Lower back pain · Young athletes · Booragoon

Does your lower back hurt when you arch backwards, bowl, tumble or return to training?

Maybe the pain settles when you rest, only to return as soon as sport gets more demanding. For a young athlete—or a parent watching from the sidelines—it can be difficult to know whether it's an ordinary sore back or something that needs closer attention.

One possible cause is spondylolysis, a bone stress injury in a small part of the lower spine. It is particularly relevant in sports involving repeated back extension, rotation or high training loads.

At Adaptive Physiotherapy & Massage in Booragoon, we start by understanding the symptoms, training demands and goals. When a stress injury is suspected, appropriate medical assessment comes first; rehabilitation then helps build movement, strength and confidence for a gradual return to activity.

What Is Spondylolysis?

Spondylolysis describes a stress injury or defect in the pars interarticularis, a small bridge of bone between joints at the back of a vertebra. It most commonly affects the lower lumbar spine, including L5. In some people, repetitive loading can contribute to a bone stress reaction that may progress to a fracture.

It is a recognised cause of lower back pain in adolescent athletes, particularly in sports that repeatedly load the spine in extension or rotation. It is not the explanation for every young athlete's back pain, and a pars defect seen on a scan does not always cause symptoms.

An important distinction

Spondylolysis is an injury or defect in the pars bone. Spondylolisthesis refers to one vertebra slipping relative to another. They can occur together, but they are not the same condition.

Common contributing factors

Repeated spinal loading

Sports such as gymnastics, cricket fast bowling and football can involve repeated extension, rotation or impact.

Training changes

Rapid increases in practice volume, intensity or competition demands may leave less time for adaptation.

Individual factors

Age, skeletal maturity, previous injuries and anatomical differences can influence bone stress risk.

Movement and capacity

Strength, control and tolerance to activity may be relevant to rehabilitation without being a single proven cause of the injury.

Symptoms that may occur

Localised lower back pain, sometimes worse on one side.
Pain with arching backwards, running, jumping, bowling or other sporting tasks.
Discomfort with longer periods of standing or training.
Symptoms that ease with reduced activity and return when training resumes.

These symptoms overlap with other back conditions. Neither the location of pain nor a single movement test can confirm spondylolysis.

When to seek medical assessment

Persistent or recurring back pain in a growing athlete deserves assessment, particularly when extension-based sport repeatedly triggers it. A GP or sports medicine clinician may consider imaging or referral. Seek urgent medical care for severe trauma, new or progressive leg weakness, numbness around the groin, or changes to bladder or bowel control. Fever or significant unexplained illness alongside back pain also warrants prompt assessment.

Assessment and Diagnosis

At Adaptive, a physiotherapy assessment in Booragoon may include a discussion of when symptoms began, which sporting activities aggravate them, weekly training loads, previous episodes, movement tolerance and a suitable physical examination.

Because spondylolysis involves bone stress, a physical examination alone cannot reliably establish the diagnosis. If it is suspected, we can recommend medical review for imaging decisions and coordinate rehabilitation with the treating clinician. Imaging choices depend on the presentation, age and clinical question, with MRI often considered when an active stress injury is suspected.

For a young athlete, our youth athlete physiotherapy service can support assessment, education and age-appropriate rehabilitation alongside any required medical care.

Evidence-Informed Treatment for Spondylolysis

Management generally begins with reducing activities that provoke the bone stress injury while keeping the person appropriately active. The aim is to allow recovery without unnecessarily losing strength or conditioning.

1. Initial Management and Activity Modification

Temporarily modify aggravating sport: high-volume back extension, rotation, repeated impact or other painful loading may need to be reduced or paused.
Maintain suitable activity: alternative conditioning and comfortable daily movement may be possible, based on the stage of injury and medical advice.
Manage symptoms: comfortable positions and simple symptom-relief measures may help, but do not substitute for appropriate activity modification.
Consider bracing selectively: a brace is not automatically required and should be discussed with the treating medical team.

Does physiotherapy have to wait until all pain has stopped? Not necessarily. Research in adolescents with confirmed active spondylolysis has found benefits from starting a carefully supervised, criteria-based physiotherapy program early. That does not mean returning immediately to full sport or loading a suspected fracture without assessment.

2. Manual Therapy — Caution Required

Hands-on treatment is not a way to heal the pars stress injury. Where appropriate, a physiotherapist may use gentle techniques for discomfort in surrounding tissues, but treatment should not reproduce significant symptoms or place unnecessary stress across the injured area.

Soft-tissue techniques for associated lower-back, hip or gluteal muscle discomfort, where suitable.
Advice about positions and movements that are comfortable during recovery.
Avoiding forceful manipulation or direct techniques intended to load the affected pars region.

Manual therapy is optional. The main rehabilitation priorities are appropriate load management, exercise progression and return-to-activity planning.

Exercise Rehabilitation for Spondylolysis

Rehabilitation is progressed according to symptoms, functional ability, the stage of the stress injury and advice from the treating clinician—not simply the number of weeks since diagnosis. The examples below are not a do-it-yourself program for a suspected fracture.

Core Activation & Controlled Movement

Early rehabilitation may introduce comfortable, low-load trunk control while temporarily avoiding provocative spinal loading.

Gentle abdominal bracing and breathing control
Modified dead bug variations
Supported bird-dog progressions, if tolerated

Strength Development & Load Tolerance

As symptoms and clinical findings allow, the focus shifts to developing physical capacity through progressively more demanding exercises.

Glute bridges and suitable hip strengthening
Side planks and anti-rotation exercises
Hip-hinge drills, progressing towards Romanian deadlifts when appropriate

Functional Strength & Return to Sport

Later stages rebuild tolerance to the specific positions, speeds and loads needed for sport. Extension and rotation are not necessarily avoided forever.

Squat, step-up and single-leg strength progressions
Controlled running, impact and plyometric progressions
Gradual reintroduction of sport-specific extension, rotation and technical demands

At Adaptive, progression may connect with our physiotherapy sports rehabilitation program when suitable for the individual and their sport.

Returning to Sport

Being pain-free during everyday activities is encouraging, but it does not automatically mean the spine is ready for full training. A return-to-sport plan considers whether the athlete can tolerate repeated movements, increasing training loads and the demands of their particular sport without a significant return of symptoms.

Build trunk, hip and lower-body strength progressively.
Reintroduce spinal extension and rotation when clinically appropriate, rather than avoiding them indefinitely.
Increase practice volume and intensity in manageable steps.
Coordinate decisions with the athlete, family, coach and medical team as appropriate.
Reassess symptoms and function throughout the return-to-sport process.

Recovery timelines vary. Some athletes return sooner than others, and rehabilitation should account for the type and stage of the bone stress injury rather than promising a fixed date.

Long-Term Management

Once an athlete has returned to activity, maintaining strength and managing training load remain useful. Rather than trying to achieve a single “perfect” spinal posture, the emphasis is on building tolerance to the movements the sport requires and allowing enough recovery between demanding sessions.

If back pain returns with increased training, it is worth reassessing the load and seeking advice before continuing to push through symptoms.

Concerned About Back Pain During Sport?

If you or your young athlete has recurring lower-back pain—particularly with arching, bowling, tumbling or other demanding movements—an assessment can help clarify the next step. At Adaptive Physiotherapy & Massage in Booragoon, we can assess movement and symptoms, recommend medical review when a bone stress injury is suspected, and guide rehabilitation when appropriate.

27 Shields Crescent, Booragoon WA 6154

Book a Physio Appointment Call (08) 9468 3555

References

Selhorst M, Allen M, McHugh R, MacDonald J. Rehabilitation Considerations for Spondylolysis in the Youth Athlete. International Journal of Sports Physical Therapy. 2020;15(2):287–300. Read publication.
Goetzinger S, et al. Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management. Journal of Sports Medicine. 2020:9235958. Read publication.
Immediate physical therapy is beneficial for adolescent athletes with active lumbar spondylolysis: a multicentre randomised trial. British Journal of Sports Medicine. Read study.
Royal Children's Hospital Melbourne. Spondylolisthesis – Spondylolysis: Clinical referral guidance. Read clinical guidance.

This information is general and does not replace individual medical assessment. Exercise selection depends on injury status, symptoms and clinical advice.

Spondylolysis: Causes, Treatment, and Rehabilitation