Stress Reaction

My son had this issue last year in college Fall ball.  Gutted through it for a couple of weeks.  Coach gave him off the final week of Fall practice and he rested another two weeks or so during the break.  Slowly resumed hitting before going back to school.  Did lots of PT and wore a brace.  Didn't do much conditioning while resting, but was in in excellent shape before that so didn't lose too much.  Was fine during season but started to flare back up toward the end of Summer ball after playing every day and long bus rides.  I think the only thing that he did differently was limit his additional BP sessions and not go heavy on the lifting.

I'm assuming we are talking potential Pars-Defect here? Get a CAT scan. "CT scanning is more rapid than an MRI, and provides better detail of the bones of your spine".

My son ended up with a bilateral pars-defect. Be warned, you wouldn't believe the extraordinarily bad advice we got from "well-qualified doctors". One of them from Riley's Childrens hospital, who told us that our son could continue to try to play sports, but pain would limit him. Yet here we are what, eight years later still playing ball pain free. All thanks to a chiropractor (who I considered witch doctors at the time).

Thank you for the replies so far.  This was a stress reaction in the pedicle, with no fracture.  Doctor who recommended the MRI and who gave us the diagnosis is double board-certified in Physical Medicine and Rehabilitation and Sports Medicine, with a special interest in non-operative spine management.     He definitely outqualifies me as to what testing to order or what the diagnosis should be, so I trust he will order a CT scan or other testing if and when he feels it is needed.  One advantage he cited when he recommended the MRI was the lack of radiation exposure to a young patient.

OK, so here's our story in detail. Kids back hurt. Went to a "specialist" who told us our son had a genetic disorder that would cause him to be a hunchback. Will never play sports. Riley's doctor stated disorder was very mild, don't worry about it, but sports are most likely out due to pain. Found chiropractor who was like "I know this, I got this". Kid needed a brace the chrio thought he couldn't prescribe. Sent him to another "specialist", who went off on the kid and wife. Told them to give up on sports, he would need care all his life, etc. Wife called me balling. Chiro managed to prescribe brace and the kid wore it for like three months while doing PT. Results? Numerous offers from DI's and an offer for a very late round draft pick.

Up to that point I thought chiropractors were akin to witch doctors. Made fun of the other parents on our team who took their kids to them. Boy was I wrong. The kid ended up with a bilateral pars-defect grade one. The vertebrae had moved 3mm. That freaked me out and told the chiro that. He informed me how joints, like the elbow, aren't held together by bone. Strengthen the muscle around them and all will be fine. Also read that people who have back problems in childhood can end up having less problems as adults because they learned how to strengthen and manage the spine as compared to other adults.

Really great story, SomeBaseballDad, and a GREAT reminder to keep an open mind while we move through recovery.  So happy for your son!

Bumping this back up in case anyone has any pointers for avoiding reinjury upon return to hitting, running, lifting.  Son is a very self-motivated switch hitter (self-taught) and although frustrated, has been diligently following doctor's and PT's instructions to rest and do PT exercises.  He has no pain right now, but has not been lifting, running, or hitting for weeks.  He  modified activities and stopped playing games 7 weeks ago and then shut down even swinging a bat or throwing following the MRI 3 weeks ago.  He has now completed about 7 weeks of PT.  Can tell poor kid has definitely lost weight (he was in great shape when the injury took place).  We will be rechecked by the doctor next week and it is possible my son will be cleared to resume some activities.  My biggest question is how to safely get back to training while avoiding the same injury?  He is currently missing training with his travel team and hopes to try out for his high school team in late winter/early spring.  I suspect the initial injury may have come from too much weight at the gym (impossible to know for sure), but my son also just pushes himself and was training very hard before the start of the fall season.  Thanks in advance for any advice or shared experiences!

I guess I'd be interested to know exactly what injury your son suffered. Mine ended up with a bi-lateral pars defect. The kid had to wear a body brace to three months I think, and do PT. At the end of the three months the chiropractor ordered another MRI. In the next visit he looked at the results and told him he was released, go have fun. He still does his core exercises. the only problems he has is a stiff back if he stands for long periods of time.

Like I said, pars defect grade I, which means the vertebra has slipped 3mm or less over the one under it. Freaks me out. Of course Andre Agassi won four majors with a grade II. And you would never know anything was wrong watching him.

https://twitter.com/IndStBaseb.../1527437456307634190

After the initial exam and negative X-ray (we visited the first orthopedic specialist available after my son confessed he was in so much pain he didn't think he could play the next day; that admission was a HUGE warning sign to me, because son loves playing almost more than anything else and has played with more minor injuries before), a muscle strain was suspected. After a follow-up visit to the spine specialist at the practice, an MRI was ordered, and the diagnosis was a stress reaction to the L-5 pedicle, with no fracture located. Discs and everything else were normal.

It is VERY encouraging to hear your son's story!

Bumping this back up in case anyone has any pointers for avoiding reinjury upon return to hitting, running, lifting.

So coming from an athletic trainer's perspective, the person who has a history of 'X' injury has an increased risk of that injury again, compared to someone who has never had it. That doesn't mean it'll happen, necessarily, it just means if we are comparing two people of the same age/playing level so on and so forth, the person who has a history of whatever injury has an increased likelihood of it happening again, usually.

The best advice would be when starting up after a break (say hitting and throwing), don't do too much too soon. A way to possibly monitor that would be asking "On a scale of 1-10, 1 being super easy and 10 being you're completely gassed, how hard was that training session for you?" and then maybe being more specific if they are a pitcher too or whatever.

So you could track that in a spreadsheet and say it should be an easy training session and they're saying "I feel like that was an 8/10" then maybe that means they need an extra day of recovery, or maybe they haven't been sleeping well and that is affecting their recovery. There's no correct answer to this per se, but this could be an option.

With training, lifting, running, they should be following some sort of program, and that program should have some sort of autoregulation in it. Hey I want you to do 3x8-12 reps with a couple reps in reserve. Well some days that might be 100 pounds, some days that might be 90 pounds (as an arbitrary example).

My biggest question is how to safely get back to training while avoiding the same injury?

His training should involve getting back to the activities required of him. They can play around with many different training factors. ROM, reps, sets, weights, tempo, but if we just shield someone from hitting and throwing and the lifting they'll do in their training, and then say, "Okay well you feel better now so I guess you can go off and do the thing," then that's not the best way to set up someone for success. Doesn't mean it can't work, just, it's not the best way to go about it.

So a conversation to be had could be "What is the next step to make sure we can get back to training safely? What are some things to look out for?"

@XFactor posted:

"So coming from an athletic trainer's perspective...

So a conversation to be had could be "What is the next step to make sure we can get back to training safely? What are some things to look out for?""

This is super-helpful - THANK YOU!

So....

@SomeBaseballDad posted:

So....

So far so good...kiddo was cleared by ortho doc and PT to return to baseball activities.  Do not think he liked having to avoid all of those weeks of lifting, running, and hitting one bit in favor of only doing PT exercises.  He has learned to strengthen the muscles that support that lower spinal area. He has now worked with a PT and an AT. So now the PT/AT exercises are part of his workout routine.     

Good to hear. Don't know it I mentioned it but while having spine issues early in life can be concerning, those who do can go on to have less issues later in life because they learn how to take care of their back. To this day he still includes the muscles of the lower spine in his workouts.

Son had a unilateral (one side) pars fracture.  We found a sports PT about an hour from our house and the owner had seen the injury numerous times in rotational athletes.   My son was in a brace for approximately 12 weeks and was not able to swing for 5 months.    He followed all the instruction of his therapist and never missed the at home work he was prescribed in between (core exercises).   A year later he has been playing with no restrictions at a high level with zero pain and zero flareups.  He continues to keep his core strong, wears a weight belt when performing squats and deadlifts, and he makes sure to keep proper form when lifting. 

There's also an excellent podcast out there discussing this injury by MLB recommended Dr. Watkins that is very informative.