![]() 3 The anterior shear, along with bony immaturity of adolescence are thought to be two of the greatest contributing factors making spondylolysis more common in the adolescent population. In young athletes, the spine is undergoing growth and re-modelling with full bony maturation of the pars interarticularis not occurring until the age of 25. 2ĭue to the anatomy of the sacral angle and the inferior facet of L5, a large anterior shear on the L5 pars interarticularis is created. 5 Moreover, earlier recognition of acute spondylolysis is associated with improved fracture healing. 5 Early diagnosis is important to prevent non-union which has been associated with an increased incidence of spondylolisthesis. 9 In the sporting population incidence of spondylolysis has been reported as high as 47-55% in adolescent athletes presenting with low back pain. Spondylolysis has a reported incidence of 6% in the general adult population and 4.4% in the paediatric population as a cause of low back pain. 2,5 Spondylolysis most commonly occurs in sports involving these movements, for example gymnastics, cricket, tennis, golf, football, hockey, athletics, swimming, and basketball. 4 The injury starts as a stress fracture, and can develop into a full fracture, non-union, and eventually a spondylolythesis. 2,3 The cause is most commonly a fatigue fracture, as a result of higher stress loads with movements combining compression and extension or rotation. 1 The fracture can be unilateral or bilateral and although any spinal level may be affected, 71% to 95% of lesions occur at L5 and 5% to 23% at L4. ![]() The pars interarticularis is a small isthmus of bone between the superior and inferior articular facets of spinal vertebra. Spondylolysis is a defect in the pars interarticularis of a vertebra. Finally, and crucially, it also underlines that to deem non-surgical rehabilitation ‘unsuccessful’ or ‘failed’, clinicians should ensure that (long-term) exercise was included in the conservative approach. It also supports existing evidence that passive therapeutic approaches should only be used as an adjunct to exercise, if at all in the management of spondylolysis. The report highlights the benefits of a graded program of exercise-based rehabilitation over the typically prescribed “12 weeks rest” prior to a return to the provocative activity. A 4-stage model of reconditioning is outlined, which may be of use to practitioners given the paucity of rehabilitation guidelines for this condition. The case presented herein outlines an inter-disciplinary, non-operative management of a 17-year old elite golfer with a moderate to severe presentation. Although non-operative interventions are deemed the gold-standard management for this condition, surgery is indicated for more severe presentations and cases of ‘failed’ conservative management. This is compounded by a culture which encourages very high practice volumes, typically poorly monitored. As such, young golfers are a high-risk group, particularly given the high shear and compressive forces associated with the golf swing action. Youth athletes participating in sports involving movements combining compression, extension and rotation appear most susceptible. The prevalence of spondylolysis amongst adolescent athletes presenting with low back pain has been reported as high as 47-55%.
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