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Lower Back Pain in Athletes

what causes it & how can we treat it?

Low back pain is one of the most common complains nowadays, but some people are more at risk of suffering from it than others. For obvious reasons, Athletes are at greater risk of developing lumbar(lower) back pain due to physical activity, as the spine undergoes lots of stress and it could get worse if there is delay in seeking medical treatment for the fear of letting the team down or missing a competition.

Here we will mention some of the common causes of low back pain in athletes and the treatment of each:

1. Musculoligamentous Strain

Musculoligamentous strains are probably the most common sports injury. This term refers to all injuries of the lumbar spine's soft tissue. Soft tissues are the muscles, nerves, ligaments, tendons, and blood vessels around the spine. These injuries are diagnosed by exclusion after all other causes of the pain are ruled out. These injuries are usually self-limiting, they do not continue to spread and get worse; they generally heal in time. Healing often happens even without getting specific treatment for the area.

Treatment generally focuses on education and prevention of future strains, through proper conditioning, warm-up, and changes in the way an activity is carried out.

2. Spondylolysis and Spondylolisthesis

So far, there is no definitive cause of spondylolysis. It is thought that spondylolysis appears in younger and older adults as the result of a genetically weak "pars interarticularis" teamed up with excessive stress to the spine and eventual stress fractures

In athletes, spondylolysis is most commonly found in those who participate in sports that have frequent hyperextension of the lumbar spine, such as: gymnastics, pole-vaulting, and football. Weightlifters also have a higher incidence of the disorder due to excessive stress on the spine.

Spondylolysis does not always produce noticeable symptoms. When it does, chronic low back pain is the most common symptom. Initially, conservative treatment is generally suggested.Anti-inflammatory medications and stretching/strengthening exercises can reduce the pain.

If your spine specialist feels you may have a true stress fracture from athletic activity, you may be placed in a back brace for 24 hours a day for several months to allow the fracture to heal. You will then be gradually weaned from the brace and allowed to return to full activity. Surgery is rarely considered in such cases.

Spondylolysis can also lead to "spondylolisthesis". This condition occurs when the weakness caused by the spondylolysis causes one vertebra to slip forward over the one below it. Most cases of spondylolysis in athletes do not lead to vertebral slippage. However, if slippage does occur, it may continue. This situation would require treatment that is more aggressive, perhaps even surgery. The chance of progression is probably more worrisome in teenagers than adults.

Many cases are non-symptomatic and do not cause any nerve problems. However, sometimes the slipped vertebra can press into the space belonging to the spinal canal. This leaves less room for the nerve roots. The neural pressure can lead to low back, buttock, and leg pain, as well as numbness in the foot. If the problem is severe, surgery may be suggested.

3. Intervertebral Disc prolapse

Because of excessive weight bearing and stress, athletes sometimes damage an intervertebral disc. These discs are placed between each of the vertebrae of the spine and pose as shock absorbers. When the fibrous outer part of the disc breaks, it allows the gel-like core to bulge outwards. The disc that is damaged then puts pressure on the spinal cord or a single nerve fibre.

The compression to the nerves caused by herniation can lead to feelings of: numbness, pain, a change in reflexes, and/or tingling in the arms or legs. Sometimes a herniated disc is referred to as "slipped disc", though the disc does not actually slip.

Herniated discs are most common in the lumbar (lower) spine because it supports more pressure than the thoracic (middle) or cervical (upper) parts of the spine. In fact, a herniated lumbar disc often produces sciatica (the sciatic nerve in the lumbar spine region connects with your legs). With sciatica, you will feel numbness and pain down the back of the leg, side of the calf, and possibly into the side of the foot, but not necessarily much back pain. The exact area where you will feel numbness depends on the nerve root that is affected; the numbness could be in the inner ankle, big toe, heel, outer ankle, outer leg, or a combination of them. When the nerve roots' motor function is damaged by disc herniation, you may also experience weakness in certain parts of the leg and foot.

Treatment is usually conservative, through bed rest, Anti-inflammatroy drugs, Analgesics, physical therapy , external spinal support which may reduce severe back painand modification of daily physical activities such as :

  • Avoiding heavy lifting
  • Avoiding bending the back
  • Picking objects from the floor should be accompanied by bending the knees and keeping the back straight
  • Reduction of excessive body weight

Surgery isn't the role but it is indicated if conservative treatment fails, or presence of bladder or bowel disturbances occur.

Finally, remember that your health is more important than any task you want to finish so take care of yourself and don’t hesitate to seek medical advice if needed.

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