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Young gymnast practicing mat routine in the gym

Why Back Pain Shouldn't be Ignored in Young Athletes

Author: CHKD Sports Medicine
Published Date: Wednesday, August 30, 2017

By: Nicole Lewis PT, DPT, ATC

The spine is made up of a column of small bones called vertebrae that work together to allow the body to move in all directions. These bones can be damaged by the repeated stress of certain types of activity, causing back pain. Spondylolysis is a common, yet potentially serious reason for back pain in young athletes.

Spondylolysis typically begins as a crack or stress fracture in a specific area of the vertebra called the pars interarticularis. This injury occurs most often in children and adolescents who participate in sports that cause stress to the lower back, such as football linemen, gymnasts, swimmers, divers, weightlifters, track and field athletes, soccer players and volleyball players. In some cases, the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine, and the vertebra starts to shift or slip out of place. This condition is called spondylolisthesis, and can be a dangerous complication as the bone can put pressure on the spinal cord if it continues to slip.

Spondylolysis is common in adolescents, but rare in adults. This is most likely due to the effects of stress on still-growing bones. As children grow, their muscles can become tight if the bones grow faster than the muscles can stretch. Common areas of tight muscles are the hip flexors and hamstrings. This combined with a weak core – including abdominal and gluteal muscles – can increase the curve of the lower back putting strain on the spine, increasing the risk of injury. The risk of injury also goes up as playing time and intensity of sports increases with age. For example, a young athlete playing the same sport on multiple teams simultaneously will have increased stresses to their back.

Persistent back pain in a young athlete should always be evaluated by a medical professional. An X-ray is used to diagnose a spondylolysis or spondylolisthesis injury. If this is not conclusive, further imaging studies may be needed. Once a diagnosis has been made, the best treatment is rest. The doctor may also prescribe a brace to help maintain a neutral spine position. For most athletes, back pain and other symptoms will improve if they follow this treatment plan.

In a 2005 study involving 57 soccer players with a spondylolysis injury, the athletes were instructed to rest and wear a provided brace for a period of three months. All 27 athletes who followed these instructions had excellent results, returning fully to their previous level of activity without any pain or discomfort. Of the five athletes who stopped sports but did not wear their brace, four had excellent results. The remaining 25 athletes chose not to rest. Of the 13 that wore their brace but kept playing, only two had an excellent result, and of the 12 that neither stopped playing nor wore their brace, none had an excellent result.

A physical therapist can also help an athlete recover from a spondylolysis injury. Treatment will focus on flexibility and stabilization exercises for the core to help maintain a neutral spine position. Once the athlete is able to demonstrate improved core control and their spine has healed, the therapist will help them safely and gradually progress to sports activities. A gradual return to sports allows the athlete to practice maintaining a neutral spine through various movement patterns as well as allowing the newly-healed bone get accustomed to the forces involved with the sport.

If you are concerned that your child has been experiencing persistent back pain without improvement, contact one of CHKD’s Sports Medicine doctors for an evaluation. They can assist with coordinating your child’s care and getting them back to their sport, pain-free, as quickly and safely as possible.

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About CHKD Sports Medicine

About CHKD Sports Medicine  CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.