Sports Related Back Injuries
By Ian P. Rodway, MD
Athletes are subject to many injuries of the musculoskeletal system, which include bones, muscles and joints. While injury to the arms or legs may be more common, injuries involving the spine do occur, and can be serious.
The most common sports injury affecting the back is a strain or sprain. These can occur in the lumbar and thoracic spine. The term strain is often used to denote over-stretch or tear to muscles, while sprain refers to ligament injury. The two causes present with similar symptoms, and are treated in the same fashion. These typically present with non-radiating pain in the middle or lower back, and sometimes the buttocks. The pain can be felt on one or both sides. In an isolated strain, there is no pain radiating into the legs. The pain is typically worse with activity and improves with rest. A strain/sprain can occur by direct or twisting injury, or due to improper lifting techniques. Poor core muscle strength and poor flexibility, especially in the hamstring muscles, can predispose an athlete to these injuries. More serious conditions must be ruled out before a patient is diagnosed with a strain/sprain. Treatment is based on the severity of the symptoms and may include a period of rest, as well as anti-inflammatory medication and physical therapy. If significant muscle spasms are present, a short course of muscle relaxants may be helpful. Once the athlete’s symptoms are improved, return to play is permitted as tolerated. Stretching, core muscle strengthening, and biomechanic training, such as improved lifting techniques, can help to prevent similar future injuries.
Isolated, non-radiating low back pain that is worse with extension can be due to a fracture of part of the vertebrae, specifically, the pars interarticularis. The medical term for this condition is spondylolysis. The pars is a thin region of bone that is subject to stress with repetitive lumbar extension. This condition is classically seen in adolescent football lineman and gymnasts, but can occur with any repetitive sports activity. The injury can involve one or both sides of the affected vertebrae, and can be a stress fracture (incomplete) or a true complete fracture. Once a pars fracture is suspected, the athlete is evaluated with a physical exam. The fracture can occasionally be recognized on x-ray, but often a CT scan is required. An MRI, or bone scan can be helpful to recognize incomplete injuries or stress fractures. MRI and/or bone scan can also be used to determine whether the injury is new or old, and to determine healing potential. Treatment involves activity limitations and brace wear for up to 3 months. Once the patient is pain free, physical therapy can be started, and the athlete is transitioned back to sport. If conservative measures fail to relieve activity related pain, surgery may be required to treat the fracture directly.
If pain is felt down one or both legs, the patient may have a herniated disc. Herniated lumbar discs can cause pain, numbness or weakness in the legs. There is not necessarily low back pain experienced with a disc herniation. The symptoms are typically felt down the back of the leg and may go as far as the toes. After the appropriate examination, an MRI is ordered if a disc herniation is suspected. Disc herniations are initially treated symptomatically with rest, medications, and physical therapy. Epidural steroid injections may be used, as well. If symptoms are very severe, or persist despite conservative measures, surgery may be indicated.
Injuries of the back related to sports activities are common, and range in severity from simple muscle strains to fractures, or disc herniations. Proper evaluation by medical personnel is required so that the correct diagnosis is made, and appropriate treatment started. With proper treatment, the athlete can be back in action in a timely manner.