Reconditioning of “Bantam Back”
“Bantam Back” is a description of a lumbar stress fracture in youth hockey players. For those unfamiliar, Bantam refers to hockey players ages 13-15 years old. Basically, it is Spondyloylsis which is a stress fracture in the pars interarticularis of the lumbar vertebrae which is a small bone joining 2 vertebrae. These fractures can happen from repetitive stress.
Unfortunately, this condition has been popping up frequently in recent years. I first heard of this condition from John Bottoms, a Minneapolis based Physical Therapist. The frequency of how many kids are in his clinic for this shocked me. What can strength and conditioning coaches do during the reconditioning process and what can they do to help prevent them from happening in the first place?
From my personal observation, the typical Bantam Back individual is a longer/taller player. They also may have recently had a growth spurt. I imagine it could happen with shorter players but from what I have seen, they’ve been on the taller side. They also play hockey on a year-round basis.
Although I do think that repetitive rotation in shooting is a contributing factor, I also believe that improper skating technique contributes. Specifically, when skating mechanics break down (“bag” skating or punishment skating after practices). This is where players can become more straight-legged versus maintaining a proper back position and knee bend. I also believe that there is an inability for coaches and players to determine the proper depth and technique for skaters. I think we can get confused when teaching taller players to get low while skating. For example, a taller player may not look low in comparison to smaller players. However, when you take hip and knee angles into consideration, they may be closer than you think. I believe that the stress in the back is higher for taller players who maybe coached to get lower. When you add in repetitive and useless conditioning drills- the outcome isn’t good.
The prescription when diagnosed with Bantam Back is 3 months of no activity. However, physical therapy can begin during that time. This is crucial so that the fracture can heal while also removing any activities that may have helped caused the injury in the first place. In the recovery process, the no activity prescription is strict. Some orthopedic specialists may recommend a back brace during the 3 months.
What can happen is that people don’t listen to the doctor’s advice. Maybe the player is diagnosed during the competitive season? Maybe a showcase that is heavily scouted is coming up? It doesn’t matter. The 3 months off is key. I understand that this isn’t good news but I look at it as a time to reset and refocus on some things before returning to the ice. The payoff is bigger in the long run.
The treatment plan at the beginning consists of low level core exercises and stretches specifically for the hamstrings and hip flexors. The progression gradually becomes challenging from low level to more functional applications so that the player can return to the ice. Usually, the rehabilitation combined with the 3 months of rest results in a positive outcome.
What can Strength and Conditioning Coaches do to help these situations and what can they do to help prevent from them happening?
Although I don’t think it is appropriate, year-round hockey is normal nowadays. Players have more opportunities to play outside of the winter hockey season. It is important to participate in other sports and/or recreational activities. I think that the time off the ice and away from hockey is important. When I think about the professional players that I get to work with, they take a minimum of 1 month off of the ice when the season ends. When they do return to the ice, the intensity and duration is progressed over the next few months up until training camp. Bantam aged players are not professionals. Their bodies are still maturing. I think the 3-month activity is a blessing for those who suffer from bantam back.
When it comes to exercises and progressions, I think it’s important to note that I am not a Physical Therapist (PT). I do help with the reconditioning of athletes. I also use exercises that PT’s will use with injured athletes with the healthy athletes that I work with. I truly believe that if a PT prescribes exercises with an injured client, why wouldn’t I want to prescribe exercises with a healthy athlete to help prevent injuries? Whether it is core exercises, pre-habilitation, or functional training- I really don’t care. As long as what we are doing is working and we are simultaneously getting faster, powerful, and stronger.
Where I think the Strength and Conditioning Coach is important is in the return to play phase and then helping the player with preventing this from happening again. When it comes to program design, I think that some modifications need to be made. Avoiding exercises that could promote hyperextension of the lower back while under load could help as well as avoiding axial loading. For example, back squats, front squats, overhead pressing, deadlifting, and Olympic lifting would be discontinued. I do think that there are many ways for an athlete to get more powerful, stronger, and faster without risking further injury.
The Mcgill Torso Muscular Endurance Test Battery (1) is used as an assessment to measure endurance in the trunk flexors, lateral endurance (side bridge), and the back extensors. This can be used as a baseline measurement at the beginning of rehab. During the course of the 3 months, this can be reassessed to see progress.
When it comes to core training, I do think improving performance of the Mcgill Torso Muscular Endurance Test Battery helps. McGill’s Big 3 (2) is a really good safe and simple way to increase not only performance in the Endurance test, but also a way to build a strong and stable back with endurance capabilities. We’ve removed what others refer to as traditional core training and have since been incorporating the Trunk Curl Up, the Side Bridge, and the Bird Dog as well as Glute Bridges for our floor-based exercises.
TRUNK CURL UP
What about Skating? As I mentioned before, I believe that less than adequate skating technique can contribute to Bantam Back. I think that after the 3-month long break, the player needs to be with a good skating coach to help the player possibly re-learn skating technique. The fundamental position of skating needs to be emphasized so that lower back health isn’t compromised. This combined with proper strength and conditioning off the ice can contribute to the player returning back to their normal level of play. I have personally seen kids come back to skate and play again at a higher level.
Again, sometimes an injury like this can be a blessing in disguise. It may sound crazy, but it is 3 months forced rest. Unfortunately, some kids need that today. A young athlete competing year round combined with less attention to technique can be as a recipe for something like this.