SANTA CLARA, California, December 13. LOWER back pain is an epidemic in the United States. Unfortunately, this epidemic does not escape swimmers, divers, or synchronized swimmers. Excessive extension or hinging from one segment of the lumbar vertebrae causes spondylolysis (making you a spondy), better known as stress fracture to the pars interarticularis. Spondylolysis is the most common form of back pain in adolescent athletes plaguing many athletes with pain and inhibiting their range of motion.
This mouthful of a diagnosis, say it with me spon-dee-low-lye-sis, occurs from overuse. Divers do around 100 approaches a practice, swimmers do thousands of dolphin kicks and synchronized swimmers use poor form to sit-up in the water, repeatedly arching their low back. These repeated extensions cause a stress fracture. A stress fracture is typically painful, especially with movement (most notably extension).
Some health care professionals feel bracing is the best approach to stabilize the unstable spondy.
However, these athletes commonly present with dismal range of motion, why would you brace, limiting range of motion, when you need to regain range of motion?
Following rapid extensions, the psoas major muscle, which runs from all five lumbar vertebrae and disc to the inside of the hip, begins to tighten, compensating, helping stabilize the spine from movement.
From my experience, improving range of motion by alleviating the compensating tight muscles is essential for a rapid recovery. Improving the muscle length of the psoas major, a hip and trunk flexor, rapidly regains full range of motion.
Once range of motion returns, stabilizing the low back is essential. Remember, a spondy is an unstable lumbar, therefore providing muscular stability of the low back is the next step for improvement and prevention of re-injury.
Lastly, improving muscle timing will help an athlete understand the subtle, but essential difference between the hip flexors and trunk flexors. This difference will improve the athlete's symptoms, but also help them become a powerful athlete, allowing them to use their hip flexors to explode off the boards or kick while the core can do its job, lumbar stability.
At this stage, the athlete is symptom free, but this doesn't mean you're in the clear. A stress fracture remains with an athlete until their skeletal system is fully matured. Therefore, maintaining proper core strength, hip musculature length and differentiation between the hip flexors and core is essential for prevention. Stress fracture is resolved. Remember, just because it is labeled a fractured, doesn't mean bracing is mandatory. Get your muscles on the same page and back to the pool as soon as possible and begin optimizing your career!
Dr. G. John Mullen is a Doctor of Physical Therapy and a Certified Strength and Conditioning Specialist. At USC, he was a clinical research assistant at USC performing research on adolescent diabetes, lung adaptations to swimming, and swimming biomechanics. G. John has been featured in Swimming World Magazine, Swimmer Magazine, and the International Society of Swim Coaches Journal. He is currently the strength and conditioning coach at Santa Clara Swim Club, owner of the Center of Optimal Restoration and creator of Swimming Science.