A stress fracture of the back, or lumbar spine, is one of the more common bone injuries in young tennis players. Lower back stress fractures are usually characterised by an ache in the lower back which is exacerbated by sporting activities and eased by rest, although a small percentage of people with a stress fracture can be pain free. Typically it is sore when the patient bends backwards, particularly if standing on one leg. If a lower back stress fracture is suspected, a doctor may decide to refer the patient for a scan to confirm the diagnosis.
Serving in tennis requires a combination of spinal hyperextension (bending back) together with rotation and side bending of the trunk. This puts a lot of stress on an area of the vertebra called the Pars Interarticularis and this is where stress fracture develops.
Practising the service should be carefully monitored by the coach to ensure the lower back is not being overloaded. This is particulary important in adolescent players who have just experienced a growth spurt as they are known to be more at risk from this injury. Core stability exercises can help prevent back problems in tennis players.
In most cases, complete rest from tennis is the treatment of choice. This would usually be for a period of 6 weeks to allow the bone to heal. In the early stages, a soothing heat pack can reduce back pain and alleviate back muscle spasm. During this period, a progressive exercise programme may commence, under the supervision of a chartered physiotherapist. This usually starts with exercises to increase the muscular stability in the lower back.
Research has shown that a lack of muscular stability in the lumbar and pelvic regions can lead to low back pain and stress fractures. The principle behind the core stability exercises is that if certain specific muscles can be recruited or contracted, the spine will have much better support. This prevents postural faults which can predispose a person to back pain.