Most people don’t expect children or teenagers to experience back pain. But for young athletes, lower back pain is actually quite common.
One possible cause? A stress fracture.
That might sound frightening! But with the right care, these injuries are very manageable.
A stress fracture is a small crack in the bone caused by repetitive activities or strain, rather than one single traumatic injury such as a fall.
In children and adolescents, the most common spinal stress fracture occurs in the lower back (lumbar spine).
It affects a small part of the vertebrae called the pars interarticularis.
These stress injuries can occur at any level in the lower back, but around 85–95% occur at the L5 vertebrae due to this region experiencing the highest amount of stress.
This condition is known as Spondylolysis.
It most commonly occurs in sports that involve:
Sports commonly linked to this injury include:
Child and teenage athletes are more likely to develop back pain from low back stress injuries than their sedentary peers.
Athletes are more likely to develop spondylolysis than non-athletes.
Research shows that around 8–15% of adolescent athletes who have no back pain at all may still have signs of this stress injury on imaging. In teenagers who do have lower back pain, the numbers are much higher. Studies suggest that up to 47% of adolescent athletes with lower back pain are found to have spondylolysis.
Firstly, don’t ignore it. Back pain in children should always be assessed by a healthcare professional, especially if it’s stopping them from enjoying sport or normal daily activities.
Yes, a fracture in the spine sounds scary but these injuries are fairly common and treated well with physiotherapy.
Book in for a physiotherapy assessment. A physiotherapist will be able to assess movement and strength, provide education regarding the injury and send off for important imaging such as an MRI scan.
Relative rest: reducing or temporarily stopping painful activities to allow healing – note, this is not complete rest.
Physiotherapy: focussing on education and load management, strengthening the surrounding muscles, hands on treatment.
Gradual return to sport: A structured, progressive return is essential. Rushing back too soon can cause flare-ups.
In some cases, a referral to a sports doctor, dietitian or specialist may be recommended to support recovery.
Early diagnosis is crucial, as it reduces the risk of the stress injury progressing to a complete fracture or developing into a chronic non-union (where the bone fails to heal properly).
Recovery timeframes vary depending on the type of stress injury, how long symptoms have been present, and how consistently rehabilitation is followed.
In early stress injuries where there is inflammation yet no crack/fracture to the bone, it can take around 4-6 weeks for pain and symptoms to settle and healing to occur. In stress injuries where there are incomplete or complete cracks/fractures to the bone usually requires 6-12 weeks for bone healing.
Most athletes take 3–6 months from diagnosis to safely return to full competition. This is because rehabilitation must be gradual and structured, allowing the body to rebuild strength, tolerate load, and reduce the risk of re-injury.
Lower back stress fractures in children and adolescents are fairly common. Whilst they are not life threatening, they are still a serious injury and should be investigated and treated properly.
With the right management and a gradual return-to-sport plan, most young athletes make a full return to sport. If your child or teenager is experiencing ongoing lower back pain, our physiotherapy team can help assess the problem early and guide a safe return to sport and activity.
