Spondylolysis

Prefersummer,
It depends very much on the staging of the injury. If it is an old injury that is unlikely to heal with bone then the typical treatment is to place the patient in a brace for a few weeks or until the pain is gone and then to do physical therapy and gradually resume playing.

If the injury is new and has the potential for bony healing then the patient is typically placed in a brace for several months and is kept out of sports for several months in order to give the injury a chance to heal. The amount of time off varies from doctor to doctor and from patient to patient. Some doctors will allow the patient to resume play while still in a brace after a couple months if they are pain free. Others won't. Also not every doctor uses brace treatment but most do.

One thing I strongly recommend for treatment of Spondylolysis is Low Intensity Pulsed Ultrasound. Ask your doctor about it. The units cost around $4,000 when purchased through insurance but they are available for about a 1/10 of that or less on ebay.

Do not mistake the low intensity ultrasound for the treatment one would get from a physical therapist for strains or sprains. That is therapeutic ultrasound and treatment at those levels would be bad for the spine.

Generally players that have this want to avoid hyperextension exercises and other exercises that put large loads on the back. Improperly done weightlifting or just too heavy of weightlifting can be bad if the back isn't fully healed. Sprints can also be bad due to the impact. The most important thing is to shut down the sports activity for as long as the doctor tells you to. Usually pitching is the hardest thing on the back relative to spondy due to the combination of twisting and hyperextension. Other activities which often result in Spondylolysis are being a football lineman, wrestling, gymnastics and ballet dancing all due to hyperextension of the back.
Not an injury you want to have.Its the one that just ended my playing days this past week

Typically,it can be pretty painful from the onset. As time goes on,you still feel tight,and generally a discomfort in the lower back,whether its standing long periods of time,or even something simple such as sleeping on your stomach.

The textbook recovery is 12 weeks. I have had this injury 2 different times,Junior and now senior year. The first time It did take only 3 months,and then some rehab. This second time,it has taken 7 months and counting. You will be put into a brace,that goes from roughly the bottom of your belly button,to right under your pex. It is not pleasant,its bulky,but you adjust eventually.I wear mine all day,until I shower each morning and night.

The doctor will likely tell you that you can still work your upper body with light weights.Avoid this for the first 2 months,because you will regret it. Look into getting a bone growth stimulator. They are expensive,but it has helped me some now,just very slowly.

When you are released,its so important to take it nice and slow.I will have back issues the rest of my life now,because I rushed back the first time,and really went at it hard in the weight room.

some problems include never really feeling like you are stretched out before games,and tightness on cold weather days. Other things include some days you will just struggle to swing,because you will just feel "tight". After you do heal, you generally feel very tight,most of the time.One thing that helps is whirlpools and heated pads.
Futurecatcher27-
I'm sorry to hear that this injury is ending your playing days. It will take a while to deal with that.

How long did your back hurt before you got the brace? How quickly did you get back into full stride in playing? Was there any pain upon returning? Did anything specific happen to reinjure your back, or do you think it was just not healed enough?

Did your dr identify the break through an x-ray, mri, or bone scan? Did you get another one done before being allowed to play again?

Thanks for sharing your story.
My son went down with this injury several years ago. He was totally restricted in a Boston overlap brace for three months. It is not an easy thing for a kid to deal with. Thankfully we caught it early and it has healed. It took about 4 months before he was able to get rid of the brace and begin reconditioning. I do know of a few athletes that have had this injury and went on to have back surgery to repair it. It is not something that you should consider unless it is unavoidable. They have returned to sports after this surgery. It is a tough thing to have to deal with, I know every time my son gets a muscle spasm in his back we start to think the worst but so far he has been very fortunate in not having a recurrance.
Prefer,

They tried to have me stretch from the onset,and that only made things worse.Do not delay the MRI,and stay on the doctor and demand it.You will not regret this.After about 5 weeks,they did an MRI and put me in a very large back brace.Get into one as fast as possible,and wear it all day everyday,even when sleeping.

The first time,after sitting for 3 months,I was able to workout and play again.I didnt feel really like I had my baseball game back until july,despite being cleared and playing in early january.It takes time to get your swing back,get back into shape,and get strong again to compete at a very high level. Take plenty of time to work the core once you can.

There was pain after returning,mostly just a very constricted feeling in the lower back,maybe its because I catch. Take plenty of time to stretch before games,break a sweat before the game it helps. It helped me to stretch job before games. I dont think I did anything specific to reinjure it.I worked out very hard last summer,since I was going to camps like PG,kansas state,MLBSB,etc and wanted to be as big and strong and fast as possible.Just be smart and know when enough is enough.I think this is what caused it to fracture again

It was identified the first time through MRI,2nd time through CT scan. Again,demand the MRI or CT scan. It isnt worth it to stretch and just sit out. While you are hurt,you can use a stationary bike,and do light upper body workouts like curls and shoulder work with a weight I`d say no heavier then 20lbs.
Something you all might want to look into---my hospital and CT/MRI people give me a copy of the scans within 15 minutes after the procedure--- I take it home with me so I have it to take to my personal doctors---the hospital also keeps a running record of the scans and wheneve I go in the can make comparisons right there and then

It is truly weird looking at your own MRI or CT scan on your own computer
It is also important to look at the radiologist's report and to discuss it with the doctor. I've seen doctors misread bone scans, radiologists misread MRIs and CT scans. One time we had to tell the doctor to read the radiologist's report after which he changed his opinion and apologized. Another time we went for a second opinion and both the doctor and the radiologist at Kerlan-Jobe both of whom are considered among the world's best had a completely different reading of an MRI from that given by the radiologist at the imaging center and with the CT we got copies of the scans for ourselves and could see significant healing yet the radiologist who had evidently only taken a cursory glance said there was none. The doctor looked at it and was thrilled with amount of healing.
Thanks for all the responses.

My son has been wearing a brace for 6 weeks and feeling no pain. He started physical therapy today. Apparently his posture has a lot to do with causing injury to his back, so the first step is improving his posture. He will continue PT and possibly start throwing a little in a couple weeks. I hear only positive comments on the PT and his doctor, so we're hopeful for a complete recovery.

It's really tough missing the entire high school season, but he's expecting to be able to be back for the Legion season beginning in June. He'll start playing outfield and work back into pitching slowly. Fortunately, his coaches have been very supportive.
This injury is really more common than people know. My son started playing again last week and so far is feeling good. He had a CT scan that showed he has fibrous healing and continues to do the exercises the PT taught him to strengthen his core and better align his back. He is playing outfield and hitting mostly every other game. He will pitch about 20-30 pitches in a game this weekend.

My son wore his brace and remained completely inactive outside of PT for 11 weeks. He went to a great PT who explained how important back alignment is and helped him really strengthen his back.

Time away from activity is crucial to healing. It was not easy for my son to watch the entire HS season from the dugout, but necessary.

Good luck to your son.
Are you all sure you are discussing the same medical/spinal condition?
There is a difference between spondylosis and spondylolisthesis. Many descriptions about braces and the like sound like spondylolisthesis, not spondylosis.
I am not a doctor but worked as a trainer for a bit in college and have done enough work in the workers comp arena to know there is an important medical difference.
A brace is often used for spondylolysis too. You're right that there is a difference between the spondies. Spondylolysis is a lumbar bone fracture and spondylolythesis is when there is slippage of the L4 or L5. The brace helps stabilize and support the back to allow either fibrous or bony healing in spondylolysis. It also serves as a reminder for adolescents who might be tempted to do too much.
prefer,
Bony healing is nice but not necessary and as long as there's no synovial fluid trapped in there it should be good to go as long as he keeps up with PT and pays attention to any warning signs. Good luck and I hope you've seen the last of it.
I'm sorry I did not notice this post earlier. My son, who is just finishing his junior year, had this same injury. His injury occured in August 2007. He was able to throw off flat ground fairly quickly, but had difficulty pitching, or more specifically throwing from a mound, until this spring 2009. He went through a year as a position player only. I had talked to someone else on this site who's son went through a simular recovery time. What I'm saying is don't be surprised if he has a 12-18 month recovery time before he can pitch again without pain. The good news is my son has recovered. Please make sure he continues to do the PT and core work afterwards. This is very important. Good luck!
It's really great to hear from so many regarding their experiences with this injury.

My son is feeling great so far except for the normal adjustments getting back into shape. His coaches have been great about easing him back into games. They've shown they have confidence in him by playing him in centerfield and in batting order, but are careful by not allowing him to play double-headers so far. He pitched two innings last weekend, but was on a careful pitch count. He felt great and did pretty well against a good team.

The complete inactivity for 3 months and PT is very important in recovering from this injury. We'll be monitoring our son closely throughout the year to be sure he remains pain free.

Please keep posting other experiences. I will update now and then.
Hi, very interesting findings in this forum. My son just turn 12 and started feeling back pain in his right side lower back only when swinging from the left side(he's a switch-hitter.) It was basically while batting practice after 10-11 swings. No pain while throwing or doing other things. I took him directly to a spine orthopedist Dr. He ordered a CT scan and a bone scan. I was almost sure he had spondylolysis. To my surprise both test came negative. So, Dr. ordered an MRI. MRI report says: L5-S1: marrow edema in the rigth pedicle and pars consistent with a stress fracture. CT correlation helpful.
My question is: is this only a stress reaction? Why does the marrow edema doesn't show on the CT and bone scan? Dr. says there's no fracture but he ordered a brace for 6 wks. I just want to make sure there is really no fracture. Thanks! This forum is awesome and good luck to all.
I'm pretty surprised that nothing showed up on the bone scan, but you wouldn't expect the oedema to show up on a CT scan. Perhaps you've caught the problem too early even for a bone scan. The doctor seems to know his stuff. The reason for putting him in a brace is that even though there isn't a fracture now, there could be one in a few weeks. It is very possible that the situation will get worse before it gets better (I hope that isn't the case.) so the brace is a wise precaution. The first step that the body takes in healing a bone injury is to clear away the damaged bone. That happens well before the body starts building new bone to replace the damaged bone. As a result when there is a sudden increase in activity a stress fracture can result even after the offending activity has been halted.
Thank you CADad. Below there's some history:
Late April - started feeling some mild pain during batting practice as a lefty. (I decrease intensity of practice).
June 2 - I decided to stop playing him.
June 11 - Bone Scan and CT scan performed (both negative). I requested and saw the final reports.
June 20 - MRI performed (marrow edema on left par)
June 22 - Dr. ordered an LSO custom made for 6 weeks.(will have it for Tuesday).

Will appreciate your thoughts and what's your opinion on any follow-up exam. Which type of exam is better for follow-up ? and, What would be a good time to perform it? 8 weeks? I think the Dr. is doing a good job. I was well educated before going to the first visit and he seems very open-minded. I remember on the first visit Dr. ordered a CT san, but I asked about the SPECT and he agreed to do both. My son still young, I just want to make sure he is well healed for the future. He finished his season a little bit earlier due to this and hit 9 HR's with his travel team. (4 of them in a row in a single day). Do not want to rush him in any way. Thanks.
Generally as long as there's no pain after 6 weeks in the brace and then PT after that there wouldn't be any follow up imaging unless the pain continued.

If there was a need for imaging then CT is usually the way to go. The key with CT is to only cover the area in question so as to minimize the radiation.

You might want to talk to your doctor about Low Intensity Pulsed Ultrasound. Some doctors will recommend it. Insurance won't cover it so you have to get the units on ebay. They'll cost from $200 to $400 on ebay.
The CT and bone scan (both negative) were done 7 weeks after the symptoms started. Do you think that the fracture could develope after those 7 weeks? Thanks!

The claims for the pulsed low intensity ultrasound looks promising, I will ask the doctor. Thanks.
Take as long as the doctor suggests to let your son really heal. Too many parents give in to their kids, who tell them they feel fine, and allow them to play again too soon. If an injury is allowed to really heal, it's less likely to cause future problems, right?

My son had a CT scan that showed fibrous healing before he was given the okay to be active again. He's continued with the core exercises and has not had any problems since returning to the field.

I know this is an old thread,  I was wondering where the pain manifested.   My son has been dealing with pain in hip/back region but closer to pelvis.     not in the joint itself but a little higher up.   I am thinking he has a slight sprain in the SI joint.     He's 15,  throws hard,  mid 80s  and slipped on wet grass long tossing about 6 weeks ago.    He kept trying to play on it,  but it just never seemed to heal.    He can throw with no pain but only to a point,  if he tries to really air it out he feels a sharp pain in that spot.      xrays were negative and have only been dealing with a chiropractor,   works with the Astros so knows his stuff but I do have a ortho apt in a few weeks in case it persists.   we shut down baseball for now,  lost summer unfortunately.  

gunner34 posted:

I know this is an old thread,  I was wondering where the pain manifested.   My son has been dealing with pain in hip/back region but closer to pelvis.     not in the joint itself but a little higher up.   I am thinking he has a slight sprain in the SI joint.     He's 15,  throws hard,  mid 80s  and slipped on wet grass long tossing about 6 weeks ago.    He kept trying to play on it,  but it just never seemed to heal.    He can throw with no pain but only to a point,  if he tries to really air it out he feels a sharp pain in that spot.      xrays were negative and have only been dealing with a chiropractor,   works with the Astros so knows his stuff but I do have a ortho apt in a few weeks in case it persists.   we shut down baseball for now,  lost summer unfortunately.  

I would try to move up that appointment with the orthopedist if you can...

My son had bi lateral pars, Broke both l5 vertebrae (ears or spondy as they called it) though not at the same time. We did take a couple of weeks off seeking several  opinions from different specialists. Never needed a back brace and started rehab work about 3 weeks after diagnosis. Looking in the mirror he was physically strong however his core was weak, that where the rehab was extremely beneficial. Son missed his high school season but is playing summer ball currently with no issues. There are specific warm up exercises and continued training that he does to help protect that area and so far so good. Spondylosis is not a baseball death sentence for everyone. Hope your son can continue his career.

Our son has a bi-lateral break with 3mm of movement. It occurred almost 6 years ago. I think it was just one side when we saw the first spine specialist. He miss diagnosed the problem and said keep playing as long as you can deal with the pain. I believe that's when the second break occurred. The next specialist knew what was wrong but said nothing could be done, back will always hurt, deal with it. At that point took him to a chiropractor who came highly recommended. He put the kid in a brace, gave him physical therapy and a road map forward. Like I said, it's been six years now and all he complains about is his back will stiffen if he stands for long periods. 

One thing I'll add. The chiropractor sent us to a third specialist to get fitted for the brace. The guy refused to do it. Told my son he will most likely not be able to play baseball, for sure would never get a scholarship or be drafted. My wife left the office in tears. I've always wanted to go back and be like "guess what bitch".

Also, our son's movement was grade 1 out of 4. Andre Agassi won four grand slams with a grade 2. 

so found another ortho   hip specialist to see him earlier.    No pain whatsover in the exam,   said the only pain in throwing at 100%.    xray negative,   where the injury is the ortho said he's 99% sure he has irritated a tendon and that its fine,   can play now if he wants  but that it likely needs 6 weeks of rest to get it too fully settle down.   so just a matter of whats important.   

Hi Gunner, good to hear. You’re doing the right thing by looking for a second opinion. 

By experience these types of pains are usually only felt when the movement is performed. In this case throwing at high velocity. No manual manipulation by any specialist will replicate the forces that occur when pitching (or swinging). If I were you, I would give the kid 4-6 weeks of break from what’s causing the pain. If he continues with the movement, the injury (yes is very minor now) will get worse. He can continue doing other stuff that doesn’t cause pain. Think about his future. 4-6 weeks now is nothing compared to where he’s going to be in 2-4 years.

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