Low Back Pain In Athletes.Causes And Management

Low back pain is mostly known to occur in older adults. However, it is also estimated that  15% of young athletes also experience pain in the lower back. The pattern and underlying causes of this condition in athletes are also different compared with less active individuals.  What are the causes and management of low back pain in athletes? This article answers these questions in detail. 

Low back pain in athletes- causes and treatments

Athletes, especially elite athletes spend a lot of time in training and competition. Due to intense physical activity, there is significant mechanical strain and extra pressure on the musculoskeletal system. 

  • Back strains and sprains are common in athletes.  These injuries affect the soft tissues of the back -including muscles, ligaments, tendons, nerves and blood vessels.  Injuries can occur after an acute trauma, and acute traumas are more likely to be seen in contact sports that involve high energy impacts -like football or rugby.  Overuse injuries repetitive microtraumas that cause low back pain are more often associated with playing skating, gymnastics or dance. That’s because these sports involve repetitive flexions, extensions and twisting the body. 

Back strains are a diagnosis of exclusion. This means that other conditions should be ruled out. The prognosis is good, as most are self-limited and athletes will recover in a short time, Treatment emphasizes education to prevent future episodes and using proper warm-up/cool-down periods, and using proper techniques during the training. 

  • Pars interarticularis injuries. Almost half of the young athletes develop so called pars interarticularis injuries and subsequently low back pain  these injuries. Pars interarticularis injuries  are caused by  repetitive stress on the bones, which lead to stress fractures of the bones of the lower spine. The back pain associated with this condition is experienced on one side of the back, rather than in the center of the back. The pain can be  localized or diffuse, gets worse when the trunk is in hyperextension or rotation, and improves with rest. Some may complain of pain in the buttocks or the legs. Sometimes these injuries do not cause any symptoms, but later on in life the athlete may develop chronic back pain.
  • Low back pain due to disc related conditions (ie slipped disc) is less likely to occur in young athletes compared with older adults, but it can happen. A herniated disc occurs when the bulging disc pushes out from its usual place into the spinal canal, creating pressure on the spinal cord and the roots of the nerves. This leads to pain, weakness,  numbness and tingling in the buttocks and legs.  When the disc ruptures, it creates even more severe symptoms. The lower back is most commonly affected  by this condition. Most cases of herniated discs respond to conservative measures, thus surgery is reserved when the symptoms, nerve irritation or dysfunction are severe. 
  • Growth related conditions like scoliosis and  Scheuermann’s kyphosis. While these abnormal curvatures of the spine are not related to physical activity, they can significantly affect the ability to play sports. Scoliosis is  often detected during puberty (around age 13 for boys and age 11 for girls)  and may further progress during the growth phase. Scoliosis has a strong genetic component and is more common in girls than boys. If brace and physiotherapy can’t improve this condition enough, surgery may be recommended. Some individuals have both scoliosis and  Scheuermann’s  kyphosis, which is characterized by a rigid deformity and the  spine is more curved than normal.  In case of Scheuermann’s  kyphosis , the symptoms aggravate when bending over and improve when standing straight up. Doctors try first conservative measures like casting or bracing to straighten the spine. If young athletes wear the brace on a regular basis, the problem is often corrected within two years, as the brace helps remodel and correct the developing spine. Surgery is recommended rarely, when certain criteria are met. 
  • In rare cases, athletes and the general population alike may have low back pain due to infections, tumors or certain inflammatory conditions. In these cases, the back pain doesn’t follow the normal pattern -like aggravation with movements or triggered by an acute injury/trauma. The back pain doesn’t seem to be related to movement, and may be associated with weight loss, unexplained fatigue, blood in the urine or stool. Blood tests are helpful to detect infections, while imaging techniques like CT scans and MRIs would show cancerous tumors. 
  • Idiopathic low back pain. Despite many tests and investigations, a doctor may not be able to identify the underlying cause of the back pain. In this case, it is labeled “idiopathic” low back pain. In these cases, general recommendations like antiinflammatory medications, physical therapy and exercise are used. 

One of the biggest mistakes made by athletes is to continue to train despite experiencing symptoms. Many athletes think they can get better on their own,  don’t want to miss competition and let down the team. However, training without treatment and exercise modifications can worsen back pain. Instead, it is best to seek medical advice, go through routine examinations and see specialists as needed.