Lower back pain, as a result of the stresses of sport is common and is due to the tremendous amount of force transmitted through the spine while throwing or kicking a ball. These high forces may lead to repeated compression of the spine which is vulnerable in the young athlete. In adolescence and as the body grows, the skeleton is not fully developed. An environment of high compression forces on an immature skeleton with insufficient rest may result in a stress fracture. However, the injury is believed to be gradual and it is not known when it develops. Individuals with stress fractures may go asymptomatic throughout their adolescent and adult years without experiencing pain. High clinical suspicion should be paid to an adolescent fast bowler presenting with lower back pain.
Examination will commonly reveal pain in the lower back with specific manoeuvres, however in highly irritable presentations most movements will elicit some discomfort. Testing the functionality and movement will allow a physiotherapist to guide on specific management. Testing of the lower limb and core function are critical components as any injury or dysfunction may lead to secondary overload of the lumbar spine. There may be tenderness in the lower back and protective muscle spasms around the area. The diagnosis is further confirmed with further investigation which may be with MRI, CT scan, Bone scan, etc. This will reveal high irritability over the affected area.
Conservative management is the most common treatment and results in excellent outcomes for return to sport. The management of stress fractures include a period of rest from aggravating activities and participation in sport. The individual will continue with normal daily activities and will work on improving core control. Return to sport is normally achieved within three to six months and focuses on pain free completion of returning to sport criteria.