low back pain, how common is the dreaded pars fracture?

[stickpile39]

So just trying to generate a little discussion and hopefully some hope as we wait to find out DD's diagnosis. first and foremost, I am not looking for medical advice or diagnosis, just maybe your story or feedback on the topic, as we cope with the stress of waiting for official word. We have seen a Dr. and we are waiting for an MRI appointment, which will most likely be within the week. DD is 14, 5'2" 110 lbs pitches 2-4 times per week, and has really worked hard to get to the point where she has a decent chance at making Varsity as a freshman a goal of hers. Last Sunday she started complaining about lower back "tightness" on her left side and mild pain during pitching. We of course shut it down immediately. The same thing happened on Tuesday and again on Thursday. Only during 100% full motion It does not/has not bothered her outside of the pitching motion. She had batting practice with no issues at all. As of yesterday we have shut her down completely as we wait
Here's what I know.
She was hit by a pitch on the exact spot of where the pain is last Saturday. Did not complain about this issue before hand. It is my hope that this is a deep bruise (or something) related to that. IT would seem quite coincidental that this would have nothing to do with the soreness. Right?
the highschool offseason work outs have begun which includes some weight lifting and core work perhaps serving as an aggravation to whatever is going on.
At the Dr. evaluation she was on her back, and the doc twisted and raised her legs in all kinds of different position and nothing reproduced the pain or tightness. this is good.
However when the doctor pressed on areas a long the lower spine there was some minor discomfort.
As an " all in" bucket dad, I'm at my wits end here worrying about this. I just cannot imagine how devastating this injury would be to her.
So, please tell me you experience of similar issues that turned out not to be a long term issue. I know the Pars fracture is becoming common, but how common? i would assume general overuse inflammation is more common.
The MRI will tell the story but in the meantime, looking for positive vibes.
If this is in fact the pars injury, is her season in jeopardy?
high school will start games in about 8 weeks and her travel team will start in about 12-14 weeks.

Thanks for your thoughts!!!
Stick

 

[Dial]

My DD was just diagnosed with a PARS fracture. My daughter just turned 14. We are looking at 6 weeks in a brace. Then I assume a couple of weeks of PT and slowly getting back to softball motions. The brace has to be custom made. We are still waiting on the brace to start the clock. Had to wait a week for insurance to pass.

We had an MRI and bone scan. I think we got lucky with our Ortho DR. His son had the same issue playing hockey. My DD started feeling pain close to the end of middle school basketball and then it went away. Then it came back when they started softball practices in January. One good thing with the bone scan is it showed the growth plates are still open specially around her knees so she is still growing. Which I think was part of the cause with her muscles not being able to stabilize the extra growing. She was excited that she is still growing. She is currently 5'7".

She has done nothing except be an eighth grader for the last 2 weeks. Stick, as for your DD it all depends on the Dr. IF it is a PARS you might get the Dr that wants to immobilize the fracture or you may get one the says rest it for a month and see how it feels. Then slowly get back into softball shape. By slowly I mean not practicing every day but work up to it by the end of the 2nd month.

Hope its just a deep bruise and your scans come up negative.

You should be ok with TB if you caught it quick enough. You dont want to rush it just because she wants to pitch varsity.

 

[stickpile39]

thanks Dial, Best wishes for a full recovery.
I read some other posts on the topic and I'm already thinking about what we might have done differently. Anything you would do differently/modify moving forward? something you might be able to pinpoint in her training or is it more of a just a freak injury issue.
May I ask what her pain quality and location was like?
Was your DD evaluated when the pain first started during basketball?
Also is her fracture on only one side?
Lastly, sounds like you have a great doc. Had I not read what I read on these forums, I would not even have heard of this injury nor would I have been able to get an MRI so soon, it took some pushing. She will have it this week. With that said, is the bone scan essential? This might be a tough sell for her doc.

 

[JAD]

I would suggest posting a video of her throwing all her pitches, to see if there is anything in her mechanics that may be causing an issue.

 

[stickpile39]

JAD, Thank you for your interest. here are some recent videos

Here is her typical motion. Hopefully working in her favor here is if anything the knock on her form is that she doesn't bring it enough.

https://www.youtube.com/watch?v=nVcRfj8QDkc&feature=youtu.be

front warmpus

https://www.youtube.com/watch?v=jO5_c3GVoEc

drop ball

https://www.youtube.com/watch?v=M_udBmO8igc

here is her really trying to push it, which does lead to some form breakdowns.

https://www.youtube.com/watch?v=gUL8509THwM

I have already tore up the pitching mat downstairs and added some additional shock resistant padding underneath. i also have her little sister to think about.

 

[Me_and_my_big_mouth]

Stick and Dial:

First of all, I am wishing for quick recoveries for both of your girls. It's an awful thing to go through, and it's heartbreaking because we're helpless as parents.

I won't go through our entire story, because it's all over DFP. So is bucketpinata's.

I am available through PM if you would like to talk.

We sent our story to Amanda Scarborough and she was awesome about getting the word out. It is far TOO common.

My personal theory? Overtraining, on concrete (indoors), without sufficient regard for core and stability during growth spurts. Our girls need rest. They hate it, we hate it - but their bodies love it. When they go hard training 12 months a year, then suddenly kick it up even more prior to start of season, it's a recipe for injuries of all kinds.

Our daughter was NO ACTIVITY for 4 weeks, then PT for 6 weeks, then gradual reintroduction to sport over the following 3 months. Her injury wa first diagnosed April 2015. She is, just now, regaining strength that she had prior to injury. The most difficult part, by far, has been what it's done to her mentally. She missed an entire season - which messed with her head and her confidence. She also now works with the knowledge that this injury could show up again any time, if her mechanics aren't solid, if she isn't keeping a strong core, or if she overtrains.

My heart goes out to you all.

 

[JAD]

I would try to eliminate the foot turn on the rubber you see in this clip. Pushing from the side of her foot could tweak her lower back. Keeping her foot straight ahead will allow her to use her leg to drive through the pitch and will eliminate some strain from her lower back.

 

[RubberBiscuit]

I don't recall when bucketpinata's case was but I fully documented my daughters case back in 2013 (I think the date was)

Bottom line is it sucks,.... it does have a chance to affect college dreams, it has a high probability of affecting high school (where it most frequently occurs due to the maturing process.

Last Sunday she started complaining about lower back "tightness" on her left side and mild pain during pitching.

It's almost always opposite the side of the throwing arm (the side that gets hurt is the "door-stopper" for the torso-twist)

It does not/has not bothered her outside of the pitching motion. She had batting practice with no issues at all.

Pars breaks have a weird profile for pain. It can almost seem to be gone then, almost always in the intensity of actual live pitching, come back like gangbusters. Recall that many girls do not ever feel their pars break at all - just our lucky DD's.....

At the Dr. evaluation she was on her back,....

I may be jumping the gun on this doctor but a doctor who knows about this injury with young female athletes knows that the best identifier is the standing evaluation and arching the back - this one puts pain in the pars break patient

As an " all in" bucket dad, I'm at my wits end here worrying about this.

I feel for you my friend - It was hell for me and It was tough for me to think about myself as it was worse for DD. Silver lining => getting through this and conquering it makes one hellofa strong DD (mentally) in the end.

I know the Pars fracture is becoming common, but how common?

When I published my DD's case here in 2013 I think the first year I was contacted by over a dozen parents & one pitcher herself. I also almost had my DD involved with a University of Australia-Adelaide study on pars breaks. Now that I think about it I wonder where that went... But I would say that with over a dozen contacting me in the first year alone the number out there in this country has got to be pretty impressive....

i would assume general overuse inflammation is more common

Over all the pitchers I knew, the specific area of pain like this was only one time something else => oblique-muscle-pull. My DD characterized her pain with pars break as unique.

looking for positive vibes

Well my DD came out with no scars except for some mental toughening. She is playing college ball and still does pitch.

If this is in fact the pars injury, is her season in jeopardy?

I think the faster you can get past the recognition of the injury, if it is a pars break, the better everyone will be. It's like ripping off the Band-Aid. Have her focus on being the best assistant to the HS coach and be the best cheerleader for the rest of the team. Target TB for the comeback.

 

[stickpile39]

Rubber thank you for the thoughtful reply. I am leaning more towards her having this after reading more about it. Again, the MRI will tell the tale. I appreciate all of the answers and comments to my questions and I am glad to hear your DD is doing well. My only hope of avoiding this here stems back to the fact that DD was hit by a pitch in the exact same spot (still attached) last Saturday and had not complained about pain or tightness previously. Fingers crossed. thank you. One thing is thanks to this board if it is, we have caught it early.

[/IMG]

 

[Me_and_my_big_mouth]

I may be jumping the gun on this doctor but a doctor who knows about this injury with young female athletes knows that the best identifier is the standing evaluation and arching the back - this one puts pain in the pars break patient

Sorry, totally forgot to mention RubberBiscuit in my original post - when I should have remembered most because I learned so much from your story and you helped me get second opinions when the doctors didn't believe what I was telling them.

Yes, this standing exercise of leaning back and lifting the leg was the dead giveaway. Every girl I've ever spoken with who had a pars fracture experienced pain during this move.

Another clear sign was that my daughter had very tight hamstrings - couldn't even touch her toes at the height of her injury. She had been playing with pain for some time, though, by the time we recognized the tightness of her hamstrings. We believe we can actually isolate the moment the injury happened. She had been running and diving for balls, and experienced pain for the first time that evening. We had her ice, take ibuprofen, and then two days later we allowed her back out in the circle and she was still having pain. She had also been doing speed and agility training (box jumps) and had increased her pitching practice time. When their young bones are still growing, something has to give. Again, overtraining and under strengthening.

This is also a very common injury in young men, too. It's seen in football and wrestling, as well as in baseball pitchers.

My daughter had some poor mechanics that she's had to work really hard to correct (some days are more successful than others in this area). She landed straight-legged and kicked back quite often, and she also turned out her push/drive foot. Our ortho doc said she has Ligamentous Laxity - hypermobility in her joints - and she's always going to fight with the hip and back rotation of her body.

We caught my daughter's injury VERY early, in large part because I am a lurker on DFP and I read RubberBiscuit and Bucketpinata's stories and my ears perked up. She did not have a spondy or separation - so a brace wasn't necessary.