Even though low back pain can sometimes be treated without major disruption to a person’s life, athletes are often reluctant to seek medical help. Many of them deny or minimize complaints in order to avoid consequences, such as: having to decrease activity in order to recover, losing a position or being removed from a team, missing a competition, or letting the team down. Some athletes simply do not want to bother seeing a doctor for pain; they hope it will recover on its own.
Many athletes-from the weekend warrior to the elite professional athlete-buck up their strength, pop some over-the-counter pain medication, and tolerate the pain for the sake of the game and personal enjoyment. But avoiding medical help can lead to further and more serious injury. Without medical help, the anatomic damage can sometimes lead to permanent exclusion from sporting activities.
There are many causes of low back pain. The most common causes in athletes are back strain, spondylolysis, spondylolisthesis, and herniated discs.
The medical term used to describe common back strain is musculoligamentous strain. This term refers to all injuries of the lumbar spine’s soft tissue. Soft tissues are the muscles, nerves, ligaments, tendons, and blood vessels around the spine. These are probably the most common types of sports injuries. Back strains are diagnosed by exclusion, which means the diagnosis is offered after all other causes of pain are ruled out. These injuries are usually self-limiting. In other words they do not continue to spread and get worse; they generally heal in time.
Spondylolysis and Spondylolisthesis
A crack in the bony ring of the spinal column is called spondylolysis. If the crack occurs on both sides of the bony ring, the spine is free to slip forward, a condition called spondylolisthesis. So far there is no definitive cause of spondylolysis. Most physicians agree that the bone defect appears in children mainly due to sports activities that put repeated stress on the pars interarticularis. The spondylolysis appears in younger and older adults as the result of excessive stresses on the spine, eventually causing a stress fracture.
Spondylolysis in athletes is most commonly found in those who participate in sports that have frequent hyperextension of the lumbar spine, such as gymnastics, pole-vaulting, and football. Weightlifters also have a higher incidence of the disorder due to excessive stress on the spine.
Spondylolysis does not always produce noticeable symptoms. When it does, chronic low back pain is the most common symptom. The pain can stem from mechanical (structural) or compressive (pressure on nerves) pain.
Spondylolisthesis occurs when the weakness caused by the spondylolysis causes one vertebra to slip forward over the one below it. Most cases of spondylolysis in athletes do not lead to vertebral slippage. But if slippage does occur it may continue. This situation requires more aggressive treatment-perhaps even surgery. The chance of progression is probably more worrisome in teenagers than adults.
Many cases are non-symptomatic and do not cause any nerve problems. Sometimes the slipped vertebra can press into the space of the spinal canal. This leaves less room for the nerve roots. The neural pressure can lead to low back, buttock, and leg pain, as well as numbness in the foot. Surgery may be suggested if the problem is severe.
Many sports produce high amounts of pressure on the spine. Over time, these repeated stresses add up and begin to affect the discs in the spine.
A herniated disc occurs when pressure to a disc’s outer fibers (annulus) is so great that it rips, and the nucleus ruptures out of its normal space. If it rips near the spinal canal, the bulging disc can push out of its space and into the spinal canal, placing inappropriate pressure on the spinal cord and nerve roots. If a disc bulges substantially, or fragments into pieces that lie in the canal, then irritation of the nerves can be severe.
The compression to the nerves caused by herniation can lead to feelings of numbness, pain, a change in reflexes, and tingling in the arms or legs. In addition, if a disc ruptures, it releases chemicals that can irritate and inflame the nerve roots, which leads to extreme discomfort. Sometimes a herniated disc is referred to as “slipped disc,” though the disc does not actually slip.
Adolescent athletes may also suffer from low back pain that is caused by growth-related problems, such as scoliosis and Scheuermann’s kyphosis. These problems may or may not be related to athletic activity. But they can affect an athlete’s ability to perform up to his or her standards.
Scoliosis is a condition that is related to growth. It appears usually just as the teenage growth spurt of puberty begins and may progress through the growth phase. The growth spurt begins at about age 11 in girls and age 13 in boys. Scoliosis is usually painless, but it may cause back discomfort with activity. The condition is genetic, which means it runs in families. It is more common in girls than boys. If the condition progresses, it can be serious. It may require treatment with a brace, or even surgery.
Scheuermann’s kyphosis is a developmental type of kyphosis. The vertebrae are normally rectangular-shaped and stacked on top of one another, like building blocks, with a soft cushion (disc) in between each one. If they wedge closer together in a triangular shape, as with Scheuermann’s kyphosis, it causes the spine to curve more than normal. Sometimes this deformity is described as “round-back posture” or “hunch-back.”