LOWER BACK PAIN IN YOUNG ATHLETES

By Dean White

This one is particularly close to my heart. As an 18-year-old in my first year of professional baseball, I was diagnosed with L5 spondylolysis, caused by an inability to handle the increased 6-day week training load during the professional baseball season. I spent three months having the issue misdiagnosed by US doctors and returned home to Perth, where, luckily, I worked with Dr Peter Steele to diagnose and recover over eight months. Long story short, I missed most of my first professional season and spent the rest of my career trying to catch up. I wasn't physically strong and resilient enough for professional sports. I should have been more prepared. 

Moving forward to the present day, we have seen a rise of new athletes beginning S&C with us after lower back issues between the ages of 14 and 16. Most commonly, it is a form of stress fracture due to overuse. In the last decade, young athletes have seen massive increases in structured average practice and game time. This increase is generally not coupled with any physical preparation for the additional load, resulting in a significant increase in overuse injuries, and we are seeing it at the coal face. High-risk sports include Athletics, Basketball, Volleyball, Tennis, Australian Rules and Cricket.

Athletes diagnosed with this injury can usually make a full return to sport with appropriate rest, treatment, rehabilitation and ongoing management (usually with strengthening exercises)

Prevention is better than a cure, so here are some tips to avoid overuse injuries:

• Understand how many total hours a week of structured activity, including school sports, is being completed by the athlete (the AIS recommends no more than 16 hours per week for athletes 18)
• Avoid early specialisation (U12), and play multiple sports for as long as possible after the age of 12 to limit repetitive actions and improve overall athletic development (the ability to do this varies by sport).
• Create a ratio of no more than 2:1 organised session to free play 
• Strength and conditioning should be included as part of the weekly training schedule. Approximately 20% of the training/game time is a good guide. The AIS  recommends "Vigorous-intensity activities and those that strengthen muscle and bone should be performed at least 3 times per week"

​Reference AIS position statement here 

Below is a US study that discusses the prevalence of lower back injuries in young athletes and how they can be managed. 
 
"Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuries, the cause and effect relationship between back pain and specific condition is often difficult to establish. In adolescent athletes, the most common underlying identified cause of low back pain is lumbar spondylolysis. During adolescent growth spurt, the severity of the pain generally correlates with adolescent growth spurt. Participation in sports starting at an early age and for a longer duration tends to increase the risk for back pain. Numerous conditions cause low back pain in athletes. These include acute trauma, chronic overuse or repetitive trauma, and referred pain"
Lumbar Spondylolysis"Spondylolysis refers to stress fracture of the pars interarticularis (isthmic type), most lesions are bilateral (80%) and affect L5 (95%) (27-29). It is one of the most common and significant conditions that causes back pain in adolescent athletes, reported in almost 50% of cases of sport related low back pain in adolescents (30,31). The incidence of spondylolysis is 6% in the general population compared with 50% in gymnasts, 40% in Alaskans and 13% in Eskimos (30-33). A higher incidence is seen in ballet, gymnastics, competitive cheerleaders, American football linemen, weight lifting, wrestling, diving, volleyball, and fast bowlers in cricket (32,33). The mean age at diagnosis in athletes is around 15–16 years, but can occur at earlier age. Repetitive axial loading and rotation, especially in an extended lumbar spine, is the most important contributing mechanism leading to fatigue fracture of the pars interarticularis (33-35)"
FULL STUDY HERE