05/14/2021

Lower Back Pain in Athletes

Jacqueline Plante, PT, DPT, SCS, Wentworth-Douglass Rehabilitation Services, Durham

The skinny on low back in athletes

It's the bottom of the seventh; the bases are loaded, tying run is on third ready to score, the count is 3 and 2, you wind up for your famous curveball, the pitch is thrown, and… OUCH! Pain starts spreading rapidly through your lower back. The batter fouled the ball, now it's time to throw again, but your back hurts! Do you throw? Do you tell the coach? What do you do?! This scenario can be applied easily to any sport. It's hard to navigate what the best and safest option would be because low back pain can be a scary thing. The spine protects the spinal cord, allows for motion, and provides general support for all our activities. Our backs are amazing things, yet they never get time off since they have many functions to perform. The positive thing about low back pain is that the bark is usually worse than the bite, and pain is not an indication of injury severity. However, that doesn't mean it's not something to be mindful of and closely monitor in high school athletes. So, let's dive into what you need to know surrounding low back pain in yourself or your athlete!

How common is it?

About 10-15 % of all athletes experience low back pain. You will find that certain sports like gymnastics, cheerleading, dance, diving, ice hockey, weightlifting, golf, American football (linemen), running, wrestling and rowing have higher rates of low back pain. This is because different sports impart different types of biomechanical stresses to the spine.

How and why is this happening?

It can be from an injury or trauma like a fall/collision, isolated incident (forceful throw or movement) during practice or a game, or from overuse and repetitive motions, such as bending backward, twisting, and compression. Athletes who tend to "specialize," especially starting young, and who play a particular sport on a full-time basis are also more likely to suffer from overuse.

You had a specific injury, and the pain didn't go away?

Best to get evaluated by a physician to ensure nothing sinister occurred during the event. They can determine the appropriate next steps of monitoring it or if imaging is needed. Contact your physician if you are experiencing pain that radiates into the legs or causes weakness, is accompanied by fever or weight loss, or keeps you awake at night.

But athletes have aches and pain all the time. Isn't that normal?

Athletes do have everyday aches from muscular use or odd positions they are placed in by their sport. But athletes also have a good sense of "normal muscle soreness," like when first getting back into sports from an off-season or a "tweak" that resolves quickly. However, this soreness should resolve over 2-3 days (like if you worked your legs out too much) and not continue to linger. If pain is present for longer than two weeks or progressing in nature, it's also time to see the physician.

Ok, ok, but pain equals gains, right?

Not if an injury is present. Pain doesn't allow you to train appropriately. You are likely to cause more pain, develop compensatory movement patterns, and end up with a worse injury! Unfortunately, high school athletes are more susceptible to bony issues with their backs, including stress reactions, stress fractures, and even movement of their vertebrae. These injuries are more common due to the skeletal immaturity of younger athletes.

So, I should be stronger to prevent overuse injuries?

A stronger core and pelvis help support the back. However, with multiple repetitions and maximal effort, fatigue will set in at a certain point. The stronger you are, the better trained, the more endurance present all help, but fatigue is still inevitable. The goal would be to stop before having any pain; pain is the body's warning system trying to prevent further issues from happening. Cross-training, doing something other than the sport you are engaged in, can help because you decrease that repetitive motion. 

Too late, I have pain, am I hopeless?!

No, of course not! But we need to allow time for things to settle and modify the routine. That may be to take a break from sports. Bed rest is never indicated even for severe low back pain, but you also don't want to keep aggravating things. Working with your athletic trainer or friendly physical therapist can help modify your sport or routine to keep you as active as possible while you recover.

You want me to take time off, say what?

The short answer possibly, yes. Sitting out for two weeks could mean you are not sitting out a season or even longer, depending on the cause of the pain. At this point, it's not getting better on its own either. Your medical providers want you to be safe and healthy in the long run. I care about the future you, as well as the present you.

But really, how much time off are we talking?

I'd love to give you a magical number. There are no set guidelines on times. Everyone's bodies heal at their own rate. What is more important is having full, pain-free range of motion, no pain with activating or stretching muscles, and no pain with most normal daily activities in order to return to play.

What about treatment?

Treatment for low back pain will depend on the underlying cause of the pain. It's never a bad thing to get an evaluation by a physical therapist to assess your movement patterns. They can help identify mechanics that may have led to the pain, help with decreasing the current pain, and get you on the road to recovery with an individualized plan of care.

If you still aren't sure what to do, it's never wrong to contact a medical provider to check things out! We are here to help and would always rather deal with a minor issue than tackle long-standing chronic problems. Chronic low back isn't just physical; it becomes mentally and emotionally taxing. Let's work together to keep everyone healthy, safe, and having fun!

About Jacqui Plante

Jacqui Plante is a physical therapist with Wentworth Douglass Hospital at the Durham Rehab and Sports location. She received her Doctor of Physical Therapy at Richard Stockton University in New Jersey and completed a Sports Residency Program through Saint Francis University in Pennsylvania. Jacqui is a certified clinical specialist in sports physical therapy and is a Fellow in the American Academy of Orthopedic Manual Physical Therapy. She spent time with Division 1 and 2 athletes working in the training room and on the sidelines providing care. She has been a competitive athlete her whole life, suffered injuries that ultimately fueled her desire to go into sports physical therapy.