Low Back Pain in female high school athletes lumbar spondylosis

Ross A. Hauser, MD
Danielle R. Steilen-Matias, MMS, PA-C

Low Back Pain in female high school athletes. A look at lumbar spondylosis

In this article, we are going to talk about your daughter, her sports, and her back pain. If you are reading this article it is likely that your daughter has been diagnosed with lumbar spondylolysis, which is a stress fracture or cracks in her vertebrae that is causing her pain and preventing her from playing sports or from being a happy teenager. We will also explore the various treatments that may work and treatments that may accelerate healing and get her back to her game perhaps a little faster including a regenerative injection program to strengthen the core spinal ligaments.

We often get emails from the parents of young athletes who need to register their daughter for an upcoming spring or fall sport event or team. Their great concern is that their daughter has significant back pain and they do not know if she can play. A typical story is one like this:

Now after another 2-3 months, if your daughter’s back pain finally went away, you are probably not reading this article. You are probably here because her back pain did not go away.

You did your research and you may have hit upon something. Physical therapy. Perhaps if you can get your daughter into an extensive PT program they can help strengthen her core muscles and provide stability that will help her heal faster. So you had the doctor, if he/she was agreeable, write you a prescription for PT and you and your daughter went with great optimism.

Now if you had the 2 – 3 months of PT and your daughter’s back pain was alleviated and she was able to return to her sport, you are not here reading this article. If you are reading this article, you are still looking for answers.

For some, conservative care will fail and it is at this time that athletes, doctors, and parents start to consider surgery. However, non-surgical treatment is effective in almost 90% of competitive athletes

Later in this article, we are going to present non-surgical options including the use of regenerative medicine injections to strengthen the core spinal ligaments. In this segment, we will discuss the surgical options as presented by surgeons at leading medical centers.

According to the research, we are going to present below, for most adolescent athletes, conservative care will help them. For some, conservative care will fail and it is at this time that athletes, doctors, and parents start to consider surgery. For some patients surgery will be the answer, however, surgeons warn, it is not the answer for every patient.

Doctors in Poland at the Poznan University of Medical Sciences, (1) offer these observations on surgery for the young elite athlete with spondylolysis: These findings were published in the European Journal of Orthopaedic Surgery and Traumatology.

Low-intensity pulsed ultrasound: Fracture healing and spinal instability

One conservative treatment that many have tried, and some successfully, is Low-intensity pulsed ultrasound. This treatment addresses the fractures and not the specific cause of how the fracture occurred. In many young athletes, as we will discuss below, the cause of the fractures can be from prolonged or unhealed ligament injury, more commonly known as a back sprain.  Low-intensity pulsed ultrasound does not address this problem but can in some instances be used in conjunction with treatment.

This was suggested in a July 2019 study in the Clinical Journal of Sports Medicine (2). Here researchers looked at 82 patients, average age 15. Patients received either standard conservative treatment combined with Low-intensity pulsed ultrasound (LIPUS) without LIPUS. The standard conservative treatment included thoracolumbosacral brace, sports modification, and therapeutic exercise.

Main outcome measures: The time required to return to previous sports activities:

Surgical problem: damaging soft tissue, muscle atrophy, and scar tissue

What jumped out at you in that observation was muscle damage, scar tissue, reduced ability. Let’s point out that the researchers of this study were suggesting a “Buck’s fusion,” or “Buck’s surgery,” a technique that would limit the soft tissue damage by addressing the fracture with the micro-surgical  implant of a screw as a means of “Direct surgical repair of spondylolysis in athletes.”

In a paper titled, “Direct surgical repair of spondylolysis in athletes,” published in the journal Neurosurgical Focus, (3) doctors at the Department of Neurosurgery, Cedars-Sinai Medical Center, in Los Angeles, suggested:

Of course, what would stand out to you is, it is 5 to 12 more months of recovery on top of the time invested already in healing.

This downtime was also suggested by a 2018 review study (4) which cited research on 59 professional and Olympic athletes undergoing lumbar microdiscectomy, The review study found that 88% of patients returned to active sport at an average period of 5.2 months following surgery. However, there was no performance-based outcome assessed in this study. The authors highlighted the role of trunk stabilization and strengthening exercises for athletes to be able to return to their respective sports.

More surgical clues that the answer may not be in surgery but in injections that create stability – addressing the lumbar sprain

Above we spoke about the lumbar sprain, spinal ligament injury as the cause of spondylosis. At this point of our article, we are going to start presenting evidence that the research the surgeons are giving us on post-operative results can make a good case for non-surgical regenerative injections. We will present the evidence in the forms of clues.

Again, in our clinic, we see the young athlete in our office with problems of stress fractures of the vertebrae, herniated disc, and spondylosis. The young athlete may have been in a back brace, may have been to physical therapy, may have taken an entire season off, yet here she is with pain. She is here because her parents may have explored a surgical option and are trying one last attempt to avoid it and one more attempt to help their daughter get back to the game she loves.

How can we help her do this? Can we help her do this?

A clue that we can help:  Core spinal ligament weakness and spinal curvature

You went to physical therapy with the idea that your daughter would be able to build up her core muscles and this would provide stability to the spine and cause her less pain. This did not happen. Why? Because physical therapy can not strengthen ligaments, those small connective tissue “rubber bands,” that hold the vertebrae in place. Why? Because physical therapy focuses on muscles and tendons.

Ligaments are a different tissue than tendons. While both are strong connective tissue, tendons have an ample supply of blood that flows to them, ligaments do not. When compromised or damaged, tendons tend to heal quickly, ligaments because they do not have direct blood circulation to them, do not heal well. This is why in the most famous sports surgeries, ligaments are replaced with a tendon, for example, the UCL in Tommy John surgery or the ACL in the knee. Tendons heal better.

So when this young athlete comes into our office, we look for spinal ligament damage and spinal instability by examining the curvature of the spine and by locating the pain triggers. Here we can identify the area of the fracture and apply treatments. We can not replace the ligaments with tendons, what we can do is direct injection treatments. Let’s look at some research first on the importance of spinal stability in treating lumbar spondylosis.

In May 2018, doctors at the Hospital for Special Surgery (5) published research in which they were looking for a connection between abnormal sacropelvic orientation (tilted pelvis, abnormal spinal curve) and both spondylolysis and spondylolisthesis (the moving forward of the vertebrae on top of the vertebrae below it causing abnormal spinal curvature as we mentioned above). The research appears in PM & R: the Journal of Injury, Function, and Rehabilitation.

What did they find?

This is the concluding statement: “Sacral slope may be an important variable for clinicians to consider when caring for young athletes with low back pain, particularly when the index of suspicion for spondylolysis is high.”

Let’s take these few brief sentences in. 

The connection between spinal curvature, spinal instability, and your daughter’s spondylolysis

In June 2018, a study from Department of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, at the University of Southern California, provided these two simple observations in the medical journal Spine,(6) about lumbar lordosis, the lower curvature of the back, and vertebral cross-sectional area (the measure of how much axial or mechanical load is on a specific part of the vertebrae.)

What does this mean to you and your daughter?

In our opinion how is a screw going to fix all this? 

Prolotherapy injections for low back pain in female high school athletes lumbar spondylosis

Spondylolysis | Spondylolisthesis

There is plenty of research to support the use of Prolotherapy for back pain (especially lumbar pain), here are some of the research summaries.

University of Manitoba, Winnipeg, Manitoba, Canada. The Journal of Alternative and Complementary Medicine. (7)

Citing our own Caring Medical research (8) in which we followed 145 patients who had suffered from back pain on average of nearly five years, we examined not only the physical aspect of Prolotherapy, but the mental aspect of treatment as well.

If our study, mentioned above, was solely based on getting 75% of patients off their pain medications, that would be wildly successful in itself. But the fact that Prolotherapy was able to strengthen the patient’s spines and decrease overall disability and return these people to a normal lifestyle. That is not pain management, that is a pain cure.

The first step in determining whether Prolotherapy will be an effective treatment for you

The first step in determining whether Prolotherapy will be an effective treatment for the patient is to determine the extent of ligament laxity or instability in the lower back by physical examination. The examination involves maneuvering the patient into various stretched positions. If weak ligaments exist, the stressor maneuver will cause pain. Pain here is an indicator that Prolotherapy can be very effective for the patient.

If this article has helped you understand problems of lumbar spondylosis and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists


1 Bartochowski Ł, Jurasz W, Kruczyński J. A minimal soft tissue damage approach of spondylolysis repair in athletes: a preliminary report. European Journal of Orthopaedic Surgery & Traumatology. 2017 Oct 1;27(7):1011-7. [Google Scholar]
2 Tsukada M, Takiuchi T, Watanabe K. Low-intensity pulsed ultrasound for early-stage lumbar spondylolysis in young athletes. Clinical Journal of Sport Medicine. 2019 Jul 1;29(4):262-6. [Google Scholar]
3 Drazin D, Shirzadi A, Jeswani S, Ching H, Rosner J, Rasouli A, Kim T, Pashman R, Johnson JP. Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes. Neurosurgical focus. 2011 Nov 1;31(5):E9. [Google Scholar]
4 Gadia A, Shah K, Nene A. Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review. Asian Spine J. 2018 Aug;12(4):754-764. doi: 10.31616/asj.2018.12.4.754. Epub 2018 Jul 27. [Google Scholar]
5 Hanke LF, Tuakli-Wosornu YA, Harrison JR, Moley PJ. The relationship between sacral slope and symptomatic isthmic spondylolysis in a cohort of high school athletes: a retrospective analysis. PM&R. 2018 May 1;10(5):501-6. [Google Scholar]
6 Wren TA, Ponrartana S, Aggabao PC, Poorghasamians E, Skaggs DL, Gilsanz V. Increased Lumbar Lordosis and Smaller Vertebral Cross-Sectional Area Are Associated With Spondylolysis. Spine. 2018 Jun 15;43(12):833-8. [Google Scholar]
7 Watson JD, Shay BL. Treatment of chronic low-back pain: a 1-year or greater follow-up. J Altern Complement Med. 2010 Sep;16(9):951-8. doi: 10.1089/acm.2009.0719. [Google Scholar]
8. Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155. [Google Scholar]



Make an Appointment |

Subscribe to E-Newsletter |

Print Friendly, PDF & Email
for your symptoms
Prolotherapy, an alternative to surgery
Were you recommended SURGERY?
Get a 2nd opinion now!
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!See why patients travel from all
over the world to visit our center.
Current Patients
Become a New Patient

Caring Medical Florida
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax

Hauser Neck Center
9734 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax
We are an out-of-network provider. Treatments discussed on this site may or may not work for your specific condition.
© 2023 | All Rights Reserved | Disclaimer