Other common fractures include those of the transverse or spinous processes. They may result from a direct injury or avulsion from a sudden strong contraction of the psoas and quadratus lumborum.
Fractures should be well healed before exercise is undertaken. An orthosis will allow mobility and provide comfort for the six to eight weeks usually necessary for fractUre healing.

Neural arch defects
The tensile and shear forces across the lumbar pars interarticularis are focused over an area measuring less than one square centimeter.19 The pars is the axis of rotation and is prone to stress fracture (Figure 1 ). Stress fractures of the pars differ from others in that they develop at an earlier age, have a hereditary disposition, and do not heal readily. Spondylolysis occurs most often at L5 and is often unilateral. Most lesions are asymptomatic and may be seen in 5% of the general population.20.21
The athlete with symptomatic spondylolysis or spondylolisthesis will have back pain and hamstring spasm, which may not be easy to demonstrate in a very flexible individual. Radiographs usually confirm the diagnosis, but may be negative early in the process, during which time a bone scan will be diagnostic. Any athlete with refractory back pain of longer than six weeks' duration requires scintigraphy to rule out a stress fracture of the pars.
Bilateral pars defects can lead to slippage or spondylolisthesis (Figure 2). Symptomatic spondylolysis or spondylolisthesis in athletes is rarely progressive, and the development of instability would be unusual in this patient population. A relatively high :incidence of neural arch defeats is found in athletes, especially ingymnasts, interior linemen, and martial artists.8,9,12,20,21
Conservative treatment iseffective in alleviating symptoms and allowing a return to sports. Mildly symptomatic lesions respond to a period of activity limitation and an exercise program to strengthen the abdominal muscles and stretch the hamstrings. An antilordosis brace works very well in resolving pain and allowing the.lesion to heal.22 Even the patient who fails to heal the defect can return to full contact sports as long as there are no symptoms and full flexibility returns. Surgical fusion is indicated for the rare slippage that is progressive or is greater than 500,10 on presentation. Refractory low grade lesions may be treated by the more limited direct repair of the defect avoiding the loss of valuable lumbar motion concomitant with successful fusion surgery.23

Burners and stingers
Injuries to the cervical disks, brachial plexus, and peripheral nerves can result in neurologic signs and symptoms involving the upper extremity . These injuries often go unreported and untreated. In a survey of 6 Division III football teams, Torg and Reilly24 reported a 52% incidence in one calendar year and only 10% of players being evaluated by the team physician.
Burners typically are sustained during head and shoulder contact. The athlete complains of burning pain, numbness, paresthesias, and often temporary paresis from the base of the neck to the hand. Symptoms usually are nondermatomal in distribution, and weakness may not be obvious until several days after the injury.24 Brachial plexus injuries are more likely to occur in younger patients with less developed musculature. They are usually traction injuries with the neck flexing laterally while the shoulder is depressed to the side of involvement. Spurling's test is negative with a brachial plexus injury, and positive Spurling's elicits paresthesias with axial compression of the cranium.
Cervical root lesions result from compression of the nerve root itself or its dorsal ganglion in the intervertebral foramen. The lesions generally are seen in an older age group and areassociated with degenerative changes seen on radiographs. Hyperextension with lateral flexion is the most common mechanism. Spurling's test is positive. If persistent symptoms warrant magnetic resonance imaging, developmental stenosis and/or disk degeneration or herniation is usually revealed.
For acute treatment, the spine should be immobilized, especially if symptoms are bilateral or involve the lower extremities. Symptoms usually abate rapidly. A full, pain-free range ofmotion, normal strength, and a normal neurologic examination are necessary before the patient can re-