Around 80% of the population experience back pain at least once in their lifetime. However, some people are more predisposed to acute and chronic back pain due to injuries because of their lifestyle. Athletes have an increased risk of sustaining a lower (lumbar) spine injury due to the amount of time spent participating in strenuous activity. During sports such as tennis, golf, running, soccer, ice skating, football, basketball, and skiing, the spine endures a lot of stress. Turning, twisting, absorption of pressure, and bodily impact are all movements that can lead to lumbar injury and pain.
Repeated strenuous activities can strain your back and may cause injury even to the fittest and elite athletes. Although the entire spine is used when participating in sports, it is estimated that 1-% of all spors-related injuries involve the lower spine. Most of these cases are traceable to particular trauma or event, while others occur due to repetitive minor injuries resulting in micro-traumas.
The following are common back injuries related to sports:
1. Musculoligamentous Strain
Musculoligamentous strain is a common back strain that involves the lower spine’s soft tissue. Soft tissues of the spine are the blood vessels, tendons, ligaments, nerves, and muscles. Back strain is possibly the most prevalent sports injury. The injuries are diagnosed through exclusion, meaning the diagnosis is made once all other reasons for the pain are ruled out. Back strain injuries are typically self-limiting and will resolve on their own. They usually heal with time when combined with rest. Usually complete healing of the strain occurs without receiving specific treatment for the affected area. In general, treatment of lower back strain consists of rest and focuses on avoidance of future strains through a suitable warm-up, proper conditioning, and if needed, changes in the activity.
2. Herniated Nucleus Pulposus
The nucleus pulposus is the soft, gelatinous material inside the body of the discs of our back. A herniated disc occurs when this jelly-like material herniates (ruptures) out the back of the disc. This occurs when the pressure to the annulus (disc’s outer fibers) is so high that it rips, leading to rupturing the nucleus out of its usual space. The herniated disc ruptures into space that nerves or the spinal cord lie, putting increased pressure on nerve roots or the spinal cord. This pressure on the nerves is what causes back pain and leg pain associated with a disc herniation.
Herniated discs are commonly seen in the lower spine as it supports more pressure compared to the cervical (upper) or thoracic (middle) parts of the spine. Lumbar disc herniation can cause ‘sciatica’, or pain and numbness down the leg and foot on the affected side. The symptoms caused by a herniated disc will be felt in a predictable pattern, determined by which level the disc herniated on.
90% of herniated discs will resolve on their own and do not require surgery. Treatment of a herniated disc usually starts with more conservative measures of rest, physical therapy, and oral anti-inflammatory medication. Sometimes targeted steroid injections are used to help provide relief of symptoms. If conservative measures fail to resolve symptoms, surgery may be indicated. In rare situations, the herniated disc can fill the entire spinal canal, which exerts massive pressure on the nerves. This may lead to paralysis of muscles in your legs and you may lose control of your bladder and bowels – however this is extremely uncommon.
3. Spondylolysis and Spondylolisthesis
Spondylolysis is a common condition in teenage athletes who take part in sports that perform frequent hyperextension of the lumbar spine. Such sports include football, pole-vaulting, and gymnastics. Weightlifters are also prone to the disorder because of exerting excessive stress on the lumbar spine. Spondylolysis will not always have noticeable symptoms, but chronic low back pain is usually the hallmark symptom. The pain can emanate from compressive (pressure on nerves) or structural (mechanical) pain. In the beginning, conservative treatment is recommended.
Spondylolisthesis (sliding spine) is a condition closely associated with spondylolysis, which occurs when the weakness caused by spondylolysis makes one vertebra slip forward on top of the one below it.
Spondylolisthesis does not always cause problems, often, patients are asymptomatic and it can be found incidentally. However, the slipped vertebra can sometimes press into the spinal canal, and stretch the nerve roots resulting in pain. The resulting neural pressure may cause low back, leg, and buttock pain, including numbness in the foot. Severe cases may require surgery.
Recreation and sport are healthy pastimes, and are encouraged. However, injury to the lower back is possible. Most injuries are mild and will self resolve. If your pain persists longer than usual – it is recommend to have your spine evaluated by a specialist.