The most frequent cause of low back pain in young athletes is lumbar bone stress injury (LBSI), including spondylolysis, which occurs in just 6% of adults.
Adolescents are more vulnerable to back pain due to spinal changes during puberty, rapid growth periods, and their immature skeletal systems. The lumbar vertebrae typically don't fully fuse until around age 23, increasing the risk for injuries like LBSI. Lower back pain can arise from acute traumatic events, such as a hard tackle in contact sports, or repetitive trauma due to overuse. This issue is particularly prevalent in athletes involved in football, rugby, ice skating, and dance.
Types of Low Back Pain in Youth Athletes
Acute Soft Tissue Injuries: Sprains, strains, and contusions often result from direct impacts, twisting motions, or forced hyperextension.
Spondylolysis: This non-displaced fracture of the pars interarticularis is common in sports involving repetitive flexion and torsion of the lumbar spine, most frequently affecting the L5 vertebra.
Spondylolisthesis: Typically arising from undiagnosed spondylolysis, this condition involves the slipping of one vertebra over another, often occurring at the L5/S1 segment.
Stress Fractures: These are caused by repetitive loading of normal bone or abnormal bone and are often linked to hyperextension and rotation injuries.
Identifying Lumbar Bone Stress Injury
LBSI is the leading cause of low back pain in young athletes, but it’s important to note that not all back pain stems from this condition. Key subjective markers include unilateral lower back pain that worsens with extension activities and eases with rest. Accurate diagnosis of LBSI typically requires imaging; unlike adults, adolescents show a higher correlation between symptoms and definitive pathology (up to 73%). MRI is preferred due to its high sensitivity and specificity.
In the absence of MRI, it’s prudent to assume LBSI is present and initiate a period of rest and activity modification.
Treatment and Management
Research supports the effectiveness of physical therapy in managing low back pain in young athletes. A multidisciplinary approach may include:
Physical Therapy: For pain management, activity modification, and a graded return to activity.
Nutrition Guidance: Dietitians can help ensure proper energy intake and meal timing.
Coaching Support: Coaches can monitor athletes during training and assist with recovery.
Family Involvement: Family support is crucial for attending appointments and encouraging adherence to treatment.
Typical recovery times are 6-8 weeks for spondylolysis and 4-6 months for spondylolisthesis. Non-complicated stress fractures generally heal within 4-8 weeks with conservative management, avoiding surgery.
At Darwin Health Group, our dedicated team of physiotherapists specialises in managing bone stress injuries and lower back pain. Book an appointment today for a comprehensive assessment and tailored management plan to help you or your young athlete stay at their physical best!
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