Earlier this week, Lucas Duda was placed on the disabled list with a stress fracture in his low back, leaving a void at first base for the New York Mets. Let's discuss what the injury is and how to recover from it.
What is the injury?
A stress fracture is a break in the bone due to a high amount of stress repeatedly placed on a bone. Bones are constantly breaking down, but at a rate slow enough that the bone can rebuild itself with new bone cells. When stress fractures occur, the rate of cell breakdown increases, yet the rate of bone regeneration stays the same; a fracture is caused since the bone cells responsible for replacing those dead cells cannot keep up.
The trickiest part of dealing with a stress fracture is diagnosing it. Stress fractures typically take three weeks to show up on an X-ray, so any symptoms are usually masked as general aches and pains. As a result, the athlete will usually push through the pain and cause more damage. There is a way to catch stress fractures early via bone scan but X-rays are typically the test given first since it is less expensive and symptoms are too vague to automatically think stress fracture.
The technical diagnosis for Duda is likely spondylolysis, a stress fracture of the pars interarticularis (aka pars). The pars is the part of the vertebrae that connects the superior (top) part of the bone to the inferior (bottom) part. Spondyolysis typically occurs in the L5 segment, the last vertebrae of the spinal column before your sacrum and tailbone. This injury commonly occurs when the athlete is required to do a lot of hyperextension (excessive back bending) combined with rotation (i.e. throwing a baseball). Although spondylolysis is much more common in adolescents, it is not uncommon for adults and athletes to suffer from this injury.
What is the rehabilitation process?
Regardless of location of the stress fracture, rest is crucial for successful recovery. The length of rest is dependent on the severity of the fracture—so the bone cells can replenish and strengthen the bone again—but the athlete should avoid any movement that causes discomfort. Back braces can be used to help restrict movement but are not always given out. Exercises will be given to stretch tight muscles, such as the hamstrings and piriformis, and to strengthen the core and deep low back muscles—specifically the tranverse abdominus and multifidus.
When working together, the core and deep low back muscles protect your spine as you move your body, regardless of the activity. Manual techniques are utilized by the physical therapist to reduce pain and inflammation from the injury and to facilitate more mobility in stiff joints and tight muscles. Finally, technical flaws in Duda's throwing could have contributed to this injury so addressing his technique will be the final step of recovery once he is ready to start baseball-specific activities. From then on, it is about conditioning to regain his strength, power, and endurance that is required to play on a daily basis.
We're looking at a two-to-three month recovery process and unfortunately shouldn't expect Duda to return to the lineup anytime soon. This has not been the first time a Mets player has went through this injury, as David Wright had the same injury in 2011, and he was out for nine weeks.