Lower Back Pain and Stress Fractures in Baseball and Softball Players

Have you or your kids ever complained of lower back pain after playing sports? If a young athlete comes to see us complaining of more than 1-2 months of lower back pain AND they play a repetitive sport that is rotational such as baseball/softball, there is a chance that athlete is dealing with a stress fracture.

Let’s learn more about this injury—what causes it, how to tell if you might have one, and what to do about it.

What Is a Stress Fracture in the Lower Back?

A lower back stress fracture is also called lumbar spondylolysis. A stress fracture is a tiny crack in a bone. In the lower back, it usually happens in a small bone called the pars interarticularis. This type of injury can happen over time when the same motion is repeated again and again—especially twisting, bending, and arching the back.

In pitchers, research shows it is more commonly on the non-throwing side of the lower back.

Which Sports Can Cause It?

Sports that involve a lot of rotation (twisting) are the most common cause of these stress fractures. Athletes in the following sports are more likely to get them:

• Baseball

• Softball

• Tennis

• Golf

This injury can also be more common in sports that have repetitive extension as well such as gymnastics and competitive cheerleading.

How Can You Tell If You Might Have a Stress Fracture?

Here are some signs you might have a stress fracture in your lower back:

• Pain in your lower back that gets worse with activity

• Pain on one side of your lower back more than the other

• The pain gets better with rest. A few days of rest can make the pain feel better, and longer periods of rest (weeks or months) it can go away entirely.

• Stiffness or trouble bending backward. Also, twisting towards that side or side bending towards it can cause pain as well.

• The pain might come and go at first, but it gets worse over time if you keep playing.

  
  

It’s important to know that not all back pain is a stress fracture, but if you play a sport with a lot of twisting and you have pain that won’t go away—it’s smart to get it checked out.

It's also important to note that many times these stress fractures can go undiagnosed for a long time as there are many athletes who have no pain.

Risk Factors That Can Lead to Stress Fractures?

There are a few criteria that can put an athlete at a higher risk for dealing with a lumbar stress fracture.

·       Playing a rotational or extension sport

·       High training volumes or playing one sport year round

·       An athlete who has poor strength and body control: We see this is more common in athletes who grow very quickly over a short period of time. This can leave their body control struggling. And after a growth spurt, they may have some newfound power to throw/swing

with more intensity but they don’t always have the muscle to control these movements.

stress fractures in baseball and softball players

What Should You Do If You Think You Have One?

If you think you might have a stress fracture in your back, stop playing and tell a coach, parent, or athletic trainer right away. Playing through the pain can make the injury worse.

You should also:

• See a sports physical therapist- We can help tell you if your symptoms look like a potential stress fracture or not. And guide you in the next steps.

• See a doctor—they will often order imaging to see if you have a fracture. Xrays and MRIs don’t always show stress fractures, so they may go with a CT scan or bone scan.

• Rest is very important. You may need to take 6–12 weeks off from your sport so your back can heal. In more severe cases, sometimes the rest required is longer.

• You may be told to wear a brace to help protect your back. This is not very common, but can still be found in some cases. Most research is suggesting that outcomes are similar whether wearing a brace to limit motion and help healing or not. We also don’t want to lose muscle and create stiffness in other areas due to wearing the brace. So for most athletes, we don’t recommend the use of a brace.

  
  

How Is a Stress Fracture Treated?

A stress fracture is an overuse injury. So the main treatment is rest and time. Here’s what it usually includes:

1. Stopping sports and physical activity that cause pain.

2. Physical therapy to help stretch and strengthen your back, core, and leg muscles. At Outshine, we can also help make sure your form with throwing, pitching, and hitting is good so you aren’t causing more issues.

3. Gradual return to sports—once your back feels better, your Doctor of Physical Therapy will help you slowly get back to playing.

4. In rare cases, if the fracture doesn't heal on its own, surgery may be needed.

   
   

Can You Prevent It?

You can lower your risk of a stress fracture by:

• Warming up and stretching before playing

• Strengthening your core muscles (your belly and back muscles)

• Using good form when playing sports. Do this by working with a Doctor of Physical Therapy that specializes in baseball and softball (like Outshine Physical Therapy and Fitness) or by working with a coach to help you improve your skills.

• Play multiple sports. This can help you prevent overuse injuries because you will have more variety in how you move and less repetition.

• Limit Your Throwing and Hitting. At Outshine, we can help you create a pitch count guideline and a general plan to make sure you aren’t overdoing it by practicing too much.

• Taking breaks and not playing through pain

  
  

Final Thoughts

Lower back stress fractures are common in sports that involve lots of twisting or bending backwards. If you have back pain that doesn’t go away, don’t ignore it. With the right care, most athletes can heal fully and get back to doing what they love.

If this sounds like you or a loved one, contact us for a free phone consult so we can help you decide what the next step should be to get over the pain and get back to activities.

Sincerely,

Dr. Sieara

Outshine Physical Therapy and Fitness

Book your FREE consult call here!