Treating Athletes with Lower Back Pain

This blog was written in conjunction with Harrison Youmans, MD. 

As many as 30 percent of competitive athletes may experience lower back pain, but according to a review of existing research, treating these injuries with surgery should only be considered once all other treatment options have been exhausted.

The review, published in the Journal of the American Academy of Orthopedic Surgeons, said lower back pain is the most common reason athletes miss playing time and that these injuries may occur as a result of repetitive stress placed on the back while training or playing sports. Most of the population has experienced lower back pain, but in competitive athletes these injuries can affect performance or lead to future mobility issues.

The human spine is made up of 24 bones, or vertebrae, that are stacked on top of each other, with flat, round discs in between them that absorb the shock when someone runs or walks. However, young athletes put themselves at greater risk for bone and disc injuries when they start and continue an intense training regimen between ages 10 to 24 and participate in elite sports between the ages of 20 and 35. This can increase the risk of sudden injury, a disc tear or a herniated disc, which can lead to leg, foot and back pain, as well as weakness or numbness in this area.

Young athletes who are wrestlers, gymnasts, divers or weightlifters also have a greater risk for a stress fracture condition called spondylolysis. These sports put ongoing stress on the lower back, so if you have severe or persistent lower back pain it’s best to be evaluated by a doctor to get treated as soon as possible.

Athletes who start an intense training regimen at a young age also put themselves at greater risk for degenerative disc disease, which may lead to weakness, numbness, or tingling in the legs due to pressure placed on the nerves exiting the spine. If non-operative treatment is unsuccessful, several surgical options may be available depending upon the amount of arthritis and disc related nerve compression, including disc removal, disc replacement, and spine fusion.

Most lower back pain or injuries can be improved without surgery. A herniated disc, for example, typically can get better within six weeks and 80 percent of athletes can return to play without surgery. Rehab with physical therapy working on flexibility, strength, and biomechanics is usually successful in these athletes, researchers said.

In addition to physical therapy, proper rest, icing the injury, using anti-inflammatory or prescription pain medications, and/or undergoing psychological counseling can help athletes successfully return to play.

As consistent with our approach, the researchers in the review  treatment should be individualized for each athlete, depending on his or her condition and the demands of the athlete’s sport. Surgery can lead to a longer recovery time and potential complications, so rehab may be the first and best option for most young athletes. Once an athlete completes rehab and undergoes an assessment, he or she then can be cleared to return to play.

Unfortunately, nothing can entirely prevent athletes from getting injured, but the right training routine with biomechanics evaluation combined with proper stretching and warm-ups before intense physical activity can reduce the likelihood of a back injury. If an athlete does experience lower back pain, avoiding surgery may help him or her return to play relatively sooner while decreasing potential complications.