Low Back Pain is NOT OK

When you push your body to its limits, and beyond, you can experience low back pain. “It is estimated that 5-10 percent of all athletic injuries are related to the lumbar (lower) spine1”.  This type of pain happens because you are not able to stabilize using your core muscles during your athletic activities. All athletes can experience this discomfort but few pay attention until it stops them from competing. When the pain stops you from exercising it usually is too late. Pushing through your limits day in and day out creates an injury that is harder to heal. While rehabilitation can help decrease your discomfort the best way to treat low back pain is to avoid it all together.

As a competitive athlete you always have the drive to do one more sprint, one more lift, or one more throw. When you push yourself to the limit there is a fine line between safe training and pushing through pain. Discomfort during training that does not go away, and often gets worse, means your core muscles are not maintaining your neutral zone in your spine. This zone is the most ideal position of your spine to provide support while exercising and standing still.

Injury can cause the ligaments and muscles around the spine to not work properly, especially when the ligaments are pulled. When this happens the muscles must take over stabilization to stay in the neutral zone. If you have low back pain then your muscles are not doing their job to stabilize2. The neutral zone can increase when there is instability in a small or large part of the spine. This increase can cause pain, increase your risk of injury (because your stabilizers do not react fast enough), and decrease your performance in sport2.

Any athlete can develop low back pain. The more demanding your sport and the more demand you put on your body the more likely you will get it. Specific sports such as weightlifting and football have more athletes that get back pain from wear and tear conditions, stress fractures (breaks in the bones over time), and injuries of the lower spine. Other sports like skiing, basketball, ice skating, soccer, running, golf, or tennis put a lot of stress on the spine also. These sports cause cushioning of pressure, twisting, turning, and bodily impact1. This continuously and forcefully loads your spine and can create stress fractures and instability of the lower back. Pinching on nerves can happen when the spine cannot keep itself stable. If you experience numbness, pain, or tingling in the arms or legs see your doctor as soon as possible. If you lose control of going to the bathroom contact your doctor immediately3.

As an athlete you can experience low back pain repeatedly but choose to train through it. You are focusing on performance more than staying healthy and preventing injury to your lower back2. You might think you have to ignore or minimize complaining about your pain because you do not want to stop competing. The pressures of losing a position, being removed from a team, missing a competition, or letting the team down can make you scared to lose your worth on the team. By ignoring your pain and not seeking medical help the low back pain will most likely not recover on its own1. Avoiding it can lead to permanent damage of the structures of your spine.

Risk factors for low back pain related to staying in your neutral zone include: your muscles turning on later than needed, lack of muscle control, lack of endurance of your back muscles, and weakness of these muscles compared to the abdominal muscles. Other factors that may contribute to low back discomfort are leg-length differences, poor posture, and swayback, muscle tension due to stress or fatigue, weak abdominal muscles, and/or lack of flexibility. It is important to strengthen and stretch the abdominal and back muscles to avoid these risks.

Anti-inflammatory medication (like ibuprofen) and muscle relaxants can help to control the pain when you first experience low back problems. Be sure to check with your doctor before taking anything. Bed rest is not a good way to treat low back pain. Treatment by health care professionals such as physiotherapists, athletic therapists, chiropractors, and massage therapists can be very effective, especially in the first few months. Acupuncture is a good way to treat stubborn muscle tension that is stopping you from getting better. Injections are another type of treatment you should ask your doctor about as well as surgery which should be the last resort.

To prevent low back pain you need to stabilize your core so your spine stays in the neutral zone. Any program to treat and/or prevent low back pain should include general exercise, a gradual return to sport-specific tasks, endurance of the spine muscles, and stability exercises of the spine2. There are three phases to address core weakness and prevent low back pain. They focus on activating the local muscles first, then dynamic exercises to challenge these muscles, and last incorporating all these movements into using the global muscles.

During phase 1, you must do exercises daily since properly activating your muscles is the most important thing to learn. These are usually exercises on your back that work local muscles close to your spine. Phase 2 is when you add exercises for the back, hip, and shoulder to create a dynamic environment for your local muscles. You are often on your hands and knees to perform all these movements. Phase 3 is done 3x/wk as part of your complete training program. You do exercises on your stomach, holding yourself up on your side (also with arms moving), and on an unstable surface to incorporate your global muscles. For more detail on these exercise see “Core Strength and Conditioning Training” in the article section.

Low back pain is from weak core muscles that do not maintain a neutral spine. Both high and low intensity athletes can develop this discomfort from either forceful movements or continuous training, especially training through pain. Lack of muscle control sets you up for injury. This injury can be prevented if you include training of local and global stabilizing muscles in your complete training routine. Remember, do not ignore your pain or you will be side-lined long enough to realize pain is NOT OK.

1. Maryland Spine Center – Low Back Pain in Athletes. http://www.umm.edu/spinecenter/education/low_back_pain_in_athletes.htm. Accessed 6/19/2008, 2008.
2. Kolber, Morey J. PT,M.S.P.T., C.S.C.S., Beekhuizen KCSCS. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength & Conditioning Journal. 2007;29(2):26-37.
3. Newsletter | SIRC. .
http://www.sirc.ca/newsletters/july07/feat1.cfm. Accessed 6/19/2008, 2008.

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