Flexibility and Stress Fractures in the Spine (Spondylolysis and Spondylolisthesis)

Flexible backs are a highly popular asset for dancers. Check any social media site and you can find extreme positions of that back extension. Many dance moves (port de bras/cambres, arabesques, needles, scorpions, and more acrobatic type poses like chin stands and elbow stands) require extreme ranges of motion in the lumbar spine.

Repetitive and constant hyperextension in combination with rotation (occurring in dance with one leg front and one leg back) of the lumbar spine can lead to weakening of the pars interarticularis, which is part of the facet joints of the vertebrae. Genetics and bone structure may also increase the probability of injury as some people have thinner shaped bones.

Spondylolysis is the term that describes when a fracture occurs in pars interarticularis of the facet joints (connecting hinge-like joints) of the vertebrae. It can occur on one side of the vertebrae or both sides.

Spondylolisthesis can occur if spondyloysis (occurring on both sides of the vertebrea) is left untreated. Spondylolisthesis is when the fracture separates allowing the vertebrae to shift forward.


With spondylolysis, some people do not experience any pain or symptoms or will only experience pain when going into that hyperextended position. Some people experience pain in the low back and/or radiating symptoms to the buttock or thigh. With spondylolisthesis, dancers may experience muscle spasms, tight hamstrings, or difficulty walking. More serious, or high level spondylolisthesis, may involve numbness and tingling and/or weakness which is due to the nerve root being compressed by the shifted vertebrae.

*It’s important to note that no pain does not equal no problem. It’s also important to note that there are many other potential causes of pain, radiating pain, and weakness besides fracture.


Typically, treatment involves resting to allow the fracture to heal, physical therapy for strengthening and flexibility, then slowly returning to regular activities. If the injury is very serious, it may require surgery.


The best way to treat a spondylolysis or spondylolisthesis would be to prevent it all together or to at least prevent re-occurrence. The best option would be to work with a healthcare professional who has experience with dancers. It’s important work on gaining and maintaining good core, back, and hip strength; improving mobility of upper back and the hips in order to make sure flexibility is not only occurring at the low back to hit those positions but along the entire body; and checking or correcting technique in order to make sure it will not be a contributing factor.

Femoroacetabular Impingement (FAI)

What is an Femoroacetabular Impingement (FAI)?

  • A structural adaptation found in hockey players
  • Abnormal contact between the ball and rim/socket during activity
  • Results from a ball that is not perfectly round (CAM) or a socket that is too deep (PINCER)
  • Repetitive impingement leads to “pinching” of the labrum between the ball and socket
  • Labral tears are common and often do not cause pain
  • Important to recognize and treat the underlying impingement
  • FAI presents as decreased hip flexion and internal rotation range of motion


A Recent Study

FAI research is in progress.  The study looked at youth hockey players from 10-18 years of age, and compared their age to prevalence of FAI and labral tears.  The results are eye opening. The table below summarizes the findings.


Age FAI Prevalence Labral Tear Prevalence
10-12 37% 48%
13-15 63% 63%
16-19 93% 93%

Signs and Symptoms

  • Deep sharp groin pain
  • Worse with quick turns
  • Limited hip rotation/flexibility/stiffness
  • Unable to sit for prolonged periods
  • Groin / Front of the hip pain after activity

PT’s Can Rule Out 

  • Rule out muscle and tendon strains, contusions, fractures, Athletic pubalgia (sports hernia)
  • The study did not report if these athletes were symptomatic. Since FAI’s are bony abnormalities it is not possible to “stretch” someone into new ranges if they have FAI because those ranges will not be available. Develop appropriate exercise accommodations and individualized programming to ensure that the athlete does not approach end range during training sessions

Upper and Lower Cross Syndrome In Athletes

Muscular imbalances in our athletes can lead to major injuries. Hockey is a fast pace, aggressive game that requires specific skills and physiological attributes. These postures and structural adaptations may result in subsequent injury. Being aware of the importance of injury prevention can lead to a better, healthier skater.

Posture and high force skate production require certain techniques that can cause adaptations such as upper and lower cross syndrome. Hockey players are in the athletic crouched “ready position” for long periods during their games and practices. Shifts last 30-45 seconds, 60-180 “hockey game minutes”, and sit on the bench resting in the same flexed hips, forward head and rounded shoulders posture. These postures are called Upper Crossed Syndrome and Lower Crossed Syndrome.

Upper Crossed Syndrome posture has rounded shoulders, forward head, increased rounded back (thoracic kyphosis). Lower Crossed Syndrome posture has an anterior tilted pelvis, weak gluteus, and arched low back (lumbar lordosis). The muscle imbalances that occur in this posture can cause pain, decreased muscle activation and muscle overuse. A comprehensive assessment should be utilized to develop an individualized program to help hockey players train at their maximum potential and diminish injury risk.