SPORTS TIP Lower Back Pain in Athletes EXPERT CONSULTANTS: Timothy Hosea, MD, Monica Arnold, DO

How common is low back pain? What structures of the back Low back pain is a very common can cause pain? problem in industrialized countries, Low back pain can come from all the affecting over 70 percent of the working spinal structures. The bony elements population. Back pain is also common of the spine can develop stress fractures, in such sports as football, soccer, or in the older athlete, arthritic changes golf, rowing, and gymnastics. which may pinch the nerve roots. The annulus has a large number of pain What are the structures fibers, and any injury to this structure, of the back? such as a sprain, bulging disc, or disc The spine is composed of three regions herniation will result in pain. Finally, the from your neck to the lower back. surrounding muscles and ligaments may The cervical region corresponds also suffer an injury, leading to pain. to your neck, the thoracic region is the mid-back (or back of the chest), How is the lower back injured? and the lumbar area is the lower back. Injuries to the lower back can be the The lumbar area provides the most result of improper conditioning and motion and works the hardest in warm-up, repetitive loading patterns, supporting your weight, and enables excessive sudden loads, and twisting you to bend, twist, and lift. activities. Proper body mechanics and flexibility are essential for all activities. Each area of the spine is composed To prevent injury, it is important to learn of stacked bony vertebral bodies with the proper technique in any sporting interposed cushioning pads called discs. activity. Improper mechanics lead to The vertebral bodies provide protection increased loads on the lower spine, for the spinal cord and nerve roots that making it more susceptible to injury. exit the spinal cord. Between each What are the common injuries vertebral body, the disc serves as a suffered by the lower back? What tests can be done to shock absorber, giving you the flexibility diagnose the cause of back pain? Mechanical low back pain is the result to move. Each disc consists of a jelly-like of an injury to the surrounding muscles A good history and physical exam by fluid filled center or nucleus surrounded of the lower back. It is most likely due to your physician will provide the most by a stiff ligament-like outer ring, called poor conditioning and body mechanics, information leading to an accurate the annulus. This hydraulic type of as well as lack of adequate warm-up. system enables you to perform heavy diagnosis of lower back pain. Several lifting and twisting tasks by moving fluid different diagnostic tests are also helpful A small tear or sprain of the annulus is in and out of the discs. However, this to aid in this assessment. X-rays reveal usually caused by a sudden movement hydraulic ability of the disc diminishes any abnormalities of the vertebral bodies, or lifting an excessive load. Since this with time and can lead to injury. such as arthritis, fractures, and slippage. structure contains a large number of pain MRIs best identify degeneration, bulging, fibers, this is quite painful. In addition and herniation of the discs. A stress to the back pain, there may also be pain fracture is best seen with a bone scan. along the sciatic nerve into the buttocks. Lower Back Pain in Athletes

A bulging disc occurs as the disc degenerates and begins to wear out and the annulus weakens as the jelly-like fluid begins to push out, causing pain. The pain is similar to a torn annulus, but the degeneration and bulging will appear on an MRI. With a disc herniation, the nucleus is squeezed through the annulus into the spinal canal. It may press against the nerves causing pain, numbness, tingling, and weakness. While an isolated excessive load may cause this complete herniation, it is usually the result of multiple lesser injuries that lead to the disc degeneration and final rupture.

Sports Tips are brought to you by the American Orthopaedic Society for Sports Medicine. They provide general information only and are not a substitute for your own good judgement or consultation with a physician. To order multiple copies of this fact sheet or learn more about other orthopaedic sports medicine topics, visit sportsmed.org. Copyright © 2016. American Orthopaedic Society for Sports Medicine. All rights reserved. Multiple copy reproduction prohibited.