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.
"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). 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).
Diagnosing Back Pain
The process of diagnosing back injuries may be difficult due to the anatomy of the spine. The pain may be localized 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).
"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).
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 judgement based on clinical experience and scientific evidence". (McGill 1998, p. 754). 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.
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). 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).
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 modelling approaches." (McGill, 1998, p. 758). 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.
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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.
The following Sports Coach pages provide additional information on this topic: