Low Back & Pelvis

What It Is

Stress fractures of the lower back, and the slipping of a vertebra that can follow, are common causes of low back pain in children and adolescents, especially those who play sport (American Academy of Orthopaedic Surgeons, n.d.). A stress fracture in the lower back is known as spondylolysis. If the vertebra then slips forward, this is called spondylolisthesis (American Academy of Orthopaedic Surgeons, n.d.). The terms can be confusing, so here is how the story unfolds.

If there is enough repetitive strain going through the spine, especially with the back repeatedly overstretching backwards (as seen in gymnastics, football and weightlifting), you can develop what is known as a pars defect (American Academy of Orthopaedic Surgeons, n.d.). What is a pars defect? It's a small crack or stress fracture in the pars interarticularis, which is like a small, thin bridge of bone at the back of the vertebra. The other name for a pars defect is spondylolysis.

In some cases, the stress fracture weakens the bone so much that the vertebra slips forward slightly on the one below. This is called spondylolisthesis (American Academy of Orthopaedic Surgeons, n.d.). If you are confused at this point, don't worry, as it is quite complicated. Spondylolisthesis is not the same as a slipped disc (NHS, 2026).

In children and adolescents, the slip most often happens during periods of rapid growth, such as a growth spurt (American Academy of Orthopaedic Surgeons, n.d.). There are five lumbar vertebrae at the base of the back. The most common site for this condition is the lowest lumbar vertebra (L5), and sometimes the one above it (L4) (American Academy of Orthopaedic Surgeons, n.d.). This is where the pelvis and the mobile lumbar spine meet, and it is the area that takes the most stress when playing sports.

Lumbar Stress Fracture Anatomy

Understanding your spine and the way it works will help you understand what is causing the pain in your lower back. Your spine is made up of many small bones (vertebrae), stacked one on top of the other. Ligaments, muscles, intervertebral discs and nerves are the other parts of your spine.

The vertebrae connect to form a canal that protects the spinal cord. The spinal column has three sections creating three curves in the back: the neck (cervical), the chest area (thoracic) and the lower back (lumbar). The lowest part of the spine (the sacrum and coccyx) is made up of vertebrae that are fused together.

How it is diagnosed

If you think you may have a serious back problem, talk to your doctor. X-rays are usually used to look for a stress fracture, and an X-ray taken from the side shows how far a vertebra has slipped. A CT scan can give more detail, and an MRI scan can show an early injury to the pars before it is visible on X-ray, or whether a slipped vertebra is pressing on the nerves (American Academy of Orthopaedic Surgeons, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Lumbar Stress Fracture

Physiotherapy or sports rehab is one of the main treatments: specific exercises can improve flexibility, stretch tight hamstring muscles and strengthen the muscles of the back and abdomen (American Academy of Orthopaedic Surgeons, n.d.; NHS, 2026), and can also help to prevent future problems (American Academy of Orthopaedic Surgeons, n.d.). Working within your medical team's plan, I can guide you through these exercises and ease tight back and hamstring muscles. See the My Approach tab for how I work.

Non-Surgical Treatment

Initially, treatment for this condition is usually non-surgical. Avoid sports and activities that make your symptoms worse, such as bending, lifting, athletics and gymnastics (NHS, 2026; American Academy of Orthopaedic Surgeons, n.d.). The NHS (2026) lists anti-inflammatory painkillers such as ibuprofen as a common treatment for spondylolisthesis. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.) In most cases, you can gradually return to sport and other activities.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Back brace: some people, mainly athletes whose pain has come on recently, may be given a brace to limit movement of the spine so that a recent fracture can heal (American Academy of Orthopaedic Surgeons, n.d.).
Prescription painkillers: stronger painkillers are available on prescription (NHS, 2026).
Steroid injections: an injection into the back to relieve pain, numbness and tingling in the leg (NHS, 2026).
Surgery: if other treatments have not worked, a specialist may consider spinal fusion, where the slipped vertebra is joined to the bone below with metal rods, screws and a bone graft; a repair of the pars fracture; or a decompression to relieve pressure on trapped nerves (NHS, 2026; American Academy of Orthopaedic Surgeons, n.d.). Recovery from surgery can take several weeks or months, so follow your surgical team's own instructions.

How I can help (see the My Approach tab)

Exercises for flexibility, hamstring stretching and back and abdominal strength
Hands-on work for tight back and hamstring muscles
A gradual return to sport, once your medical team agrees

Tips

Avoid prolonged periods of extending or arching your back if you have this condition.
Periods of rapid growth can make a slip of the vertebra more likely in children and adolescents (American Academy of Orthopaedic Surgeons, n.d.).
Sports such as weightlifting, football and gymnastics place a lot of stress on the lower back, because they make the athlete repeatedly overstretch the spine backwards (American Academy of Orthopaedic Surgeons, n.d.).
The condition can cause muscle spasms that stiffen the back and tighten the hamstring muscles, which can change the way you walk and stand (American Academy of Orthopaedic Surgeons, n.d.).
The pain is usually in the lower back, may feel like a strained muscle, and tends to get worse with activity and better with rest (American Academy of Orthopaedic Surgeons, n.d.).
Many people with these conditions have no symptoms at all (American Academy of Orthopaedic Surgeons, n.d.).

Treatment

My Approach

A lower back stress fracture needs time away from the sports and movements that strain it. Your doctor decides when you can return to sport, and I work within their plan. If the pain stops your normal daily activities, or you've had surgery, I need your medical team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

I assess how your back and hips move, your hamstrings, and the strength of your trunk and hips, without pushing into painful positions. Parents are welcome to sit in, with their child's agreement.

While It Heals

Hands-on work for tight back and hamstring muscles, without mobilising the injured part of your spine
Gentle hamstring stretches and finding a comfortable, neutral position for your back
Deep trunk and hip strength, starting with gentle holds

Getting Back to Sport

Building up to bridges, squats, lunges and heavier strength work
Reviewing anything that arches your back under load, whether in gymnastics, football or lifting
A graded return to sport, once your medical team agrees

After surgery, once your surgeon is happy, I help with swelling, stiffness, scar work once the wound has healed, and the muscles that have been compensating, then a gradual return to strength.

What to Expect

Typical Course

Typical course: Visits are usually weekly while the fracture heals, then once or twice a week as we build strength for sport, then less often. Most people get back to sport over a few months, following your medical team's plan; recovery after surgery can take several weeks or months.

What I Focus On

Working Within Your Team's Plan

Hamstring & Back Release

Trunk & Hip Strength

Technique Review

Gradual Return to Sport

Please read

When to See a Doctor First

When to see your family doctor or nurse practitioner

See your family doctor or nurse practitioner if you have lower back pain, or pain in your thighs or bottom, that does not go away after 3 to 4 weeks; pain, numbness and tingling down one leg for more than 3 or 4 weeks; difficulty walking or standing up straight; or other symptoms such as a high temperature, sweating at night or weight loss you cannot explain (NHS, 2026).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Spondylolysis and spondylolisthesis. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/ (Accessed: 7 October 2026).
NHS (2026) Spondylolisthesis. Available at: https://www.nhs.uk/conditions/spondylolisthesis/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooLumbar Stress Fracture

What It Is

Lumbar Stress Fracture Anatomy

How it is diagnosed

Self-Care & Treatment

How to Treat a Lumbar Stress Fracture

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It Heals

Getting Back to Sport

Typical Course

When to See a Doctor First

When to see your family doctor or nurse practitioner

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooLumbar Stress Fracture

What It Is

Lumbar Stress Fracture Anatomy

How it is diagnosed

Self-Care & Treatment

How to Treat a Lumbar Stress Fracture

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It Heals

Getting Back to Sport

Typical Course

When to See a Doctor First

When to see your family doctor or nurse practitioner

References

Related Conditions

Ankylosing Spondylitis (AS)

Cervical Spondylotic Myelopathy

Coccydynia

Coccyx Fracture

Book a session