Back Pain

Back Pain

The lumbar spine, or lower back, is an area that is subjected to many types of stresses and forces during athletic competition. The lumbar region is susceptible to injuries and athletes will experience their share of them. The most common cause of low back injuries is acute trauma or chronic stress. All conditions affecting the lumbar spine can be aggravated by various contributing factors, such as inadequate or inappropriate conditioning, inflexibility of the hamstrings or lumbar spine, congenital abnormalities, or poor posture.

The most common injuries to the lumbar spine region are contusions, sprains and strains. Contusions are caused by a direct blow to the low back region and usually affect the paraspinal muscles. Muscle strains and ligament sprains are common in the low back. Both types of injuries are caused by the same types o forces. Violent muscle contractions against resistance, overuse, and overstretching are the most common mechanisms resulting is sprains and strains in the soft tissues in the back.

Sprains and strains are very common injuries and will affect almost all athletes. These injuries will resolve with therapy and active rest. If an athlete chooses to ignore their back pain a simple strain can progress to disc injuries or bony fractures. Treating these injuries at an early stage will assist the athlete in returning to competition sooner.

Treatment of lumbar injuries begins with prevention. Every athlete must be in proper physical condition prior to the season, and have worked on flexibility. Proper conditioning and flexibility will prevent most lumbar injuries from occurring. Proper conditioning should include aerobic conditioning and strength training. Proper core, abdominal and back, strengthening is very important as a optimal sport performance and injury prevention. Flexibility training should concentrate on the hamstrings and gluteal muscles to prevent lumbar injuries.

Treatment after the lower back is injured begins with ice, as in any acute injury. The extent of the injury must then be determined. Many of these injuries are due to muscle spasm, and can be treated quite easily. A smaller number are more serious, however. The signs and symptoms of a more serious back injury are severe pain, inability to touch the toes without severe pain, pain radiating down one or both legs, an "electrical" shooting pain down one or both legs, one or both legs do not seem to function properly, or the inability to run due to leg weakness.

The most common "major" injuries in the lumbar spine are Spondylolysis and Spondylolisthesis. These two injuries involve a fracture in the pars interarticularis, the area where two vertebrae form a joint. Spondylolysis is often referred to as a "scottie dog fracture," this is due to the shape of the bone involved. Plain film x-rays will show a fracture that appears to be the collar on a scottie dog. Spondylolisthesis results when the fracture becomes unstable the the vertebrae on top slides forward on the vertebrae below. These conditions are very common in football lineman and gymnasts. This is due to the large amount of back extension (backward bending) that these athletes must endure during participation. Both of these conditions are extremely painful and can result in life-long disability if treated improperly. It is important to consult a physician when dealing with long-term back pain to rule out these conditions. (A more detailed article on Spondylolysis can be found by clicking this link.)

One other area of concern with back injuries is to rule out a vertebral disc injury. The vertebral disc is located between the vertebral bodies. These structures serve as cushions and allow for smooth motion in the spine. The disc is structured like a jelly donut; there is a hard outer crust (Annulus Fibrosus) and a soft middle (Nucleus Pulposus). When long-term stress is applied to the hard outer crust, it begins to weaken and the soft middle begins to protrude. The resulting protrusion pinches on the nerve roots as they exit the vertebral column. This leads to muscle spasm and may lead to nerve damage if not treated appropriately.

Once the extent of the injury has been determined, proper rehabilitation can begin. If a physician has been consulted remember to follow their suggestions before beginning any exercises. Evidence now shows complete rest is detrimental to proper healing. Active rest is the choice of Sports Medicine Physicians and Athletic Trainers. Active rest involves flexibility training, cycling, walking, gentle strengthening, the use of therapeutic modalities, and/or physician prescribed anti-inflammatory and muscle relaxant medications.

Flexibility Exercises

Strengthening Exercises

General Back Rehabilitation Sheet In PDF Format

Your personal physician should be consulted to determine which exercises are applicable for your particular condition.

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM