Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat.
Factors predisposing the young athlete to back injury include the growth spurt, abrupt increases in training intensity or frequency, improper technique, unsuitable sports equipment, and leg-length inequality. Poor strength of the back extensor and abdominal musculature, and inflexibility of the lumbar spine, hamstrings and hip flexor muscles may contribute to chronic low back pain.
Excessive lifting and twisting may produce sprains and strains, the most common cause of low back pain in adolescents. Blows to the spine may create contusions or fractures. Fractures in adolescents from severe trauma include compression fracture, comminuted fracture, fracture of the growth plate at the vertebral end plate, lumbar transverse process fracture, and a fracture of the spinous process. Athletes who participate in sports involving repeated and forceful hyperextension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis. The large sacroiliac joint is also prone to irritation. The signs and symptoms of disc herniation in adolescents may be more subtle than in adults. Disorders simulating athletic injury include tumours and inflammatory connective tissue disease. Often, however, a specific diagnosis cannot be made in the young athlete with a low back injury due to the lack of pain localisation and the anatomic complexity of the lumbar spine.
A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques. Diagnostic tests may be considered, though, for the adolescent athlete whose back pain is severe, was caused by acute trauma, or fails to improve with conservative therapy after several weeks. Radiographs, bone scanning, computed tomography, and magnetic resonance imaging may help identify, or exclude serious pathology.
Fortunately, the majority of cases of low back pain in adolescents respond to conservative therapy. Immediate treatment of an acute injury, such as a sprain or strain, includes cryotherapy, electrogalvanic stimulation, anti-inflammatory medications and gentle exercises. Prolonged bed rest should be avoided since atrophy may occur rapidly. Strong analgesics are also usually contraindicated, except for sleep, since they mask pain and may allow overvigorous activity.
Early strengthening exercises include the Williams flexion exercises and/or McKenzie extension exercises. Both exercise motions may often be prescribed. Athletes with an acute disc herniation, however, should only perform extension exercises initially. Athletes with spondylolysis, spondylolisthesis and facet joint irritation should initially be limited to flexion exercises.
Brief sessions of walking, pool walking or jogging, and upright cycling may be started when tolerated to maintain aerobic conditioning. The proper timing for an athlete to return to activity depends on the demonstration of functional skills necessary to perform a specific sport. The final component of a young athletes’ back rehabilitation programme includes a long term stretching, and back and abdominal strengthening programme.
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Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. Journal of Bone and Joint Surgery 72(3): 1990
Bowerman JW, McDonnell EJ. Radiology of athletic injuries — football. Radiology 117: 33–36, 1975
Cacayorin E, Hochlauser L, Petro GR. Lumbar and thoracic spine pain in the athlete: radiographic evaluation. Clinics in Sports Medicine 6(4): 767–783, 1987
Clancy WG. Symposium: low back pain in athletes. American Journal of Sports Medicine 7(6): 361–368, 1979
Deyo RA, et al. How many days bed rest for acute low back pain? A randomized clinical trial. New England Journal of Medicine 215: 10–64, 1986
Foster DN, Fulton MN. Back pain and the exercise prescription. Clinics in Sports Medicine 10: 197–209, 1991
Harris JH, Harris WH. The radiology of emergency medicine, 2nd ed., Williams and Wilkins, 1981
Hochschuler SH. The spine sports, Hanley and Belfus, Philadelphia, 1990
McKenzie RN. The lumbar spine, pp. 49–80, Spinal Publishing Ltd, Waikanae, New Zealand, 1981
Micheli LJ. Back injuries in dancers. Clinics in Sports Medicine 2(3): 473–484, 1983
Nachemson A. The lumbar spine: an orthopaedic challenge. Spine 1: 59–71, 1976
Nachemson A. Exercise, fitness and back pain. In Exercise fitness and health, pp. 533–540, Human Kinetics Press, Champaign, Ill, 1988
Nachemson A, Spitzer WO, et al. Scientific approaches to the assessment and management of activity-related spinal disorders. A monograph for clinicians: report of the Quebec Task Force on Spinal Disorders. Spine 12(Suppl. 1): S1–S59, 1987
Ohnmeiss DD, et al. Nonsurgical treatment of sports-related spine injuries. In Hochschuler (Ed.) The spine in sports, Hanley and Belfus, Inc. Philadelphia, pp. 241–266, 1990
Pelz DM. Radiologic investigation of low back pain. Canadian Medical Association Journal 140(1): 289–295, 1989
Rossi F. Spondylolysis, spondylolisthesis and sports. Journal of Sports Medicine and Physical Fitness 18(4): 317–340, 1988
Scavone J, Latchaw R, Rohrer G. Use of lumbar spine films: statistical evaluation at a university teaching hospital. Journal of the American Medical Association 246: 1105–1108, 1981
Shalen PR. Radiographic evaluation of thoracolumbar sports-related injuries. In Hochschuler (Ed.) The spine in sports, pp. 221–240, Hanley and Belfus, Inc., 1990
White TL, Malone TR. Effects of running on intervertebral disc height. Journal of Sports Physical Therapy 12: 139–146, 1990
Wiltse LL, Widell EH, Hackson DW. Fatigue fracture: the bone lesion in isthmic spondylolisthesis. Journal of Bone and Joint Surgery 57–22, 1974
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Harvey, J., Tanner, S. Low Back Pain in Young Athletes. Sports Med 12, 394–406 (1991). https://doi.org/10.2165/00007256-199112060-00005
- Lumbar Spine
- Nucleus Pulposis
- Disc Herniation
- Young Athlete