical patient is an adolescent athlete who presents with:
Localized back pain: The pain is felt in the lower back, often on one side.
Pain on exertion: The pain is particularly provoked when bending the back backwards, but can also be more vague.
The effect of rest: The pain is relieved with rest, but returns as soon as you return to sports. Sometimes the pain can be quite constant.
Diagnostics – How is the injury diagnosed?
Back strain injuries in children are challenging to diagnose with standard X-rays, as early-stage strain osteopathy is not visible on them.
Magnetic resonance imaging (MRI): It is the best examination method. It shows bone swelling (edema) even before a fracture occurs.
X-ray: It may show an existing, older fracture, but it is insufficient for diagnosing the initial situation.
Treatment and recovery
The cornerstone of treatment is sufficient and long rest from sports stress.
Rest (2–4 months): The sports ban typically lasts a couple of months. During this time, you should avoid hitting, jumping, and twisting your back.
Physiotherapy: Plays a crucial role. The physiotherapist guides core control and corrects any incorrect positions or tightness (e.g. tight hamstrings) that increase the load on the lower back.
Gradual return: You can only return to sports when your back is completely pain-free and your doctor gives you permission.
Health Village article
Duodecim's article
https://www.duodecimlehti.fi/duo15199
Orthobullets
https://www.orthobullets.com/spine/2058/pediatric-spondylolysis-and-spondylolisthesis