Back Pain in the Active Individual

Back pain is a common complaint of many individuals. It is an ailment that will afflict 8 out of 10 people at some point in their lives. Although an athlete may be in better overall physical condition than someone who is sedentary, they are very much at risk of sustaining a back injury due to the many repetitive and excessive stresses and strains that they subject their body to.

Paddlers and rowers subject themselves to numerous factors that can lead to neck and back pain. The highly repetitive nature of paddle sports involve high torque, awkward asymmetric mechanics, and an unstable platform to perform from, all of which may contribute to the possibility of back or neck problems. These problems may then lead to shoulder, arm, hip, or leg complaints. Combine this with poor technique, poor recovery and regeneration methods, and improper or insufficient dryland training and you have a great recipe for creating injuries!

This article will attempt to give the Sports Aider some guidelines in terms of helping manage the athlete with back pain. This is by no means a comprehensive guideline. Always remember to do no harm when assisting an athlete, and when in doubt, refer it out!

Initial Management of Back Pain

Gathering a thorough history and doing a physical assessment is the first step to ensure proper care of an athlete complaining of back pain. Eliciting the mechanism of injury is important to establish a proper treatment protocol. Acute injuries are managed very differently than chronic injuries.

A good history of a back complaint should include the answers to the following questions:

• Where is the pain located?
• Does it radiate anywhere?
• When did it start?
• What were the events that led to the injury?
• Has there been a gradual increase in low back discomfort or did the pain come on suddenly?
• Was there any trauma?
• Can you describe the pain and its intensity?
• Is the pain worsening or improving?
• Is there any numbness and/or tingling, suggesting neurological involvement?
• Any weakness? Any warmth or coldness in the arms or legs?
• What aggravates the problem, and what relieves it?
• Are there any other associated aches or pains?
• Has the athlete had any flu, fevers or other illnesses recently?
• Have they noticed any changes in bowel or bladder habits?
• Are they on medication?
• Do they have a history of previous back injuries?
• A preliminary physical assessment should include the following evaluations:
• Posture
• Ranges of motion
• Strength
• Flexibility
• Stability
• Palpation of the area of complaint and surrounding tissues
• Orthopedic testing
• Checking neurological and vascular status

The questions are numerous but all are very important in determining the nature and extent of the back injury. Providing this information to a health care provider will be of great assistance and highly appreciated.

Acute Back Pain

Back pain that comes on suddenly deserves special attention. Bad slips, falls, and collisions do occur, and some can lead to serious complications. Any history of significant trauma should result in a "red flag" being raised and the injured athlete should be treated as a possible spinal cord injury. It is wiser to err on the side of caution in this situation. Immobilize the patient and call for emergency assistance.

If direct trauma is not involved, then the athlete should be instructed on the R.I.C.E. Principle (rest, ice, compression, elevation). Resting on their back with the knees elevated and a large ice pack under the injured region is recommended. The athlete should then be instructed to see a health care practitioner familiar with managing back pain for more thorough investigations and treatment.

Chronic Back Pain

Chronic and/or recurrent back pain can be very frustrating. Unlike other diseases or injuries, back pain can often occur with no clear reason. It also must be remembered that certain athletic activities are simply excessively stressful on the spine. Most often, chronic back pain results from a succession of micro-traumas to the elements of the spine, which include the vertebrae, intervertebral discs, posterior facet joints, ligaments, tendons, muscles, nerves, and blood vessels. There are a multitude of mechanical factors related to chronic back pain that include chronic or excessive traction, compression, torsion, or shearing of the spine and related structures and tissues. Certain athletic activities like paddling are simply excessively stressful on the spine. Poor technique or form in any sporting activity also makes an athlete more susceptible. Be aware of technical faults as the athlete fatigues. Lack of strength, flexibility, and stability, and coordination can predispose an athlete to injury. Poorly designed or poorly fitting equipment and an unsafe environment can also be contributing factors to back pain.

Treatment of Back Pain

To ensure the complete and proper recovery and rehabilitation of an athlete with back pain, s/he should be referred to a health care practitioner who is properly trained, skilled and familiar with managing such injuries. Prompt and proper initial management of an injury can significantly reduce healing time and minimize future complications. A trained specialist in back pain can often make a diagnosis based on a thorough history and physical exam, often avoiding expensive and time consuming laboratory and diagnostic tests. X-rays are often unnecessary but may be beneficial, if not to confirm a diagnosis, then to rule out other possible causes of pain.

Management of low back injuries is a rapidly evolving field. Physical therapy and chiropractic manipulative therapy are just two of the more common conservative forms of treatment. Massage therapy and acupuncture can also be of significant benefit. Surgery is only considered in a few more serious situations.

Treatment should consist of limiting pain (modifying activity), then increasing ranges of motion, flexibility, and strength. Ranges of motion can be improved with active and passive stretching, soft tissue therapy, and skillfully applied manipulative therapy. Reconditioning should include exercises to enhance flexibility, strength, stability, and proprioception.

A thorough biomechanical analysis can help identify and correct any faults that may be a contributing factor to back injuries. Skill and technique analysis by someone who is familiar with both the workings of the human body and the sport specific tasks of the athlete can identify and minimize certain predisposing factors to injury. Individuals working as parts of an allied health care team often offer the safest, most effective care as members can share expertise in the common goal of treating and rehabilitating the injured athlete. Do not hesitate to communicate with the professional managing the injured athlete.

Prevention of Low Back Pain

Above average levels of strength, flexibility, spinal stability and coordination should be expected of any athlete so that they may be better prepared for the sudden and unexpected stresses faced in training and competition. These parameters should be established prior to any involvement in sport, particularly in relation to the "weekend warrior" events. Proper technical skill should be developed and practiced to ensure biomechanical efficiency and to avoid possible risk of an injury developing. If an athlete is not recovering properly between workouts, fatigue levels may accumulate. Proper hydration strategies, diet, rest, and relaxation are all essential components to enhanced performance.

Just as you want to be as well prepared as possible to help manage an injured athlete, you should desire the athlete to be prepared for the rigors of the activity they are pursuing!

Rob Hasegawa is a chiropractor with a strong interest in the treatment and prevention of sport injuries. He practices in Victoria, BC and is very involved with the sports of triathlon, distance running, and cycling.

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