Adolescents participating in sport are at risk of developing lower back pain, but often the causes are different than with adult sportspeople. ISEH consultant Dr Eleanor Tillett presented at the 2014 British Association of Sport and Exercise Medicine (BASEM) conference on the diagnosis, treatment and rehabilitation of young athletes with lower back pain.
What causes lower back pain in young athletes?
A study comparing adolescent athletes suffering lower back pain with adults with lower back pain in the general population found considerable differences in the underlying causes. In adults the most common causes were disc-related (48%), with 27% per cent being due to tendon or muscle strain; only 5% of cases were due to spondylolysis – stress fracture(s) of part of the vertebrae which comes under particular load when running or bending backwards.
By contrast, in adolescent athletes the most common cause was spondylolysis, which led to almost half (47%) of cases. Management of the condition is important, with the focus being on healing the stress fracture. If it doesn’t heal then the condition can progress leading to spondylolisthesis (vertebral displacement), which can mean an early end to the athlete’s career.
Diagnosis and treatment of spondylolysis
Spondylolysis occurs in many sports where extension of the spine and/or high-impact landings occur, such as gymnastics, cricket and figure skating.
Diagnosis is often difficult as clinical testing alone cannot distinguish between spondylolysis and other forms of lower back pain. Successful diagnosis rests on a number of factors including the patient’s pattern of symptoms in relation to exercise and other activities, a detailed examination of their spine and how they move and specific findings on imaging.
Upon confirming the diagnosis, the focus then becomes reducing the risk of the condition progressing, healing the stress fracture (if possible) and in parallel, preparing them to ‘return to play’.
The first phase of rehabilitation consists of addressing ‘movement dysfunctions’ in areas of the body that may have contributed to the condition developing eg stiff hips or a lack of spinal muscle co-ordination or stability. Low-level core stability exercises are used alongside stretching of tight muscles and physiotherapy to encourage an even pattern of spinal movement. After six to 12 weeks, if the athlete is pain free and has good basic core muscle stability , rehabilitation can be intensified to include some spinal extension and more complex movements with gradually increasing impact. If there is no residual tenderness and once good control and general conditioning have been restored, the athlete can return to competitive sport. The whole rehabilitation process for spondylolysis can take around three to six months, depending on the severity of the stress fracture.
Dr Eleanor Tillett was speaking at this year’s BASEM conference, held in Edinburgh in October. Dr Tillett is an ISEH consultant and Chief Medical Officer for the British Figure Skating Team.
References
1. Huynh L, Chimes GP (2014) ‘Get the Lowdown on Low Back Pain in Athletes ACSM's Health & Fitness Journal 18(1): 15–22, January/February.
2. Sairyo K, Sakai T, Yasui N et al (2012) ‘Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?’ Journal of Neurosurgery: Spine 16(6): 610–4, June.
3. Sys J, Michielsen J, Bracke P et al (2001) ‘Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment. European Spine Journal (2001) 10: 498–504.
4. Micheli LJ And Wood R ‘Back pain in young athletes. Significant differences from adults in causes and patterns‘, Archives of Pediatrics & Adolescent Medicine. 149(1):15-8, 1995 Jan.