Q: I am a 16-year-old tennis player who has had pain in my lower back for the last six months. The pain was initially intermittent, but now it bothers me whenever I serve or hit an overhead.

I saw my family doctor who got X-rays and he said that everything was normal. I rested for a few weeks and did some physical therapy, which helped at the time but the symptoms came back as soon as I went back to play. I want to play for my high school team and hopefully be good enough to play in college. If the X-rays are fine and it has been this long, why am I not better and what should I do?

A: I recommend that you see an orthopedic surgeon or a spine specialist for evaluation of your lower back. A very common injury in tennis, gymnastics and football linemen is a stress fracture of the lower back, in an area known as the pars interarticularis. Repetitive hyperextension moves of the lumbosacral can cause these stress fracture symptoms.

X-rays many times will not reveal an abnormality and special testing may be necessary to establish an accurate diagnosis. An MRI scan may be helpful in making certain there are no disc abnormalities, as well as determining if there is a stress fracture. A bone scan or CAT scan may also be helpful in defining whether this is an active process and the extent of the injury.

If a stress fracture of the lower back is found, you may require a period of rest or bracing for this to heal. If the problem is related to a chronic muscle strain, it may respond to changes in your rehabilitation regimen and technique modification.

The Jock Doc column runs every other week.

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