Low Back Pain in Athletes: Part 1

Low Back Pain in Athletes Series: Part 1

Adolescents and Teenagers

This is Part 1 in a series of posts on low back pain with athletes that will cover the lifespan. In my Physical Therapy practice, we regularly encounter patients with a high level of pain, fear, and misunderstanding with their symptoms. The purpose of this series is to provide a background on the causes, risk factors, and treatment strategies that will assist in the understanding the importance of early treatment and resolution. 

Overview

Low back pain (LBP) in young athletes must be taken seriously and early in order to appropriately treat and return to athlete to sports participation. Nearly 30% of young athletes experience low back pain (LBP) at a young age for a variety of reasons. Back pain is often debilitating and frustrating for young athletes because of missed practice or game time, social involvement, and anxiety. Prevalence is higher in girls than boys, with increasing risk with age. Proper assessment, diagnosis, and treatment from a physician or physical therapist early is essential to reduce pain and return to sport. 

Common Diagnoses

Many factors must be considered when appropriately diagnosing LBP in children. Back pain is complicated and can result from a number of factors, which should be considered by a medical professional.

  1. Spondylolysis (47%)
  2. Hyperlordotic Mechanical Low Back Pain (26%)
  3. Disc Herniation (9%)
  4. Scoliosis (8%)
  5. Muscle strain (6%)

Spondylolysis is a stress fracture of the pars interarticularis of the spine and is the most common cause of LBP in adolescents. As bones grow at different rates (see below), stresses are not symmetrically displaced along the bone. This results in repetitive pressure that can result in injury. Repeated extension (back bending) increases the stress at this site.

It is important to note that LBP in young athletes is uncommonly due to a simple muscle strain, as this is not the case with adults. Therefore, LBP in children should be considered serious and assessment from a medical professional is essential.

Asymmetries and Growth

Bones grow at different rates, and different types of bones grow in different manners. This is evident in foot and shin growth, as compared to the skull. As the bones grow at different rates, 2 things occur. Children who have a growth spurt of >5cm over a 6 month period are 3x more likely to have LBP. 

First, the muscle and tendons are often slower to elongate and may pull on the attachment sites of the bones, causing "growing pains", typically at the patellar tendon and Achilles tendon. Similar changes occur at the muscular attachments at the spine.

Second, asymmetrical bone growth results in abnormal joint mechanics. This can create asymmetrical movement, excessive forces along a joint, or stress reaction (spondylolysis). Competitive young athletes are at higher risk for injury during this time because of the increase in activity level.

A medical professional should examine movement patterns, range of motion, tissue length, joint mobility, and strength to identify issues that may arise here in order to treat the athlete. The Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA) are tools used by physical therapists to identify asymmetries that should be corrected.

Sport-specificity

Back pain is most common in football, gymnastics, figure skating, dancing, and soccer. Contact sports injuries are traumatic in nature and thus, should be immediately examined by a physician. Overuse back injuries from gymnastics, dancing, running, volleyball, lacrosse and other sports are often due to repetitive loads in one direction. Asymmetrical movement, such as a volleyball player who hits with only one arm, are at risk.

gymnastics.jpg

Extension-based (back bending) in dancing, gymnastics, and volleyball are frequent causes of back pain due to the repetitive nature and stress on the spine. A spondylolisthesis is the displacement of a spine vertebra from the normal curvature. Female athletes often exhibit excessive lumbar curve and hormonal changes that increase ligament laxity. Coupled with weakness of the deep spinal stabilizing muscles and repetitive motion, this can result in injury.

Treatment

Postural assessment, movement assessment, and imaging may be warranted to identify the cause of back pain in young athletes. Again, early identification of cause and risk factors is essential to return to full function and sports participation.

Physical Therapists are movement specialists and should be considered the provider of choice for low back pain in young athletes. Eliminating pain and returning functional movement prior to return to sports participation is critical to reduce the risk of re-injury. Improper training is an important consideration for the the young athlete as they progress back to sport.

Treatment strategies:

  1. Reduce pain
  2. Correct asymmetries: stretching, strengthening, joint mobility
  3. Returning normal patterns of movement
  4. Return to sports participation

See our post "Core Strength for Athletes" for more information on strategies to reduce risk of LBP in young athletes.

Free consultations are available for athletes who are currently experiencing back pain or are interested in understanding and addressing injury risk factors for prevention.