Low back pain

In adolescent athletes

The spine or vertebral column consists of bony vertebrae held stable by way of bone structure and an intricate interplay of spinal and trunk ligaments and muscles.
Each bony vertebra consists of an anterior body, and a posterior bony ring with two articulating surfaces on the left and right of the vertebral body. These called facet joints and these joints provide stability to the spine with the adjoining vertebrae above and below.

In a condition called spondylolysis, there is a defect in the articulations between the facet joints. In young athletes, this defect can be due to a stress fracture of a thin section of bone that connects the superior and inferior facets. A disruption of this thin portion of the bone can be unilateral, involving one side, or bilateral, involving both sides.

Some sports, such as gymnastics, weight lifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. The result can be a stress fracture on one or both sides of the vertebra.

In cases of bilateral stress fractures the facet bone structure becomes weakened so much that it is unable to maintain the proper position of the vertebral body, and the vertebra can start to shift out of place. This anterior shift of the vertebral body is called spondylosis. If too much slippage occurs, the bones may begin to press on nerves and pain arises.

This condition usually affects the fifth lumbar vertebra in the lower back and, much less commonly, the fourth lumbar vertebra.

In young people with persistent low back pain, it is important to review if there has been a recent history of sports trauma, an increase in a sports workout schedule, if the adolescent has had a recent growth spurt.

Spondylolysis may present with the following symptoms:

  • Pain usually spreads across the lower back and may feel like a muscle strain.
  • The condition can cause spasms that stiffen the back and tighten the hamstring muscles, resulting in changes to posture and gait.

For those with symptoms, an xray ordered by your doctor can assess of there is a bony defect and if there is an alteration of bony alignment of the lower lumbar vertebra.

Physical Therapy Treatment

A thorough education is essential to assist the adolescent athlete to plan and proactively avert unnecessary stresses to the low back in their sports activities. Designing a customized program of stretching may include emphasis on hamstring and hip flexor flexibility to ease strain upon a lower lumbar segment that is vulnerable to extension stresses and strains.

A progressive core strengthening program of exercise for the back and abdominal muscles is a critical component of a successful recovery from the pain associated with this condition.

During an acutely painful stage, the physical therapist may include use of modalities such as ultrasound, soft tissue mobilization, or muscle stimulating techniques to improve muscle healing and reduce inflammation.

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