Archives of Orthopaedic and Trauma Surgery

, Volume 137, Issue 5, pp 685–691 | Cite as

Prevalence and clinical features of sports-related lumbosacral stress injuries in the young

  • Hideto Kaneko
  • Mototsune Murakami
  • Kazuya Nishizawa
Arthroscopy and Sports Medicine



Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. These injuries can be detected by bone marrow edema lesion on MRI. However, little is known about the prevalence and clinical features of early stage lumbosacral stress injuries. This study aimed to evaluate the epidemiology of lumbosacral stress injuries.


A total of 312 patients (under 18 years of age) who complained of sports-related lower back pain that had lasted for ≥7 days underwent magnetic resonance imaging (MRI) scans. We reviewed patients’ records retrospectively.


MRI showed that 33.0% of the patients had lumbar stress injuries and 1.6% had sacral stress injuries. Lumbar stress injuries were more common in males than in females and were found in 30% of 13- to 18-year-old patients. About 50% of the patients that participated in soccer or track and field were diagnosed with lumbar stress injuries. No clinical patterns in the frequencies of sacral stress injuries were detected due to the low number of patients that suffered this type of injury. Plain radiography is rarely able to detect the early stage lesions associated with lumbosacral stress injuries, but such lesions can be detected in the caudal–ventral region of the pars interarticularis on sagittal computed tomography scans.


Thirty-three percent of young patients that complained of sports-related lower back pain for ≥7 days had lumbar stress injuries, while 1.6% of them had sacral stress injuries. Clinicians should be aware of the existence of these injuries. MRI is useful for diagnosing lumbosacral stress injuries.


Lumbar spine Sacrum Stress injury Prevalence Low back pain 



The authors thank Prof. Akira Andoh, M.D., Ph.D., of Shiga University of Medical Science, for his editorial assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest and there is no funding source.


  1. 1.
    Daffner RH, Pavlov H (1992) Stress fractures. Am J Roentogenol 159:245–252CrossRefGoogle Scholar
  2. 2.
    Miller JH (2003) The radiological aspect of stress fractures and chronic stress injuries. Curr Orthop 17:150–155CrossRefGoogle Scholar
  3. 3.
    Hollenberg GM, Beattie PF, Meyers SP et al (2002) Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 27:181–186CrossRefPubMedGoogle Scholar
  4. 4.
    Campbell RS, Grainger AJ, Hide IG et al (2005) Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skeletal Radiol 34:63–73CrossRefPubMedGoogle Scholar
  5. 5.
    Sairyo K, Katoh S, Takata Y et al (2006) MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents: a clinical and biomechanical study. Spine 31:206–211CrossRefPubMedGoogle Scholar
  6. 6.
    Grier D, Wardell S, Sarwark J et al (1993) Fatigue fractures of the sacrum in children: two case reports and a review of the literature. Skeletal Radiol 22:515–518CrossRefPubMedGoogle Scholar
  7. 7.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48:452–458CrossRefGoogle Scholar
  8. 8.
    Leone A, Cianfoni A, Cerase A et al (2011) Lumbar spondylolysis: a review. Skelet Radiol 40:683–700CrossRefGoogle Scholar
  9. 9.
    Standaert CJ, Herring SA (2000) Spondylolysis: a critical review. Br J Sports Med 34:415–422CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sakai T, Sairyo K, Suzue N et al (2010) Incidence and etiology of lumbar spondylolysis; review of the literature. J Ortop Sci 15:281–288CrossRefGoogle Scholar
  11. 11.
    Sakai T, Sairyo K, Mima S et al (2010) Significance of magnetic resonance imaging signal change in the pedicle in the managemant lubar spondylolysis. Spine 35:E641–E645CrossRefPubMedGoogle Scholar
  12. 12.
    Yamane T, Yoshida T, Mimatsu K (1993) Early diagnosis of lumbar spondylolysis by MRI. J Bone Jt Surg 75-B:764–768Google Scholar
  13. 13.
    Ulmer JL, Elster AD, Mathews VP et al (1995) Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles om MRI images. Am J Roentogenol 164:429–433CrossRefGoogle Scholar
  14. 14.
    Longhino V, Bonora C, Sansone V (2011) The management of sacral stress fractures: current concepts. Clin Cases Miner Bone Metab 8:19–23PubMedPubMedCentralGoogle Scholar
  15. 15.
    Zaman FM, Frey ME, Slipman CW (2006) Sacral stress fractures. Curr Sports Med Rep 5:37–43CrossRefPubMedGoogle Scholar
  16. 16.
    Alsobrook J, Simons SM (2007) Sacral stress fracture in a marathon runner. Curr Sports Med Rep 6:39–42PubMedGoogle Scholar
  17. 17.
    Kobayashi A, Kobayashi T, Kato K et al (2013) Diagnosis of radiographically occult lumbar spondylolysis in young athletes by magnetic resonance imaging. Am J Sports Med 41:169–176CrossRefPubMedGoogle Scholar
  18. 18.
    Fink-Bennett DM, Benson MT (1984) Unusual exercise-related stress fractures. Two case reports. Clin Nucl Med 9:430–434CrossRefPubMedGoogle Scholar
  19. 19.
    Micheli LJ, Curtis C (2006) Stress fractures in the spine and sacrum. Clin Sports Med 25:75–88CrossRefPubMedGoogle Scholar
  20. 20.
    Ahovuo JA, Kiuru MJ, Visuri T (2004) Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol 14:500–505CrossRefPubMedGoogle Scholar
  21. 21.
    Volpin G, Milgrom C, Goldsher D et al (1989) Stress fractures of the sacrum following strenous activity. Clin Orthop 243:184–188Google Scholar
  22. 22.
    Sairyo K, SakaiT, Amari R et al (2010) Causes of radiculopathy in young athletes with spondylolysis. Am J Sports Med 38:357–362CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Hideto Kaneko
    • 1
  • Mototsune Murakami
    • 1
  • Kazuya Nishizawa
    • 2
  1. 1.Murakami Orthopaedic ClinicKokaJapan
  2. 2.Department of Orthopaedic SurgeryShiga University of Medical ScienceOtsuJapan

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