ASSESSING LOW BACK PAIN IN YOUNG ATHLETES

Healthcare providers commonly treat low back pain in people of all ages. Some people suffer minor discomfort but others suffer so greatly that they are severely limited in daily activities. Every case of low back should be examined and determine the cause.  Low back pain in young athletes is often “benign” but some young athletes face more serious issues, so it is essential for healthcare providers to assess the all complaints to avoid serious or even permanent spinal damage.

When a young athlete reports an onset of low back pain it should be addressed and evaluated to rule out more serious pathology.  Often times a diagnosis of a lumbar strain initiates a treatment program that includes modalities to control the pain and an exercise routine to enhance core control, strength and overall flexibility.  Unfortunately, this does not always resolve the symptoms.  If the symptoms worsen or do not change in intensity levels or resolve altogether within a few weeks, the athlete should be examined more closely for more serious pathology.   Often times an x-ray, CT scan, or MRI will be prescribed to examine the joints, bone and all soft tissues in the low back.

One common finding in this population of patients is a fracture of the vertebra in a particular location called the Par Interarticularis.  This is diagnosed as Sponylolysis.  This area is located between the two facets which are the location of the vertebra that “connects” or articulates with a neighboring vertebra.  The little junction of bone can be placed under tremendous force during exercise and often times develops a stress reaction which progresses to a fracture site if it is not treated properly.  The vast majority of these fracture sites occur at the very lowest level of the lumbar spine.  There are 5 lumbar vertebra and greater than 70% of all pars Interarticularis fractures occur at the L5 – S1 level.   The L4 – 5 junction accounts for another 20%, therefore, it is very uncommon to have this type of fracture occur anywhere else in the young athlete’s spine.

In most cases, a young athlete that competes in a sport that involves activities that produce high loads on the lumbar spine while they rotate or extend are most susceptible to developing spondylolysis.  Sports such as baseball, tennis, golf, hockey, basketball, football and lacrosse are commonly associated with this condition.  The anatomy of the most involved spinal segment experiences tremendous anterior shear forces during the motions that commonly cause the stress reaction to occur.  The young athlete’s vertebra does not become skeletally mature until the age of 25.   The progression of this condition can lead to a permanent change in the alignment of the spine if it is not treated properly.  The stress reaction can develop into a fracture.  If the fracture does not heal the vertebra can “slide” forward a condition known as spondylolisthesis?

Most young athletes will complain of low back pain that worsens in intensity as they play their sport.  The pain level improves with rest but returns as soon as they increase their activity level.  They report a constant ache that intensifies as they rotate or perform an activity that causes them to impact the ground forcefully.  Often times the athlete has an increased lordosis and their pain extends into their buttocks.

Conservative treatment following a positive diagnosis is normally successful and it includes rest, activity modification and physical therapy.  Physical therapy treatment protocols include the use of modalities and manual therapy to reduce symptoms and increase motion.  The exercise routine will focus primarily on core and hip strength and flexibility.  The rest period is usually 3 months or longer followed by a gradual return to all activities.  A follow-up imaging study might be performed to confirm the healing of the bone.

The occurrence of low back pain in young athletes is common due to the lack of core strength and immaturity in their skeletal age.  Fortunately, most cases of low back pain occur due to muscular strains or other soft tissue damage that leads to muscle guarding.  Due to the severity of the condition that can occur if a stress reaction in the pars Interarticularis is not treated properly, all low back pain in the young athlete should be fully examined and diagnosed properly.