The Hows and Whys of Back Pain in Young People Alex Levchenko, DO Interventional Physiatrist October 22, 2017
Basics of back pain
• Relatively common • Acute (2-4 weeks duration) • Chronic (>13 weeks) • Less common in under 10 years old • Often musculoskeletal and self-limiting • Affect 10-15% of young athletes • More common in football, figure skating, gymnastics and soccer Risk factors
• Overinvolvement in physical activities • Improper training: • Starting at early age • Longer duration of training • Excessive training • Poor technique: • Improper lifting techniques in weight lifting, ballet and figure skating • Twisting motions in tennis and golf can cause strains and sprains Risk factors
• Sedentary lifestyle • Carrying heavy backpacks • Computer and TV use • Overweight • Chronic poor posture • Psychological issues and stress Risk factors
• Growth spurts: • Muscle imbalance • Inflexibility • Developing spine is susceptible: • Compression • Distraction • Torsion injuries Sports and back pain
• Football • Racquet sports • Basketball • Rowing • Cheerleading • Rugby • Dancing • Running • Diving • Weight lifting • Gymnastics • Wrestling • Ice hockey Causes of back pain
• Strains and Sprains and muscle contusions • Fractures including spondylolysis • Disk herniations • Postural • Psychosomatic • Thoracolumbar Scheuermann disease • Lumbarization or sacralization • Spina bifida • Facet joint syndrome • Tumors • SIJ pain Causes of back pain
• Apendicitis • Pancreatitis • Pyelonephritis • Renal stones • UTI • Pelvic inflammatory disease • Leukemia • Inflammatory bowel disease • Rheumatoid • Metabolic • Neuromuscular disease • Myopathy Causes of back pain
• If the pain is severe • Accident or injury • Pain has lasted longer than one month • Neurologic deficits (weakness or numbness) • Bowel or bladder changes • Fever, rash, other joint pain, loss of appetite and weight loss, night pain Do not delay seeing a doctor! Back pain in a young athlete
• Soft tissue sprains, strains and muscle contusions • Lumbar spondylolysis • Spondylolisthesis • Disc herniation • SIJ pain
Sprains, strains and muscle contusions
• Most common back injury • Absolute bed rest is not recommended • Daily activities as tolerated • Analgesics and muscle relaxants • Back rehabilitation program • Full recovery within a few days to a few weeks but could take up to two months with sprains and overuse injuries Lumbar spondylolysis
• Common condition • Stress fracture of pars interarticularis • Ballet, dance, gymnastics, figure skating, cheerleaders, football, weight lifting, wrestling, diving, volleyball • Pain in the lower back without leg pain Lumbar spondylolysis
• Rehab is focused on core and flexibility training • Return to sports once pain free following rehab and being cleared by a physician • May take 4-8 weeks to 3-6 moths to return to play Lumbar spondylolisthesis
• Common complication of bilateral spondylolysis • Aching pain in the lower back, buttocks and posterior thighs • Young athletes have to be followed regularly • Similar treatment as in spondylolysis • Return to play in 4-6 months Disk herniation
• Relatively rare in children • Weight lifting, gymnastics, wrestling and collision sports • Back and leg pain • Relative rest, restriction from sports, NSAIDs • PT • Treatment 6-12 weeks with return to play in 3-6 months • Excellent prognosis Sacroiliac joint pain
• Buttock pain • Rowing and cross country skiing • Relative rest • Modification of activities • NSAIDs • PT Goals of rehabilitation
• Regain pain free ROM • Improve core strength and stability • Correct abnormal posture • Improve biomechanics • Improve sport techniques Prevention
• Recognition of risk factors • Improper technique • Muscle imbalances/inflexebilities • Training should be reduced during rapid growth • Core strengthening • Hamstring and hip flexor stretches • Adequate sleep and rest Return to play
• Specific to the diagnosis, sport/activity, age and maturity • Once pain-free ROM and normal strength has been obtained THANK YOU FOR YOUR TIME AND ATTENTION!