I care for a lot of athletic teens, and while many of them participate in several sports, more and more ’tweens and teens now specialize in one sport. They may only play soccer or basketball, or be a gymnast, dancer or swimmer. In some cases, they practice or compete almost 365 days a year. I think they often are only off on the six holidays per year that our office is closed! They all work hard at their sport.

Recently, I’ve had more than a handful of elite young athletes, especially girls who are gymnasts, cheerleaders and dancers, come to me complaining of back pain. In most cases, lower back pain is musculoskeletal in nature and will resolve with anti-inflammatories (like ibuprofen), alternating ice and heat on the back, and a few days of rest. In some cases, however, the pain worsens, especially with activity, and further workup is required.

In several cases, the ongoing back pain is due to a spondylolysis, a fracture of the pars interarticularis of the vertebrae. The injury is akin to a stress fracture in other areas. It’s most commonly found in the pediatric population and is thought to be due to mechanical stress of the trunk with repetitive flexion, hyperextension and trunk rotation.

All of those maneuvers are the “usual” for a cheerleader doing back flips or a gymnast performing exercises with hyperextension. Young athletes who are into weightlifting and even children who carry heavy backpacks may be at risk.

The spondylolysis may show up on a plain X-ray of the back or may require a CT scan to see the fracture.

In our community, there’s some difference of opinion on how best to treat the condition. Unfortunately, it seems that the best treatment is rest, which may be for weeks or months. This is certainly not what a competitive young gymnast or star football player wants to hear.

Once the pain has resolved, a structured physical therapy program seems to be of benefit, as well. If conservative management for over a year doesn’t help, some orthopedists recommend surgery. Again, there are several different views as to the benefits of surgery in this age group.

If your child has persistent lower back pain that worsens with activity and hyperextension, you should think carefully about this condition and talk to your doctor. It’s becoming more prevalent as our kids compete at higher and higher levels.

Dr. Sue Hubbard is a pediatrician, medical editor and media host. Submit questions at