Spondylolysis in Elite Junior-Level Ice Hockey Players

BACKGROUND: Spondylolysis is a common cause of low back pain and significant loss of play in the young athlete. Its incidence in hockey players has not been reported. This study reviewed the incidence and potential causative factors of low back pain and spondylolysis in an elite junior-level ice hockey program over a 15-year period. HYPOTHESIS: Because of the repetitive movements of the lower spine required by the sport, spondylolysis was expected to be a frequent cause of low back pain in hockey players. STUDY DESIGN: Retrospective case review. LEVEL OF EVIDENCE: Level 4. METHODS: The medical and athletic trainer records of male ice hockey players, ages 15 to 18 years, who presented with the complaint of low back pain were reviewed. This elite program consisted of 2 rosters. There were approximately 44 players total per year representing these 2 teams. For players diagnosed with spondylolysis, the following factors were reviewed: year in the program, age at presentation, symptoms and duration, studies performed, level of spondylolysis, presence of spondylolisthesis, affected side to shooting side, player position, treatment, and current level of play. RESULTS: Over 9 hockey seasons, 25 players presented to medical staff with low back pain. Of those, 44% were confirmed to have lumbar spondylolysis. The majority of these cases presented in the first year of the program without clear history of trauma but rather vague pain with weight lifting or hockey. Less than half of spondylolysis cases were diagnosed on plain films. There were no cases of spondylolisthesis. Spondylolysis occurred on the shooting side in 73% of players. Sixty-four percent of players with spondylolysis were forwards. The treatment for most included rest from lifting and hockey and physical therapy. Average return to play was 8 weeks. Ninety-six percent of players continued to play at an elite level. CONCLUSION: Spondylolysis should be strongly considered in the differential of low back pain in ice hockey players with consideration for advanced imaging. Considerable loss of play occurs with spondylolysis, but with proper treatment, excellent outcomes occur. CLINICAL RELEVANCE: This study brings to light the prevalence of spondylolysis in ice hockey players. With an increased index of suspicion, the condition can be diagnosed and properly treated to allow full return to play.