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Stress Fractures


What are Stress Fractures?

A stress fracture occurs when the vertebrae take on too much stress, and tiny cracks form in the bone. Spinal stress fractures, also called spondylolysis, most commonly occur in the lower back, especially in the fifth lumbar vertebra. Stress fractures can also occur in the fourth lumbar vertebra, but this is much less common. Sometimes, stress fractures can weaken the vertebra so much that it shifts out of its proper position. This condition is known as spondylolisthesis. The bones may press on the nerves, resulting in pain, tingling, and numbness. In more severe cases, surgery may be needed to correct this problem.


Some people with spinal stress fractures will not have any symptoms at all. Others will have pain that spreads across the lower back. This pain is sometimes mistaken for a muscle strain. An X-ray can confirm the diagnosis of a stress fracture. If the fractured vertebra shifts out of place, patients may experience muscle spasms that tighten the lower back and hamstring muscles. The spinal nerves may also be compressed, which may result in sciatica.


Stress fractures are most common among athletes. Activities like gymnastics, weight lifting, and football put a significant amount of stress on the lower back. These types of activities also require the athlete to hyperextend or overstretch the lower back, adding to the stress.

Stress fractures in the spine are often the result of overuse. When an athlete performs the same motions repetitively, the muscles in the back can become fatigued, and can no longer absorb shock effectively. That additional shock is transferred onto the vertebrae, and can eventually cause the tiny cracks we know as stress fractures.

There may also be a genetic component to stress fractures. Some people may be born with thinner vertebral bones, making them more susceptible to stress fractures. Conditions like osteoporosis can also weaken the bones, increasing the likelihood of a stress fracture.

Potential Treatments

Initially, a spinal stress fracture is treated using conservative, nonsurgical methods. Patients will need to take a break from the activity that caused the stress fracture, as well as any other activities that put stress on the lower back. In most cases, symptoms will go away after a period of rest. In the meantime, patients can take over-the-counter anti-inflammatory medications like ibuprofen to help with pain.

In some cases, a back brace may be recommended to keep the back in proper positioning while it heals. Physical therapy may also be recommended to strengthen the back and abdominal muscles. Periodic X-rays may be ordered to monitor the fractured vertebra and make sure it isn’t shifting out of place. If the fractured vertebra continues to slip out of place after nonsurgical treatment, a spinal fusion procedure may be recommended. Rods and screws may be used to hold the vertebrae together as they heal.

If you suspect that you may have a stress fracture, seek the advice of a medical professional. If you can get treatment early on, you can reduce your risk of a more serious injury.