USA Hockey Magazine

A S K D R . H O C K E Y 14 // JUNE 2026 USAHOCKEYMAGAZINE.COM Your goalie drops into a but- terfly position, springs back up and does it again- hundreds of times per practice. It's an athletic feat done with relentless repetition that can come with a cost, showing up as per- sistent low back pain that rest alone won't fix. The culprit is often a condition called spondylolysis- a stress fracture involving the lower back caused by repetition. It's not the result of a bad fall or awkward collision. It is the slow accumulation of thousands of rep- etitions on a skeleton that's still developing. Unfortunately, it is more common in young goalies than most parents and coaches recognize. Why Goalies? Modern goaltending demands extreme flexibility and repeat- ed extension of the lower back. Every RVH, butterfly recovery, post integration, and despera- tion save requires the goaltender to repeatedly arch and rotate through the lumbar spine repeatedly. Unlike a single traumatic injury, spondy- lolysis usually develops gradually. Think of it as a fatigue fracture: thousands of repetitions eventually create a small crack in the bone as the back struggles to keep up with the demands placed on it. The adolescent years are particularly vul- nerable because the skeleton is still developing while training volume continues to increase. What Does It Feel Like? The classic symptom is low back pain that: • Develops gradually over weeks or months. • Worsens with skating, butterfly work, or off-ice training. • Increases when arching backward. • Improves with rest. Many goalies describe feeling fine at rest sitting in the locker room but experience pain whenever they return to the ice. Common Mistakes One of the biggest mistakes is assuming every young goalie with back pain simply has tight muscles. The second is continuing to play through pain because there was no specific injury event. Spondylolysis often sneaks up gradually on hockey players, making it easy to ignore until symptoms become severe. How Is It Diagnosed? An MRI is the preferred advanced imaging study because it can identify bone stress before a complete fracture develops and avoids radiation exposure from a CT scan. Early diagnosis matters because treatment is most effective when the injury is caught promptly. Treatment: The Good News Most adolescent goalies with spon- dylolysis recover fully without sur- gery. Treatment typically includes: • Temporary cessation of hockey activities. • Physical therapy focused on core stabilization. • Hip mobility training. • Gradual return-to-play progression. Many goalies can return to full competition once pain-free with restored strength and motion. The timeline depends on injury severity, but typical cases usually take at least 3 months. Can It Be Prevented? While no injury is completely preventable, several strategies may reduce risk for spon- dylolysis: • Avoid dramatic year-round increases in training volume • Maintain excellent core strength • Prioritize hip mobility and flexibility • Address low back pain early rather than playing through it Remember, soreness after a hard weekend tournament is normal. Persistent back pain lasting several weeks is not. Bottom Line If your adolescent goalie has low back pain that worsens with butterfly work, RVH posi- tioning, or arching backward, don't assume it's just a muscle strain. Spondylolysis is a common and treatable stress injury in growing athletes. The earlier it's recognized, the faster they can make a safe return to the crease. P My son is a 14-year- old goalie and since the start of spring hockey he has been complaining of low back pain whenever he gets on the ice. It hurts most after practices with a lot of butterfly work. He doesn't recall a specific injury. Any thoughts on what might be going on? He's just not himself out there. – Brian from Connecticut A Q T H E D O C I S I N A N D R E A D Y T O A N S W E R Y O U R H O C K E Y Q U E S T I O N S If you have questions for Dr. Hockey, please email Justin.Felisko@ usahockey.org ? Why Does My Goalie's Back Hurt So Much? g By Charles A. Popkin, MD intervertebral disc Pars Defect 'Spondylolysis' facet joint sacrum vertebra Lumbar Spine Showing Pars Defect

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