Is Sports Activity A Pre-Existing Condition For Back Pain?

All but a few of us will experience some kind of back pain during our lifetimes, especially as we grow older. But a new study shows that being young is no longer a guarantee that back pain left untreated will simply pass. If you play organized sports, compete as a weekend warrior or simply like to be active, you may need your own game plan to assess back ailments, which can range from simple strains to serious spinal conditions.

That's the conclusion of new research from James P. Lawrence, MD, a resident at Yale Medical School in New Haven, Conn., and Jonathan N. Grauer, MD, co-director of the Spine Surgery Service at Yale-New Haven Hospital and assistant professor at Yale Medical School. They are the lead authors of a study published in the December 2006 issue of the Journal of the American Academy of Orthopaedic Surgeons examining athletic back injuries and their treatment.Back pain affects approximately 30 percent of athletes, but this rate may vary by sport. For example, Drs. Lawrence and Grauer found that 50 percent of football players suffer from back injuries, compared with 11 percent of gymnasts. "Certain injuries are sports-specific: herniated lumbar disks are more prevalent in football and weightlifting; degenerative disks and spondylolysis (a stress fracture occurring most often in the 5th lumbar vertebrae) are more common in gymnasts; and traumatic lumbar injuries are mostly seen in wrestlers and hockey players," they write in the Journal.Risk factors for lumbar injury in athletes can include:

• Prior back injury
• Decreased range of motion
• Poor conditioning or flexibility
• Excessive or repetitive axial loading
• High body weight
• Improper play techniques and abrupt increases in training.

Many athletes assume back pain will subside in time, but more long-lasting injury and pain should be ruled out by a physician. If pain persists, a physical exam is essential.Physicians record the patient's age, medical and sports activity history, as well as position of the spine at the time of injury. They also review existing imaging studies and the sport-specific movements affected by the injury.In addition, they should estimate the amount of force applied to the lumbar spine during the injury, location and duration of pain, onset of symptoms, and whether the injury is due to repetitive microtrauma or fatigue of the spine that can result in sprains and strains.Drs. Lawrence and Grauer noted that physicians look for warning signs of postural abnormalities, such as the presence of kyphosis (a rearward curvature of the spine that creates a hunchback) or scoliosis (an abnormal lateral spine curvature).A critical part of the examination should include range of motion, a neurological exam including motor and sensory testing, and reflex examination (including a straight leg raise, which indicates pain location).Potential pain generators in and around the spine include intervertebral disks (broad, flat cartilage structures containing a gel-like fluid that cushion and separate vertebrae), facet joints (joints that connect two vertebrae), muscles and ligaments. Identification of the precise pain generator may be compounded by a deformity from kyphosis or instability from spondylolysis or spondylolisthesis.Athletes in pain should discuss activities that reduce or increase pain with an orthopaedic surgeon to eliminate the possibility of other illnesses, such as cancer or kidney problems that may manifest as back pain."Lumbar pain in the athletic population requires detailed investigation, including the true pathology of intervertebral disk degeneration or herniated disks and whether they were initiated or aggravated by athletic activity," said Dr. Lawrence."The orthopaedic surgeon must determine the long-term implications of athletic activities on the lumbar spine and make recommendations such as rest, specialized exercise programs or therapies. Surgical intervention occasionally may be necessary. Further, these methods must be subjected to rigorous scientific methods," he said.Back pain may also require imaging, such as multiplanar X-rays to rule out structural abnormalities. Flexion/extension radiographs can assess dynamic instability and computed tomography (CT scan) can help define bony anatomy when radiographs do not have enough detail. Magnetic resonance imaging (MRIs) can evaluate disks, neural elements or other soft tissue and can provide information about obscure fractures or uncontrolled growth in tissues. Bone scans may rule out metabolic activity in lesions, fractures of unknown age or defects.An orthopaedic surgeon is a physician with extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.(Source: Yale Medical School : January 2007.)