Spine in Athletes

Abstract

Spinal lesions in athletes can be classified into overuse and acute injuries. Overuse injuries can be found after repetitive spinal load during sport activity; acute trauma injuries of the spine are common in contact sports. We present an overview of the wide spectrum of spinal injuries related to sport activity and review their imaging findings. Concerning overuse injuries, we focus on degenerative spine disease, spondylolysis, pedicle fractures, apophyseal ring injuries, Schmorl's nodes, and Scheuermann's disease. Acute spinal injuries are relatively frequently reported in athletes and may be the reason for severe morbidity. Similar to the general population, the type of acute spine fracture in athletes depends on the specific trauma mechanism.

Keywords

spine - sports - injuries - review

Publication History

Received: 20 November 2025

Accepted: 15 December 2025

Article published online:
09 February 2026

• References

• 1 Minoves Font M. Clinical applications of nuclear medicine in the diagnosis and assessment of musculoskeletal sports injuries. Rev Esp Med Nucl Imagen Mol (Engl Ed) 2020; 39 (02) 112-134
• 2 Schöffl V, Lutter C. The “Newbie” syndrome. Wilderness Environ Med 2017; 28 (04) 377-380
• 3 Schroeder GD, LaBella CR, Mendoza M. et al. The role of intense athletic activity on structural lumbar abnormalities in adolescent patients with symptomatic low back pain. Eur Spine J 2016; 25 (09) 2842-2848
• 4 Wasserman MS, Guermazi A, Jarraya M. et al. Evaluation of spine MRIs in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. BMJ Open Sport Exerc Med 2018; 4 (01) e000335 Published correction appears in BMJ Open Sport Exerc Med 2018;4:e000335corr
• 5 Ivković A, Franić M, Bojanić I, Pećina M. Overuse injuries in female athletes. Croat Med J 2007; 48 (06) 767-778
• 6 Barile A, Limbucci N, Splendiani A, Gallucci M, Masciocchi C. Spinal injury in sport. Eur J Radiol 2007; 62 (01) 68-78
• 7 Boden BP, Prior C. Catastrophic spine injuries in sports. Curr Sports Med Rep 2005; 4 (01) 45-49
• 8 Domingues R, Hassel B, Neto JG, Lopes FPPL. MR Imaging at Rio 2016 Olympic and Paralympic Games: Report of experience using state-of-the-art 3.0-T and 1.5-T wide-bore MR imaging scanners in high-performance athletes. Magn Reson Imaging Clin N Am 2018; 26 (04) 645-651
• 9 Heiss R, Guermazi A, Jarraya M, Engebretsen L, Roemer FW. The epidemiology of MRI-detected pelvic injuries in athletes in the Rio de Janeiro 2016 Summer Olympics. Eur J Radiol 2018; 105: 56-64
• 10 Bethapudi S, Budgett R, Engebretsen L, O'Connor P. Imaging at London 2012 Summer Olympic Games: analysis of demand and distribution of workload. Br J Sports Med 2013; 47 (13) 850-856
• 11 Guermazi A, Hayashi D, Jarraya M. et al. Sports injuries at the Rio de Janeiro 2016 Summer Olympics: use of diagnostic imaging services. Radiology 2018; 287 (03) 922-932
• 12 Swärd L, Hellström M, Jacobsson B, Nyman R, Peterson L. Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine 1991; 16 (04) 437-443
• 13 Koyama K, Nakazato K, Kubo Y. et al. Effects of competition level on the prevalence and incidence of lumbar disk degeneration in Japanese collegiate gymnasts. Orthop J Sports Med 2022; 10 (11) ): 23 259671221119439
• 14 Abdalkader M, Guermazi A, Engebretsen L. et al. MRI-detected spinal disc degenerative changes in athletes participating in the Rio de Janeiro 2016 Summer Olympics games. BMC Musculoskelet Disord 2020; 21 (01) 45
• 15 Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; 26 (17) 1873-1878
• 16 Wong JS, Lalam R, Cassar-Pullicino VN, Tyrrell PNM, Singh J. Stress injuries of the spine in sports. Semin Musculoskelet Radiol 2020; 24 (03) 262-276
• 17 Rossi F, Dragoni S. Lumbar spondylolysis: occurrence in competitive athletes. Updated achievements in a series of 390 cases. J Sports Med Phys Fitness 1990; 30 (04) 450-452
• 18 Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 1995; 149 (01) 15-18
• 19 Linton AA, Hsu WK. A review of treatment for acute and chronic pars fractures in the lumbar spine. Curr Rev Musculoskelet Med 2022; 15 (04) 259-271
• 20 Shelat NH, El-Khoury GY. Pediatric stress fractures: a pictorial essay. Iowa Orthop J 2016; 36: 138-146
• 21 Tezuka F, Sairyo K, Sakai T, Dezawa A. Etiology of adult-onset stress fracture in the lumbar spine. Clin Spine Surg 2017; 30 (03) E233-E238
• 22 Kinoshita Y, Sakai T, Sugiura K. et al. Can MRI replace CT in the diagnosis and staging of lumbar spondylolysis in pediatric patients? A validation study using MR bone imaging. J Pediatr Orthop 2026; 46 (01) e56-e60
• 23 Cheung KK, Dhawan RT, Wilson LF, Peirce NS, Rajeswaran G. Pars interarticularis injury in elite athletes—the role of imaging in diagnosis and management. Eur J Radiol 2018; 108: 28-42
• 24 Hollenberg GM, Beattie PF, Meyers SP, Weinberg EP, Adams MJ. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 2002; 27 (02) 181-186
• 25 Vucevic D, Malis V, Yamashita Y. et al. Ultrashort echo time and fast field echo imaging for spine bone imaging with application in spondylolysis evaluation. Computation (Basel) 2024; 12 (08) 152
• 26 Fischer G, Schlosser TPC, Dietrich TJ. et al. Radiological evaluation and clinical implications of deep learning- and MRI-based synthetic CT for the assessment of cervical spine injuries. Eur Radiol 2025; 35 (11) 6936-6948
• 27 Watura C, Mitchell AWM, Fahy D, Houghton J, Kang S, Lee JC. T1-VIBE and STIR MRI of lumbar pars interarticularis injuries in elite athletes: fracture characterisation and potential prognostic indicators. Skeletal Radiol 2024; 53 (03) 489-497
• 28 Alway P, Brooke-Wavell K, Langley B, King M, Peirce N. Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation. BMJ Open Sport Exerc Med 2019; 5 (01) e000529
• 29 Sairyo K, Katoh S, Sasa T. et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med 2005; 33 (04) 583-590
• 30 Ulmer JL, Elster AD, Mathews VP, Allen AM. Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol 1995; 164 (02) 429-433
• 31 Koyama K, Nakazato K, Min SK. et al. Anterior limbus vertebra and intervertebral disk degeneration in Japanese collegiate gymnasts. Orthop J Sports Med 2013; 1 (03) 2325967113500222
• 32 Mok FP, Samartzis D, Karppinen J, Luk KD, Fong DY, Cheung KM. ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals. Spine 2010; 35 (21) 1944-1952
• 33 Greenan TJ. Diagnostic imaging of sports-related spinal disorders. Clin Sports Med 1993; 12 (03) 487-505
• 34 West RV. The female athlete. The triad of disordered eating, amenorrhoea and osteoporosis. Sports Med 1998; 26 (02) 63-71