Lumbar Hyperextension Injury in Young Athletes

by Alyssa Kendrick, OMSII, RN

Hyperextension Injury of the Lumbar Spine:  What is it?

What do Olympic gymnasts, world champion rowers, and NFL linemen all have in common? Without a doubt, they are all elite athletes working extremely hard to master their craft, but they are also all individuals who are at an increased risk for a lumbar hyperextension injury.

Whether someone is a young competitor at the highest level or just starting out their first season, it is vital to acknowledge the risk of a lumbar hyperextension injury especially in particular sports. Lumbar hyperextension injuries occur when the lower level of the spine is bent backwards, or arched, past the normal anatomical position repeatedly.1 Such additional, repetitive stress may lead to serious complications and damage to the bones, or vertebrae, and nerves in the back.

Complications of lumbar hyperextension injuries:

Specific complications related to lumbar hyperextension injuries include:

  • Spondylolysis
  • Spondylolisthesis

    Spondylolysis occurs when one of the vertebrae in the spine develops a break or fracture due to the stress of the lumbar hyperextension.3 Figures 1A and 1B point out the common location for this fracture in the vertebra in spondylolysis: the pars interarticularis.

    A further complication of lumbar hyperextension injury and spondylolysis is spondylolisthesis. If the fractured area of the pars interarticularis becomes too weak there is a risk of it breaking off completely.2 The vertebral body can no longer remain in the correct alignment, and it will naturally slip forward as seen in Figure 1C. This can lead to both damage of the surrounding nerves and damage to the discs that provide cushion between each vertebra.  Further and even more serious complications such as cauda equina syndrome may develop if treatment is not sought out.2

    To find further video animation on both spondylolysis and spondylolisthesis please visit: Spondylolysis and Spondylolisthesis

    Who is at risk?

    Although any individual participating in stressed lumbar hyperextension is at risk, young athletes are at a particular increased risk for lumbar hyperextension injuries including both spondylolysis and spondylolisthesis complications. Growing adolescents are at risk because of tighter back and hamstring muscles due to rapid bone growth. Those young athletes participating as gymnasts, rowers, linemen, and weightlifters are at an even higher risk due to the increased hyperextension required of these activities.1

    Signs of Lumbar Hyperextension Injury:

    When looking for signs of a lumbar hyperextension injuries, the first noticeable sign is lower back pain that is severe while lasting at least a few days or becoming more intense over time.2  However, this may be vague and hard to distinguish from other injuries such as strain to the surrounding muscles, disc herniation, and stenosis.2 Lower back pain that worsens on extension, or arching the back, in addition to muscle spasms, stiffness, radiating buttock and thigh pain, tight hamstrings, and difficulty standing or walking may also be indicators of a lumbar hyperextension injury.1,2 Signs in adolescents and young children may include complaints of low back pain that persists for more than 2-3 weeks and worsens with extension or twisting.1

    How can I prevent it?

    In a perfect world, prevention of lumbar hyperextension injury involves avoiding any strenuous arching of the lumbar spine.  However, this is unrealistic for almost all athletes of any age.

    As parents of children who are at risk, consistently promote active stretching of the hamstrings before and after all activities.1 Adequate warm-up and cool-down periods are also beneficial.1 Never encourage movement of the spine during athletic activity that initiates pain from the athlete. When in doubt, seek care and guidance from a physician who specializes in the spine.

    As an athlete, pay special mind to the form of every skill performed that involves lumbar hyperextension. Ensure that the movement remains as controlled as possible and strive to master the form before adding 100% speed and force to the movement. Lastly, listen to your body, and if problems ever arise seek medical treatment promptly from a spine specialist to aid in preventing the problem from worsening. Awareness and proactivity can be the key to avoiding a devastating lumbar hyperextension injury and all its complications.

    Sources:

  1. Low back Pain: Could it be a Spondy? Nationwide Children’s Hospital. (n.d.). https://www.nationwidechildrens.org/specialties/sports-medicine/sports-medicine-articles/low-back-pain-could-it-be-a-spondy.
  2. (2021, July 26). Spondylolisthesis treatment: Spine specialists in Columbus, OH. OrthoNeuro. https://orthoneuro.com/spine/spondylolisthesis/.
  3. Spondylolysis and SPONDYLOLISTHESIS – OrthoInfo – AAOS. OrthoInfo. (n.d.). https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and-spondylolisthesis/.

Video:

Lumbar Spondylolysis. Transcript. Spine-health. Veritas Health. Accessed August 4, 2021. https://www.spine-health.com/video/lumbar-spondylolysis-video?jwsource=cl

Figure 1. American Academy of Orthopedic Surgeons. (2021). Pars Interarticularis, Spondylolysis, and Spondylolisthesis. OrthoInfo. Spondylolysis and SPONDYLOLISTHESIS – OrthoInfo – AAOS. OrthoInfo. (n.d.). https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and-spondylolisthesis/.

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