Site map

Low back problems in Sport

As well as having a weight bearing function, the spine acts as the centre for all movement. The spine and pelvis must create a stable base from which all movements can take place. In sport, the athlete is required to consistently perform at a high level, whether it be running, throwing, kicking or hitting and problems with this stable base, no matter how minor, can have detrimental effects on performance. Sportsmen and women, despite their relative fitness, are prone to lower back problems just like the rest of the population and management follows the same pathways. However, as only small reductions in performance are important to them, it may be argued that they may need more intensive treatment for relatively minor problems.

Sportsmen and women are prone to lower back pain due to acute trauma (e.g. a fractures after a fall, or acute muscle tear after forceful movement), and due to repetitive low force injury where they may suffer a prolapsed intervertebral disc, or pain from internal disc disruption, from the facet joint or sacroiliac joint. In addition they may be more prone to injuries such as an acute spondylolysis, a stress fracture of the spine.

A CT Scan of a Lumbar Vertebra showing the bony structure and stress fracture or Spondylolysis.

A CT Scan of a Lumbar Vertebra showing the bony structure and stress fracture or Spondylolysis.

A spondylolysis often occurs in people who are required to perform repetitive hyperextensions of the lower back (e.g. gymnasts, fast bowlers in cricket). Pain is usually located on one or other side of the lower back and may begin suddenly or start with discomfort that suddenly worsens. Pain usually does not radiate into the legs and is made worse by bending backwards. The problem may not always show on x-ray examination so often an isotope bone scan is required to confirm the diagnosis. Treatment is based around avoidance of hyperextensions and impact, and improving the stability of the spine through exercise. Usually symptoms settle quickly but it may be several weeks before full resumption of sporting activity is possible. Occasionally, pain continues and may require surgery to the spine.

Chronic disc pain is a frequent cause of low back pain in athletes. Pain can often refer into the lower limb muscles, particularly the hamstrings and calves. There often may be associated tightness within these muscles (often called adverse neural tension) which impedes performance. Local treatment to the muscles may help (physiotherapy, massage, dry needling), but treatment to the spine is often required in addition. On occasion, in such situations, an epidural corticosteroid injection can help reduce both the back and leg symptoms for a few weeks, allowing the physiotherapist to rehabilitate the athlete more effectively.