The forgotten aspects of lumbar stress fracture: a clinical perspective

Cossens, Phil Bach. of Physiotherapy, Master of Sports Physiotherapy, Atlas Sports Physiotherapy, Canberra, Australia 

How can it be that mobile athletic individuals are able extend their lumbar spine sufficiently to touch their thoracic spine to their buttocks?  Can lumbar flexion be a significant causative factor for posterior lumbar spine stress fractures?  Such questions are important to ask as part of clinical management of stress injuries to the posterior elements of the lumbar spine. 

Stress injuries to the posterior elements of the lumbar spine are commonly seen in the dance population, and therefore commonly treated by health professionals in this field.  One may perceive that diagnostic factors, assessment techniques and rehabilitation guidelines are well understood amongst those with an interest in dance medicine.  But questions should be asked; are we progressing our knowledge effectively to maximise the rehabilitative capacity for such injuries?

Evidence to support the presence of mobility within individual lumbar vertebrae is discussed within.  Such evidence demonstrates that cyclic lumbar flexion/extension movements may contribute to the onset of stress injury to the posterior elements of the lumbar spine.  When combined with factors such as direct weight bearing through the posterior elements, the presence of anterior shear forces, and abutment of adjacent bony prominences, the clinical consequences can be dramatic.  These factors are discussed with reference to the clinical implications during assessment, treatment and rehabilitation of the dancer with stress injury to the posterior elements of the lumbar spine.