KidsMD Health Topics


  • Overview

    At Children’s Hospital Boston, we know that adolescents who have been diagnosed with an overuse injury such as spondylolysis often feel frustrated about the disruption in their normal athletic routines. Our experienced clinicians will approach your child’s treatment with sensitivity and support, helping him heal as quickly as possible so he can return to sports safely. 

    Here are the basics about spondylolysis:

    • Although some children are born with a genetic predisposition to developing spondylolysis, the injury is more common in adolescents who participate in sports that involve repetitive hyperextension (over-stretching) of the spine, such as gymnastics, football, rowing, and diving.
    • 4.4 percent of all children develop spondylolysis before the age of 6, and 6% have evidence of it by adulthood. In these cases, it does not represent an injury, and younger children who develop spondylolysis often don’t show any symptoms, and the condition might not be detected unless they get an x-ray for a separate problem. 
    • The primary symptom of spondylolysis is pain in the lower back that gets worse when the child leans backwards.
    • Adolescents with spondylolysis can usually return to sports after several months of activity modification, physical therapy, and occasionally bracing.

    How Children’s Hospital Boston approaches spondylolysis

    Experts in the Orthopedic Center at Children's provide comprehensive assessment, treatment and follow-up care to children, adolescents and young adults with spondylolysis and other overuse injuries. Our skilled orthopedists and sports medicine experts work with physical therapy staff to develop long-term treatment and activity plans. Our team has also developed innovative evaluation programs and effective injury prevention programs and strategies. Together, we provide your child with expert diagnosis, treatment and care—as well as the benefits of some of the most advanced clinical and scientific research in the world.


    Spondylolysis: Reviewed by Michael P. Glotzbecker, MD
    © Children’s Hospital Boston; posted in 2012

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115


    Children's Hospital Boston
    319 Longwood Avenue
    Boston MA 02115

  • In-Depth

    Clinicians in the Orthopedic Center at Children’s Hospital Boston have extensive experience treating adolescents with overuse injuries such as spondylolysis. Our collaborative approach allows us to us to provide more accurate diagnosis and prompt and effective treatment.

    What is spondylolysis?

    Spondylolysis is a stress fracture that occurs in the lower back:

    • A stress fracture is a type of overuse injury, or an injury that occurs when trauma is repetitively placed on the same part of the body.
    • In spondylolysis, repetitive trauma is placed on the lower back. This repetitive trauma causes a crack to form in the lower back, usually nearthe lowest of the lumbar vertebrae.

    Who is at risk for getting spondylolysis?

    Spondylolysis is commonly found in children and teenagers who play sports that place a lot of stress on the lower back or involve a constant over-stretching (hyperextending) of the spine.

    The sports that put adolescents at the highest risk for spondylolysis are:

    • diving
    • gymnastics
    • football (particularly for offensive linemen)
    • rowing

    Are there any medical complications associated with spondylolysis?

    If fractures don’t heal properly, spondylolysis can progress to spondylolisthesis: a condition in which one or more vertebrae slip out of place and slide past each other.

    • Spondylolisthesis is more common in children who developed spondylolysis early on in life rather than repetitive-use athletes.
    • Symptoms include lower back pain and tight hamstrings.
    • Treatment for spondylolisthesis depends on the severity of symptoms. Rest, physical therapy and back braces are used in mild cases, while more severe cases are treated with surgery.


    What causes spondylolysis?

    Some children have a genetic predisposition to developing spondylolysis and acquire a crack in their backs by the age of  5 or 6. These children usually have no signs or symptoms and are only diagnosed when they get an x-ray for another problem.

    When symptomatic, spondylolysis is more commonly caused by overuse. An overuse injury happens when too much stress is continuously placed on a single part of the body. When this stress occurs repeatedly over time, the body's muscles don’t have time to recover and become unable to absorb the shock of impact. As a result, the stress load transfers to the bone instead.


    What are the symptoms of spondylolysis?

    Many children who are born with a genetic predisposition to spondylolysis have no symptoms and don’t even know they have the condition. Symptoms usually occur in adolescents who participate in sports that place a lot of stress on the lower back.

    • The most significant symptom of spondylolysis is pain that spreads across the lower back and worsens when a child leans backwards. The pain tends to progress in stages:
    • At first, the child may only experience mild pain while playing sports.
    • As repetitive trauma continues, the pain becomes more constant.
    • Eventually, the child will experience constant pain in his lower back, even when he’s not playing sports.
    • Tight hamstrings are also common in adolescents with spondylolysis.

    What is the long-term outlook for a child with spondylolysis?

    Overuse injuries heal very quickly in children and adolescents. However, it’s important that children follow the activity restrictions and strengthening rehabilitation program put in place by their doctors. Most children with spondylolysis can return to regular activities after a few months of rest and healing time. If there is a risk of re-injury, the doctor may recommend that the child avoid certain sports.

    Questions to ask your doctor

    If your child has been diagnosed with spondylolysis, you probably already have some ideas and questions on your mind, but it can be easy to forget the questions you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot them down ahead of time to make sure that all your concerns have been addressed.

    Some questions you might want to ask include:

    • Will there be restrictions on my child’s activities? If so, for how long?
    • Will my child’s spondylolysis cause any permanent damage?
    • How does Children’s treat stress fractures?
    • Should my child return to playing sports?
  • Tests

    At Children’s Hospital Boston, we understand that an early and accurate diagnosis of spondylolysis is an important first step in helping your child safely return to his normal routine.

    How is spondylolysis diagnosed?

    The first step in diagnosing spondylolysis is a physical exam. If a child shows symptoms, such as back pain that gets worse with extension, your child’s doctor will order x-rays to look for a fracture.

    Since some stress fractures can’t be seen on x-rays, the following diagnostic tools may also be used:

    • A computerized tomography scan (also called a CT or CAT scan): Often used for diagnosing spondylolysis, this imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. CT scans are more detailed than general x-rays. It can be used to help decide if the fracture is old or new.
    • Bone scan: this non-invasive imaging technique uses a special dye that circulates through the bloodstream to help clinicians visualize bone metabolism and cell activity. If the stress fracture is active, it will appear “hot” on bone scan suggesting that this is a new injury.
    • Magnetic Resonance Imaging (MRI): an imaging procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. An MRI can be used to diagnose spondylolysis, and may help in deciding if the injury is new or old.  MRI is particularly helpful in cases of spondylolisthesis.
  • At Boston Children's Hospital, we understand that healing from spondylolysis can be a difficult experience for both adolescents and their families.  All the members of our Orthopedic Center are here to help. Our clinicians have a tremendous amount of experience treating overuse injuries and remain sensitive to the emotions of children, adolescents and young adults.

    How is spondylolysis treated?

    The primary method of treating spondylolysis is taking time off from sports and activities. This gives the stress fracture time to heal.

    During the healing period, your child's doctor may also recommend:

    • physical therapy: this type of therapy focuses on stretching hamstrings, strengthening the core muscles and increasing mobility.
    • bracing: a child who has a lot of pain when leaning backwards may need to wear a back brace for about 3 months. The brace works by holding the spine in a straighter position, preventing it from bending back.

    Your child's doctor may also give you more information about bone stimulator treatment if he believes it to be a viable treatment option.

    Will my child need surgery?

    It is unlikely that a child with spondylolysis will need surgery.

    Surgery is usually only necessary for children who have:

    • spondylolisthesis, a condition in which two or more vertebrae slip out of their proper position and slide past each other
    • pain that persists after other non-surgical methods are used

    How long does it take to recover?

    The healing period for spondylolysis is important because it gives the injured area time to rest and recover. Your child should heal from an overuse injury in a period of weeks or months, depending on the severity of the injury.

    Clinicians in the Orthopedic Center here at Children's typically recommend that an adolescent with spondylolysis spend at least 3 months wearing a back brace and doing physical therapy.  Approximately 3 to 4 months of rest is often needed before the child can return to sports.

    Who at Children's will be caring for my child if she develops a stress fracture?

    Members of our orthopedic team will provide expert care and support for your child. Our staff includes 28 orthopedic surgeons, 10 primary care sports medicine specialists, two podiatrists, a nutritionist, a sports psychologist, eight physician assistants, 17 nurses and four certified athletic trainers. Our skilled clinicians work with physical therapy staff to develop long-term treatment and activity plans for children, adolescents and young adults who have sports-related orthopedic injuries.

    Coping and support

    Even though you and your child understand the importance of resting his overuse injury, you may both experience his healing period as a difficult time. Fortunately, there are many resources for information and support available to you here at Children's:

    • In the Division of Sports Medicine at Children's, counseling is available to help injured athletes deal with the psychological stresses of a sports-related injury. Call 617-355-3501 to request an appointment.
    • With Children's goal of dramatically reducing overuse injuries in youth sports, members of the team in our Orthopedic Centeroften travel to local and regional schools, youth groups and sports clubs to teach leg strengthening and other techniques. We also conduct frequent safe training programs and clinics for coaches. Call 617-355-3501 for details.

    Outside resources

    The following websites may also be helpful to you.

    Please note that neither Boston Children's Hospital nor the Orthopedic Center at Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

  • Research & Innovation

    For more than a century, surgeons and investigators in the Orthopedic Center at Children’s Hospital Boston have played a vital role in the field of musculoskeletal research and have made major advances in the care and treatment of ailments such as spondylolysis. We take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their respective achievements.

    Clinical Effectiveness Research Center

    The Clinical Effectiveness Research Center (CERC) helps coordinate research and clinical trials to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and plays an instrumental role in establishing—for the first time—evidence-based standards of care for pediatric orthopedic patients throughout the world.

    Major areas of focus for the CERC include:

    Orthopedic basic science laboratories

    Working in our basic science laboratories are some of the leading musculoskeletal researchers in the nation. These orthopedic labs include:

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