Injury Prevention

Back Injuries In Young Athletes

Dr. Larry W. McDaniel Ed. D. and Christina Cunningham discuss various problems related to common back injuries in young athletes.

Introduction

"The most common sources of back pain in adolescence are related to the bony skeleton, the surrounding musculature, and the intervertebral discs. Although consideration must be given to other etiologies the spinal column is at risk for injury in childhood because of the increased elasticity of stabilizing ligaments" (Macdonald 2007, p. 703)^[4]. Examples of extreme movements in the spine are flexion, extension, and rotation. Flexion of the spine is a forward bending movement. Extension of the spine is moving from the forward bend to a vertical or erect state. Rotation is turning the spine to the right or left while lateral flexion is bending to the right or left. Sports require repetitive motion in one direction, putting the spine at risk for developing pathological curves such as scoliosis (Macdonald 2007, p. 704)^[4].

Who is at Risk? Back injuries have been reported to be higher in athletes and members of club sports (Uitenbroek 1996, p. 380)[6]. The reason athletes are at higher risk for back injuries is that their physical activities are more frequent and intense. It is common for these participants to injure themselves at least twice in one season. An example of a sport that constantly uses flexion, extension, and rotational forces in the spine is gymnastics. Reports have demonstrated that with the high impact of bone movement that this sport requires results in back injuries related to acute macro-trauma or repetitive microtrauma. An example of these injuries is disc generation that has been strongly associated with gymnastics (see Figure 1.). Training in excess of 15 hours per week has been found to be a risk factor.

Figure 1 The Spine, 2010

Diagnosing Back Pain

The process of diagnosing back injuries may be difficult due to the anatomy of the spine. The pain may be localize or radiating. Lumbar pain is a problem in both athletes and the general population. Studies have shown 80-90% of lumbar injuries are not found. Because the signs and symptoms in this area are difficult to find, they are often misdiagnosed. Although lumbar pain is common, identifying the anatomical source of pain is extremely difficult.

There are three general categories related to adolescents with back pain: muscular, bone-related, and discogenic. These areas are used to classify pain into two broad groups: conditions causing pain with extension and conditions causing pain with flexion. Other types of back injuries adolescent may suffer are contusions, strains and sprains. Contusions are a result from a direct blow to the back. It can often lead to hematoma formation, pain, and swelling. With excessive stretching during concentric or eccentric contractions may strain muscles and tendons. A sprain is caused from a ligament stretching beyond its elastic limit. Chances of developing injuries such as strains and sprains or much greater for those who do not warm-up or stretch prior to exercise (MacDonald 2007 , p. 708)^[4].

"The overall growth of the adolescent can contribute to the development of back pain. Muscle, ligaments, and fascia all can lag behind bone growth during early puberty, giving rise to tight back extensors and hip flexors. This tightness can also predispose to overuse injuries." (MacDonald 2007, p. 709)^[4].

Common Injuries

A common injury in young athletes is Isthmic spondylolysis. This occurs as what we know, the relationship between evaluation and rehabilitation of back is unique. The anatomical cause is not as significant as the symptoms and functions for successful rehabilitation. For that reason, evaluation of the lumbar pain is based on signs and symptoms. Therefore, a general 4-level classification system that does not necessarily identify an anatomical cause was developed. The "red flag" is one level that describes lumbar pain. Athlete's signs, symptoms, and decreased function are the other 3 levels. This classification system is used for referral, participation, and rehabilitation decisions. "Given that low back tissues may the optimal exercise requires judgment based on clinical experience and scientific evidence". (McGill 1998, p. 754)^[5]. Specific measuring techniques are: relative importance of strength, flexibility and endurance.

To successfully strengthen the back after an injury it is important to understand the mechanism of injury. This will help formulate the exercise program and development of injury- avoidance strategies.

Figure 2 is a picture of a technique used during physical therapy to strengthen the back. Rehabilitation exercises are used to challenge muscles and enhance performances but that are performed in such a way to minimize loading of the spine and reduce the risk of injury exacerbation. This is done by putting stress on both damaged tissue and healthy supporting tissues to foster tissue repair while avoiding further excessive loading. There are three specific ways in measuring the progression during rehabilitation. Mentioned before, endurance is the main technique therapist use. Endurance refers to the ability to maintain a force for a period of time. Another important technique is strength that refers to the maximum force a muscle can produce during a single exertion. (McGill 1998, p. 756)[5]

Figure 2 McGill,1998

Conclusions

Engaging in exercise and sport has distinct benefits for health and well being. "Low back pain is a frequent complaint even in the general population of juvenile people, particularly in girls. As many as 30% of adolescents have experienced back pain." (Cupisti 2004, p. 50)^[1]. Youth in strong competitive sports have a high risk of injury. Football and gymnastics are two sports with a high risk of injury. Because of the repetitive movements and heavy tension on joints, 50-85% of participants are at risk. Three types of injuries an adolescent may suffer are contusions, strains and sprains. Since the back is still in the process of developing muscles, ligaments, and fascia may lag behind bone growth during early puberty, giving rise to tight back extensors and hip flexors. Being at a younger age with greater leanness may prevent some back pain. Those that do not smoke display less anxious/depressive behaviour and develop an increase in muscle strength and flexibility. All of these factors can represent ways to prevent lower back pain (Cubisti et al. 2004, p. 49)^[1].

Understanding the mechanism of injury is important in the process of developing exercise programs and strategies to avoid injury. "The low back region is an extremely complex mechanical structure, and direct measurement of tissue loading in vivo is not feasible. The only tenable option for tissue load prediction is to utilize sophisticated modeling approaches." (McGill, 1998, p. 758)^[5]. Recovering from a back injury requires work and patience. It is important to have an appropriate therapy plan to strengthen the injured muscles involved. After the assessment and rehab plan has been placed into action, it is vital to complete the entire program.

Referenced Material

1. CUPISTI, A. et al. (2004) Low back pain in competitive rhythmic gymnastics. Journal of Sports Medicine and Physical Fitness, 44 (1), p. 49
2. HECK, F. et al. (2000) A classification system for the assessment of lumbar. Journal of Athletic Training, 35 (2), p. 204
3. LEDDY, M. et al. (1994) Psychological consequences of athletics injuries among high level competitors. Research Quarterly for Exercise and Sport, 65 (4), p. 347
4. MACDONALD, J.& D'HEMECOURT, P. (2007) Back Pain in the Adolescent Athlete. Pediatric Annals, 36 (11), p. 703-712
5. MCGILL, S. (1998) Low back exercises: Evidence for improving exercise regimes. Physical Therapy, 78 (7), p. 754
6. UITENBROEK, D.G. (1996) Sports, exercise, and other causes of injuries: Results of a population survey. Research Quarterly for Exercise and Sport, 67 (4), p. 380

Page Reference

The reference for this page is:

• McDANIEL, L. & CUNNINGHAM, C. (2010) Back Injuries In Young Athletes [WWW] Available from: http://www.brianmac.co.uk/articles/article064.htm [Accessed

About the Authors

Larry W. McDaniel Ed.D. is an Associate Professor of Exercise Science at Dakota State University Madison, SD. USA. Dr. McDaniel was a First Team All-American football player (USA Football), a Hall of Fame Athlete, and Hall of Fame Wrestling Coach.

Cristina Cunningham is an outstanding student of Exercise Science at Dakota State University.

Associated Pages

The following Sports Coach pages should be read in conjunction with this page:

• Coaching Articles
• Training Articles
• Sports Specific Articles
• Literature Review