Trainer’s Corner: Low Back Pain in Athletes

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jen degman,  certified athletic trainer, central regional hsBy Jen Degnan, a Certified Athletic Trainer at Central Regional Middle School in Bayville, New Jersey. Jen currently works Tuesday nights during Dr. Tauro’s Sports Clinic hours.

The fall sports season is now in full swing.  An athlete suddenly presents with lumbar (low back) pain which increases with activity. As a result, athletic performance is affected.  With no history of lumbar spine injury, what is the cause of the lumbar (low back) pain?

In adolescent athletes, there are a few common causes of low back pain:  1) lumbar sprain, 2) poor core strength, and 3) tight hamstring musculature which impacts the range of motion (ROM) of the lower back.  Any or all of these problems can lead to low back pain at any time.  Let’s examine each of these problems and how they relate to lumbar spine pain and athletic performance.

lumbar 11) Ligament Sprains:

The lumbar spine consists of 5 moveable vertebrae numbered lumbar 1 to lumbar 5 (L1 – L5).

The lumbar spine is very flexible providing movement in many different directions. There are a number of ligaments that help to maintain the stability of the lumbar spine and limit its ROM to prevent injury.

Ligament sprains in the lumbar spine are very common; most sprains occur at the L4 or L5 region of the spine. A sprain is caused when ligaments, the bands of tissue that hold bones together, are stretched or torn from their attachments.

This injury results in inflammation which causes lumbar spine pain. Athletes’ symptoms may include loss of ROM, pain, and muscle spasm. If these symptoms persist, an orthopedic physician should be consulted to rule out more serious injury. Diagnostic testing such as an X-Ray may be appropriate in some cases but MRI is usually not necessary.

Treatment: Physical therapy may be prescribed to address any decreased ROM, decreased flexibility, and any imbalance in muscles of the lower extremity. The athlete can return to full activity when the symptoms subside with no restrictions.

2) Poor Core Strength:

lumbar 4There is a direct correlation between weak core muscles and lumbar spine pain. When you hear the term “core,” what does that mean?

The core is a large group of muscles located in the middle of the body, to include the abdominal muscles, lower back, gluteal muscles, and the hips. Basically, your core includes everything except your arms and legs. Core muscles work when you lift, turn, twist, pick something up, bend, or reach overhead; in other words, just about everything you do.

When an athlete attempts any movement, the core muscles unconsciously tense to allow that movement to occur. Core strength is defined as the balance between the deep and superficial muscles that stabilize, align, and move the trunk of the body, as well as, help the athlete maintain stability in motion.

Core muscle strength helps determine posture. Poor posture is often a sign of weak core muscles. This weakness results in the shoulders coming forward causing the athlete to slouch. Also, when the core muscles are weak, the curvature of the lumbar spine can change placing an increased pressure on the spine and surrounding ligaments making the athlete more prone to injury.

Treatment: Under the direction of an orthopedic doctor and physical therapist, the athlete needs to complete a variety of exercises specifically designed to strengthen the core muscles. Abdominal exercises, planks, back extensions, and mountain climbers are a few exercises to accomplish this goal. Upon restoration of core muscle strength, the lumbar spine pain and any ROM limitations will go away, allowing the athlete a full return to activity.

3) Tight Hamstring Muscles

lumbar 2The hamstring muscles are a group of 3 muscles that connect from the buttocks area of the pelvis to the back side of the lower leg. The hamstring muscles bend the knee and extend the hip. Normally, the lumbar spine is in a set position that holds a small curve in the low back. Inflexible or tight hamstring muscles pull down on the pelvis which flattens out the lower back.

This rounded position stresses the lumbar spine and the ligaments leading to low back pain and increasing the risk of injury.

lumbar 3Treatment: To overcome tight hamstring muscles, the muscles of the lower abdomen and low back need to be strengthened to re-establish balance between the muscles of the lower extremity. The strengthening and stretching protocol will be established by an orthopedic physician in conjunction with a trainer or physical therapist.

Low back pain in athletes can be caused by a variety of problems and lead to significant lost time on the playing field. A thorough physical evaluation can help isolate the problem and allow the athlete a safe return to the athletic field as soon as possible.

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