Low Back & Pelvis

What It Is

One possible cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae (the bones that make up the spinal column). This condition is called spondylolysis. It most often affects the fifth lumbar vertebra in the lower back, and sometimes the fourth lumbar vertebra (AAOS, n.d.).

Some people may be born with vertebral bone that is thinner than normal, which may make them more prone to this condition (AAOS, n.d.). Spondylolysis can also occur in people of all ages without any injury or sport. If the vertebra goes on to slip forward (spondylolisthesis), in children and adolescents this most often happens during periods of rapid growth, such as a growth spurt (AAOS, n.d.).

Sports that involve frequent over-arching (hyperextension) of the lower back, such as gymnastics, football and weightlifting, make this more likely (AAOS, n.d.). Stress fractures are more common in young athletes and gymnasts (NHS, 2026).

Spondylolysis Anatomy

The vertebra is made of different sections. At the back of the vertebra is a small, thin bridge of bone called the pars interarticularis (the pars), which connects the upper and lower facet joints. It is the weakest part of the vertebra (AAOS, n.d.).

Due to repeated stress on the spine, this part of the vertebra can develop a stress fracture or crack, and this is known as spondylolysis or a pars defect.

Spondylolysis is hard to diagnose without a scan. X-rays taken from different angles, and sometimes CT or MRI scans, are used to confirm it (AAOS, n.d.). The pain can feel like more common mechanical low back pain or a muscle strain. Spondylolysis is often found by chance, sometimes years later, on an X-ray taken for another reason (AAOS, n.d.). It is not necessarily painful: it can be pain free or cause only minor low back ache. However, it can develop into a spondylolisthesis, which is where the vertebra slips forwards following on from a spondylolysis.

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

Treatment

Self-Care & Treatment

How to Treat Spondylolysis

Physical therapy is often recommended, with exercises to stretch tight hamstrings and strengthen the muscles of the back and abdomen (AAOS, n.d.). I can guide you through this with hands-on work and a graded exercise programme. See the My Approach tab for how I work.

1. Nonsurgical Treatment

The first treatment for this condition is nonsurgical, and for most people symptoms improve this way (AAOS, n.d.). Take a break from the sports and activities that are causing you pain.

AAOS OrthoInfo lists non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, as a way to help reduce swelling and relieve back pain in spondylolysis (AAOS, n.d.). (This medicine information comes from AAOS OrthoInfo, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

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

Options outside my scope

Back brace: some people, particularly athletes with recent sudden pain, may be given a brace to limit spinal movement and allow a recent fracture to heal (AAOS, n.d.).
Regular X-rays: your doctor may arrange X-rays from time to time to check whether the vertebra is changing position (AAOS, n.d.).
Surgery: if a slip is severe or getting worse, nerves are being compressed, or pain does not improve with nonsurgical treatment, an operation such as spinal fusion (joining the vertebrae with bone graft, often held with rods and screws) or a pars repair may be considered (AAOS, n.d.).

How I can help (see the My Approach tab)

Hands-on work for tight back, buttock and hamstring muscles
Exercises to strengthen your back and stomach muscles and stretch your hamstrings
A gradual return to sport

Tips

Gymnastics, football and weightlifting place a lot of stress on the bones of the lower back (AAOS, n.d.).
The pars is most vulnerable to repetitive stress and overuse (AAOS, n.d.), so allow your body time to rest between periods of activity.
If you notice changes in the way you walk, such as a stiff-legged walk caused by tight hamstrings, get your back checked (AAOS, n.d.).

Treatment

My Approach

Spondylolysis is a stress fracture at the back of a vertebra, usually from repeated over-arching in sport. My aim is to settle the pain, give the bone a break from the movements that stress it, and build the strength and flexibility that protect your lower back when you go back to sport.

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 start by assessing how your back and hips move, your posture, hamstring flexibility and trunk strength, and I check the nerves to your legs (sensation, reflexes and strength). I'll also ask about your sport and training.

While It Settles

Taking a break from the sports and movements that hurt, especially over-arching your back, while staying active in ways that don't
Hands-on work for the low back, buttock and hamstring muscles
Warm or cool applications in the clinic, and I'll show you how to use ice or heat safely at home
Gentle hamstring and hip flexor stretches, and holds for the deep stomach and back muscles

Building Strength

Bridges, side planks, bird dogs, partial squats and lunges, keeping your back steady
Gym-based strength work, with lifting technique coached so your back isn't over-arched
A home programme between visits
A gradual return to sport, building training back up step by step

Buttock and hip work needs your informed consent and a written consent form. Many people with this condition are teenagers; parents are welcome to sit in, with their child's agreement. If you've had surgery, I need your surgeon's okay before any hands-on treatment. If you get leg weakness or numbness, or the pain keeps getting worse, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, then less often as you take over the home programme, with a reassessment at about 4 to 6 weeks. Usually the pain settles over a few months, and a return to full sport often takes around 3 to 6 months.

What I Focus On

Assessment

Back & Hamstring Release

Trunk Strength & Control

Load Management

Gradual Return to Sport

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Spondylolysis and spondylolisthesis. 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–WaterlooSpondylolysis

What It Is

Spondylolysis Anatomy

Self-Care & Treatment

How to Treat Spondylolysis

1. Nonsurgical Treatment

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

Tips

My Approach

While It Settles

Building Strength

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooSpondylolysis

What It Is

Spondylolysis Anatomy

Self-Care & Treatment

How to Treat Spondylolysis

1. Nonsurgical Treatment

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

Tips

My Approach

While It Settles

Building Strength

Typical Course

References

Related Conditions

Acute Back Pain

Cervical Disc Herniation

Cervical Facet Joint Sprain

Cervical Spondylosis

Book a session