Low back pain in athletes can be a crippling condition. It is also one which we can easily overlook. I think this has to do with the fact that so many people have themselves suffered from low back pain. When their young athlete tells them their back hurts, they relate with what they have felt in the past and tell them to just push through it. While sometimes low back pain can just come and go in young athletes depending on their training volume, it is something which shouldn’t be ignored. If the athlete’s complaints remain for over a few days, or it keeps recurring, I believe they should get evaluated.
Several structures in the low back can be the source of pain for the athlete. They could have a disc problem, muscle strain, sacroiliac joint issue, or bony structure complication. If we can pause here for just one second to comment on bony structure complications. If your athlete competes in a sport with repetitive extension (ie. gymnastics, diving, football linemen) and they are reporting pain with back bending, then you need to be thinking about spondylolisthesis. This fancy word is a condition in which a part of the vertebrae actually fractures due to the repetitive stress on the bone. A quick correct diagnosis of this condition will set them up for the most success in recovering from the injury. (See our past video interview with Dr. Kruse for more on back pain in gymnastics)
With the fact that there can be several structures in the low back causing the pain to the athlete, it is important to get a proper evaluation to isolate the movements which cause pain and the structures being affected. This seems obvious and I believe most people understand this concept.
Treatment Approach for Low Back Pain in Athletes
I want to share one method for approaching treatment of low back pain which we use heavily in the clinic. The method I want to discuss here is one called regional interdependence. The thought process behind this approach is to look at the structures in the body above and below the area in pain, to see if they are contributing to excess strain being placed on the injured structure. I heard Gray Cook explain the concept this way once. Imagine if you had two workers carrying boxes to load a truck. One of the workers it going strong. He’s working hard and getting a lot of work done. The other worker on the other hand is lazy. He’s not focused and not contributing to the work load. After a month of this type of work, the first worker who has been working hard gets injured. His back went out on him. The question then is, “Whose fault is it?” Should we focus on what the first worker can do to get better and recover? Possibly. This is no doubt important. However, in the long run, isn’t it more important to resolve the issue of the other worker not contributing to the work load?
I believe the low back is the first worker, constantly blamed for not working correctly. When in fact the real culprits are other issues like hip stability, or thoracic spine mobility, or lack of ankle mobility. Understanding how the different regions of the body are related to each other is vitally important for proper rehabilitation.
Example of Low Back Pain in an Athlete
Let’s see how this might play out in a real athlete. Suppose a 15 year old female diver is having pain in her lower back. She reports pain with back bending during her dives. She’s already been properly evaluated to rule out any bony structural issues. What might be some causes of her low back pain? The first place we would want to look is her hip flexor tightness as well has her thoracic spine extension mobility and latissimus dorsi flexibility. Why? Because if these are not contributing to the motion of extension, then the low back is doing triple duty! While I understand this is a simplistic example, I believe it is often missed. We could also take this one step further. What if we took that same athlete and evaluated her hip flexor tightness, latissimus dorsi tightness, and thoracic spine mobility before her season? If we found issues with these structures, we could give her exercises to do on her own to help prevent back extension pain from ever beginning.
Here are is an exercise program which would address all these areas. Please note this would be for an athlete who is susceptible to back injury due to repetitive back extension in their sport or position. This of course shouldn’t be used to self diagnose or treat an injury. You should always consult a medical professional for proper diagnosis and treatment.
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