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08/04/11 11:13 AM ET

Watch your back: Stress fractures revealed

Buchholz's injury can be more dangerous to return than imagined

I have a theory that what you do for a living influences the way you watch a baseball game. I'm pretty sure that architects and engineers see the ballpark in a way most of us don't. To accountants, the net isn't what's used to top the Green Monster, it's a dollar figure that depends upon how many beers and dogs were sold. Landscapers can better appreciate the meticulous grooming of the field. Doctors? Maybe they see a game as an injury waiting to happen.

"I wouldn't go that far. At least not with baseball," says Dr. Kevin McGuire, co-director of the Spine Center at Beth Israel Deaconess Medical Center. "But I don't like to watch football for that very reason."

I had called Dr. McGuire to talk about the problems that the Red Sox were experiencing with back problems. Specifically the news that the lower back pain that had kept pitcher Clay Buchholz out of the rotation since June 20 had recently led to the diagnosis of stress fractures in his spine.

A stress fracture is a tiny crack or cracks in a bone that normally gets repaired by the body. Dr. McGuire informed me that we all get stress fractures all the time with normal activity. The amazing thing is that our bodies repair these as part of the normal turnover of bone. With increased activity such as training for a marathon, significant stress fractures can occur in areas of the lower body like the leg or foot. Certainly stress fractures of the spine are less common.

"Stress fractures of the spine are not uncommon in athletes, but they do occur more often among football lineman, volleyball players and gymnasts,"McGuire said. "Those are the sports where repetitive hyperextension, or bending backwards of the spine occurs often and can lead to traumatic stress fractures."

Most of us know that our spines are a construction of 24 articulating vertebrae (separated and cushioned by spinal discs) and nine other bones that fuse together to form the sacrum. The spine also carries and protects the spinal cord. This incredible development of evolutionary engineering allows us to bend forward and back, side-to-side, and rotate the upper torso, all of which are movements our ancient ancestors needed to hunt and gather. They also happen to be movements the Sox's pitching rotation needs as well.

"In many ways, the more you come to learn about the spine, the more remarkable it is," said Dr. McGuire. "Still, it's not a perfect construction. On the back of the spine, there are bony protrusions where the muscles that give us this incredible range of motion, not to mention allow us to stand upright, connect. Not to get too technical, but in between those protrusions is an area known as the pars interarticularis or pars. That's the area where these stress fractures can occur."

According to Dr. McGuire, about 5 percent of the population will have a defect in the pars. Instead of having solid bone, it is more tissue-like and therefore more vulnerable to injury. Traumatic stress fractures, on the other hand, are often the result of repetitive motion injury that can occur when we ramp up an activity too quickly or engage in repetitive exercises without using the proper technique.

"For example, you may have an exercise routine that involves weightlifting and it's working fine," Dr. McGuire said. "But maybe you step awkwardly off a curb and feel a twinge in your back. The next time you are lifting at the gym, you have to alter your position a bit to get comfortable. You might not even realize it, but now your body is experiencing stress in a different way, and if you continue to cause that stress, it can lead to injury."

We don't know how Buchholz's stress fractures occurred, but Dr. McGuire says that the idea of shutting the pitcher down for the season would make sense, given the usual course of treatment.

"Let's say I saw a young volleyball athlete with a similar problem," Dr. McGuire said. "My first recommendation would be rest. Stop the activity that is causing the problem. We might suggest a brace for a few weeks to support the back and prevent further injury, but it's really a matter of giving the body time to heal itself. There would be isometric exercises that would help maintain muscle tone, but it would be six to eight weeks before you would be able to start more vigorous exercise to build up the core muscles that would really promote stability and help prevent future damage. If we are talking a professional pitcher, there's the additional issue of building your arm back into shape. I'm not sure how long that would take, but I can't imagine that the athlete or the ballclub would want to risk rushing back without a clean bill of health."

The same advice goes for the rest of us by the way, not just for folks with stress fractures. Considering that 85 percent of us will have at least one episode of acute back pain at some time in our lives allows me to make a pitch for a little preventive maintenance. Good core strength is a great start. Proper technique is key when it comes to exercise. Working through the pain is not always wise. Rest when it's called for and you'll be back in action in no time.

Check that ... take all the time you need.

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.