To reduce the strain on the lumbar spine, it is important to ensure the range of motion while maintaining flexibility of the trunk and the hip joint muscles, and strengthen the trunk muscles. Particular attention should be given to the limitation in a range of motion of hip joint, because the lumbar spine may compensate the movement (retroflexion of lumbar spine may compensate a limitation of hip joint extension), and that stress may contribute to the development of lumbar spondylolysis.
On-site evaluation and first aid
Points of evaluation at sports sites
Lumbar spondylolysis is characterized by retroflexion pain of the trunk and tenderness and recessus of the spinous processes (Photo 1). Retroflexion movements need to be checked whether the person does retroflexion with only the lumbar spine when seeing from the lateral side (Photo 2). In addition, growing athletes need to be careful if they have low back pain that lasts for more than a week. Athletes who are suspected of having the lumbar spondylolysis based on these assessments should seek medical attention.
Photo 1: Spinous process can be checked from the direction of the buttock to seek the tenderness.
Photo 2: Retroflexion movements need to be checked whether the person does retroflexion of the trunk with only the lumbar spine when seeing from the lateral side.
During the acute phase, when symptoms such as pain and muscle tightness are severe, physical therapy or stretching may help relieve symptoms. Physical therapy during the acute phase would be icing therapy (cryotherapy). Heat therapy, such as hot packs, may be used when the symptom become stable and in a chronic phase. On the other hand, stretching may be performed on the lower back, buttock, and thigh regions. Make sure to be careful not to increase hip joint extension or lumbar spine lordosis, which induces pain, in each movement (Photos 3 to 6).
Photo 3: Stretching the lower back
A: At sitting position, flexing the upper body roundly the entire back with the knees slightly flexed, with the legs open in a sitting position. With the legs opening in a sitting position and the knees slightly flexed, the upper body is flexed so that the entire back is rounded.
B: Using balls is effective.
Photo 4: Stretching the buttocks
Placing the upper body on the foreleg and stretch the left buttock in the photograph). Changing the position of the foreleg also changes the feeling of stretching.
Photo 5: Stretching the quadriceps
Make sure to be careful not to have pain by avoiding the lower back from diverting.
Photo 6: Stretching the hamstrings
The upper body is flexed as the athlete hunches the entire back.
When the symptoms subside, athletic rehabilitation progresses to the next stage. One of the causes of the lumbar spondylolysis is that retroflexion of the trunk is not done with pelvic retroversion or hip joint extension, but only with the lumbar spine. Thus, in athletic rehabilitation, stretching the hip joint extension and training of the abdominal muscles to encourage pelvic retroversion should be performed to reduce the strain on the lumbar spine during retroflexion of the trunk. Hip joint extension stretching is conducted in stages to the extent that pain is not present (Photo 7).
Photo 7: Stretching hip joint
Extension is done gradually from the neutral position
B: Stretching with partners
A trainer should stabilize the patient’s pelvis and conduct the stretching (The photo shows stretching on the left side for explanation, but he/she originally should be positioned on the same side with the athlete).
The exercise to tilt the pelvis backward is initially performed by the trainer while checking the movement (Photo 8-A). As the patient gets used to it, it can be done by himself/herself (Photo 8-B) and gradually proceed to the abdominal muscle training (Photo 9).
Photo 8: Exercise to tilt the pelvis backwards
A: The trainer puts his/her hands on the lower back and let him/her press the hands with the lower back.
B: The hands is placed on the lower back, and the lumbar region compresses the hands with contraction of the abdominal muscles. The athlete memorizes the movement that tilt the pelvis backward by a contraction of the abdominal muscle. The upper body is lifted to the extent that the navel can be seen.
Photo 9: Training of the Abdominal Muscles
For athletes with not only the lumbar spondylolysis but also low back pain, the important points of conditioning are to maintain flexibility around the trunk and hip joint, and to increase the trunk muscles.