Low back pain (LBP) is a very common complaint among children and teenagers, especially in athletes. Symptoms may include:
- Back or buttock pain
- Pain from the lower back down into one or both legs
- Numbness, tingling or weakness in one or both legs
- Difficulty walking or sitting for long periods of time
Some cases of LBP can be serious, particularly if the injury is related to heavy or repetitive training activities.
Statistics from the American Academy of Pediatrics and from the American Physical Therapy Association indicate that sports most commonly associated with LBP are gymnastics, cheerleading, football and weightlifting.
Sprains and Strains
Most cases of LBP are caused by a strain (injury to a muscle) or a sprain (injury to a ligament). These injuries can be very painful, limit motion, and require a rest from competition and training. If pain persists, evaluation by a doctor is recommended.
A much more serious injury in the lower back is spondylolysis. This is a stress fracture in the lower back vertebrae (usually at the fifth lumbar level). This injury is diagnosed with an X-ray, CT scan or an MRI scan. It can be hereditary and sometimes growth spurts are a contributing factor. The stress fracture can occur on one or both sides of the vertebrae. If the athlete’s symptoms return during or after each workout, and begin to regularly affect activities, the athlete needs an evaluation by a doctor.
If a stress fracture occurs and is allowed to progress, a spondylolisthesis may occur. This is a forward slippage or displacement of one vertebrae on another. If too much slippage occurs, the vertebrae may begin to press on spinal nerves and surgery may be necessary to correct the condition.
Relief Treatments for LBP
Physical Therapy: Physical therapy can help relieve pain by stretching tight muscles and strengthening back, abdominal and lower extremity muscles to help with stabilization of the spine. Emphasis is placed on pain relief, core stability and sport-specific training. Applying heat to the lower back can provide significant pain relief and is effective in relaxing the back prior to a stretching exercise program.
Medicine: Anti-inflammatory medicine (or NSAIDS for nonsteroidal anti-inflammatory drugs) are often another effective treatment. A doctor may suggest an over-the-counter medicine such as ibuprofen (Motrin®, Advil®) or naproxen (Aleve®), or may prescribe a medicine. For young athletes who can swallow pills, Aleve® works well because it is taken only twice a day (morning and night). Athletes do not need to take it during school or before workouts. Ibuprofen should be taken three times a day. Anti-inflammatory medicine should be taken for 10 to 14 days to allow the medicine to build up to therapeutic levels. Taking medicine every now and then allows the medicine levels to drop, which decreases its effectiveness.
Ice: Icing is often an effective anti-inflammatory treatment. The best time to apply ice is immediately after the workout, such as the car ride home from the game or practice field. One effective way to ice is to apply an ice cup massage. Fill several Styrofoam cups with water and freeze them. When frozen, tear off one inch around the cup’s rim to create a frozen snow cone. The ice should be applied directly to the sore area in a circular massaging motion until the area becomes numb, usually about 10 to 15 minutes. This can be repeated every 60 to 90 minutes, several times a day.
Activity Modification : As with many other orthopaedic aches and pains related to overuse, LBP can be relieved by a combination of resting from the athletic activities that are increasing the pain, taking over-the-counter, anti-inflammatory medications and applying ice to the painful area.
Spondylolysis/Spondylolisthesis Treatment: Treatment for a spondylolysis or spondylolisthesis usually includes bracing and immobilization, and significant restrictions in activities—especially hyperextension motions (bending backward). It also includes restrictions to compressive forces on the spine such as jumping and landing.
There is no way to guarantee an athlete will not develop LBP, but there are some ways to minimize the risk of injury.
- Eat a well-balanced diet to keep extra weight off and to provide proper nourishment
- Strengthen the back and abdominal muscles to stabilize the lower back
- Maintain flexibility in the lower back to prevent strain on joints and muscles
- Prevent overuse by resting and changing activities to avoid repetitive injuries