Back Pain in Young Athletes: Spondylolysis Diagnosis & Care | Evansville

What is spondylolysis?

Spondylolysis is a stress fracture in a small bridge of bone at the back of a vertebra called the pars interarticularis. It almost always happens in the low back, most often at the lowest lumbar vertebra (L5). A teenager's spine is still maturing, and sports that repeatedly arch and twist the low back put that bridge of bone under stress, the same way repeated running can cause a stress fracture in the shin.

It's far more common in young athletes than most families realize. In a well-known study comparing 100 adolescent athletes with low back pain to 100 adults with low back pain, 47% of the young athletes had a spondylolysis, compared with 5% of the adults.

Sports with a lot of arching and twisting carry the most risk: gymnastics, dance and cheer, volleyball, diving, football (especially linemen), wrestling, and throwing and hitting sports like baseball, softball and tennis.

Signs parents and coaches should watch for

Low back pain that's worse when arching backward: serving or spiking, back walkovers, blocking, landing jumps
Pain on one side just above the belt line
Pain that eases with rest and comes back with practice
Tight hamstrings
Back pain lasting more than two weeks

Back pain that lasts more than two weeks in a young athlete deserves a proper exam. Back pain is less common in kids than in adults, so persistent pain is worth taking seriously.

See a physician promptly for back pain with fever, unexplained weight loss, pain at night or at rest, numbness or weakness in the legs, or any change in bladder or bowel control.

Why it's so often missed

Spondylolysis usually starts as a stress reaction in the bone before it becomes a visible crack, and plain X-rays often miss that early stage. In one study of 200 young athletes with low back pain, nearly half of those whose X-rays looked normal turned out to have a pars injury on MRI. Exam tests alone can't confirm it either.

So the pain gets called a pulled muscle, the athlete goes back to full practice, and the fracture has no chance to heal. The early stage is also the stage with the best chance of the bone healing completely. That's why getting the diagnosis right, early, matters so much.

How we diagnose it

It starts with a detailed history: the sport and position, training load, recent growth spurts, and exactly which movements hurt. Dr. Mitz then examines how the spine and hips move, checks for pain with arching and single-leg extension, looks at hamstring and hip flexibility, and does a full neurological exam.

When the history and exam point to a spondylolysis, we don't guess. Many families don't know that chiropractors in Indiana can order advanced imaging, including MRI and CT scans. Dr. Mitz orders the right study directly:

MRI is usually the first choice for young athletes. It can show an early stress reaction before a fracture line appears, and it uses no radiation.
CT shows bone detail best and is used when we need to see the fracture clearly or confirm that it has healed.

Imaging also rules out other causes of back pain. If a scan shows a slipped vertebra (spondylolisthesis) or anything that needs a specialist, we coordinate with your pediatrician or an orthopedic spine physician.

How we treat young athletes

Most young athletes with spondylolysis heal and return to their sport without surgery. Care is built around letting the bone heal while keeping the athlete fit and strong:

The right kind of rest. Time away from the movements that load the fracture, usually around three months for an active fracture, with conditioning that doesn't arch the back, such as stationary cycling, so fitness doesn't slip. Some athletes also benefit from a brace for part of that time.
Gentle hands-on care. Soft-tissue work and gentle mobilization of the hips and upper back to ease muscle guarding. We avoid forceful adjustments to the injured area while it heals.
Rehab that protects the spine. Core work that teaches the trunk to resist arching and twisting, hip strengthening, and hamstring and hip flexor flexibility.
Movement retraining. Fixing how the athlete arches, lands, serves or blocks, so the same stress doesn't cause the same injury again.
Bone health basics. Enough total calories, calcium and vitamin D. Under-fueling is common in young athletes and slows bone healing.
A clear return-to-sport plan. A graded return to practice and competition once arching is pain-free and strength and control are back, with updates for parents and coaches along the way.

In a recent study of adolescent athletes with an active spondylolysis, 95% were pain-free and back to normal activities after three months of rest, bracing and rehab, without surgery.

Why an accurate diagnosis gets athletes back sooner

The fastest way back isn't playing through it. It's knowing exactly what's wrong. An athlete whose stress fracture is found early has the best chance of complete healing and a single, planned stretch away from the sport. An athlete whose fracture is missed often spends a season or more cycling between rest, re-injury and frustration.

About Dr. Mitz

Dr. Eric L. Mitz has been licensed in Indiana since 1996 and is certified in Cox flexion-distraction. He has taught more than 1,000 hours of postgraduate courses to chiropractors, physical therapists and physicians in 12 states, and since 2017 has been a Logan University clinical preceptor, training future chiropractors in our office. Meet our doctors or read about sports injury care and low back pain.

Questions

Is it just a pulled muscle?

Sometimes. But in a young athlete, back pain that lasts more than two weeks, especially pain that's worse when arching backward, should be checked for a spondylolysis before returning to full practice.

Can a chiropractor order an MRI?

Yes. Chiropractors in Indiana can order advanced imaging, including MRI and CT. Dr. Mitz orders imaging when the history and exam call for it. Some insurance plans require approval before an MRI.

How long will my child be out of their sport?

It depends on the stage of the fracture. For an active stress fracture, time away from the aggravating movements is usually around three months, followed by a graded return. Many athletes keep conditioning during that time.

Will my child need surgery?

Rarely. Most young athletes heal with rest, rehab and sometimes a brace. Surgery is considered only when pain persists after a thorough course of nonsurgical care, and we'd coordinate with an orthopedic spine physician.

What's the difference between spondylolysis and spondylolisthesis?

Spondylolysis is the stress fracture itself. Spondylolisthesis is when a vertebra slips forward, which can happen when the fracture is on both sides. Imaging tells us which one is present.

Do we need a referral?

No. You can schedule directly. Call (812) 401-2140.

Sources: Micheli LJ, Wood R. Back pain in young athletes: significant differences from adults in causes and patterns. Archives of Pediatrics & Adolescent Medicine, 1995; Kobayashi A, et al. Diagnosis of radiographically occult lumbar spondylolysis in young athletes by magnetic resonance imaging. American Journal of Sports Medicine, 2013; Panteliadis P, et al. Athletic population with spondylolysis: review of outcomes following surgical repair or conservative management. Global Spine Journal, 2016; Hospital for Special Surgery study of nonoperative care for adolescent spondylolysis, reported March 2026. This page is general information, not a diagnosis.

Back pain in young athletes: when it's a spondylolysis