back pain

Back Pain accounts for 5 to 8 percent of reported youth sports injuries.

Dr. Carol Frey

Co-Director, West Coast Sports Medicine Foundation Fellowship
Manhattan Beach, California 

If you thought only Grandma had back pain, you would be incorrect. Kids experience injuries to their backs, but, unlike Grandma, their low back pain is rarely from anything specific and usually goes away without any treatment.

It is more likely that an athletic kid will have back problems than a kid who does not play sports. Athletes are simply doing more things that can expose a weakness in their bodies.

Pain in the lumbar spine (meaning lower part of the back) accounts for 5 to 8 percent of reported youth sports injuries. Although back pain is not the most common injury, it may be the most challenging to diagnose and treat.

The signs and symptoms of a bulging disc in youth may be less obvious

The large sacroiliac joint in the back part of the pelvis (upper buttock area) is also prone to irritation (it’s also known as the SI joint). The signs and symptoms of a bulging disc (herniation) in youth may be less obvious than in adults. More unusual things like tumors and arthritis can occur, but this is rare in kids.

It is often difficult for kids to point to a specific spot for the back pain. The anatomy in this area is complex, and sometimes the nerves get irritated and move the pain around (this is called radiation pain). A thorough physical examination and description of what happened is helpful to make the diagnosis.

Doctors should order tests for injured athletes who have long-term problems

Doctors should order tests for the injured athlete who has long-term, severe problems, after a severe injury, or if there is no improvement with standard treatment. X-rays, bone scans, computed tomography (CT), and magnetic resonance imaging (MRI) can be used to help make the diagnosis.

Most low back pain in a kid responds to standard treatment. Prompt treatment of a new injury should include ice, electrical stimulation, anti-inflammatory medications (such as ibuprofen), and gentle exercises. Let’s take each one:

A study of 2,846 patients noted that 75 percent of the kids with low back pain had a mechanical origin for the problem, such as poor strength in core muscles and pelvis. The average age of athletes in this study was around fourteen, and 63 percent of them were girls. If there was a diagnosis, it was commonly (in 7 percent of kids) spondylolysis (where part of the bone of the lower spine weakens and breaks) (Miller, 2011).

Gymnastics and cheerleading require lots of twisting motions

Spondylolysis and spondylolisthesis can be seen in kids who participate in sports that require twisting and hyperextension of the back. Sports such as gymnastics, cheerleading, basketball, volleyball, and sailing are sports that require these motions. The young athlete will often have complaints of pain that is worse when arching the back.

Spondylolysis is a leading cause of back pain in kids, especially in the young athlete. The problem often starts with a stress fracture (of the pars interarticularis) that most commonly happens at the fifth lumbar vertebrae (L5).

This condition is often thought to be a sprain or strain at first. For this reason, the condition can sometimes be ignored or missed for a period of time. X-rays are often normal, which is why advanced imaging studies such as bone scans, MRI, and a CT scan may be necessary to make the diagnosis.

This type of back injury is more common during growth spurts when there is more stress on the bone. The stress fracture that results may be a complete or incomplete fracture (for clarification, a complete fracture breaks all the way through the bone, and the incomplete fracture does not).

In about 15 percent of pars interarticularis stress injuries, and resultant fractures, there is a progression to spondylolithesis (a forward slipping of the vertebrae on each other).

Young athletes need to work on flexibility and strength

Recovery requires a period of relative rest, ice, medication, and strength and conditioning exercises. It is important the young athlete work on flexibility and strength. Strengthening of the trunk (core) muscles is a very important part of rehabilitation.

The athlete needs to rest or the fracture will get worse and result in a complete fracture. This can then lead to a persistent problem. Sometimes the bone does not heal (this is called a nonunion). The repeated stress of running, jumping, and bending activity can then produce a stress (also known as a fatigue) fracture. Activity must be restricted until the bone is healed.

In some cases, a brace may be helpful to rest the back and control pain. In mild cases, the problem can be treated like a sprain or strain. In severe cases it may take about six months to return to sports. It is rare for surgery to be required.

Good rehab will most likely lead to a return to the sport

If there is a slip in the vertebrae, there are special things to think about. A player who has less than a 50 percent forward slip can usually return to all sports when he or she is pain free and after a good rehabilitation program. If there is a forward slip of 50 percent or greater, it may be recommended that the athlete change sports to something less aggravating to the injury.

Players with a spondylolithesis (slipping) should be checked every six months for any more forward slipping. This is especially important to get periodic checks during growth spurts.

As with all back injuries, a complete rehabilitation program is very important prior to the athlete returning to sports.

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