Some persons have a higher risk of having acute and chronic back injuries due to their lifestyle of such kind which is not very good for their back. Athletes are also included in this category the people of which have to suffer from the lumbar injuries more than the ordinary population. No matter, if the sport you are involved in is basketball, ice skating, football, skiing, running, golf, tennis or soccer, etc. In all these sports, your vertebral column has to tolerate a lot of stress, twisting, pressure absorption and turning. All these strenuous activities exert extra stress and strain to back that can cause damage to back muscles, ligaments and bones of vertebral column even in the fittest and cautious athletes. That is the reason, many of the athletes are willing to buck up their power and strength. They take some over the counter available pain-relieving medications and suffer the pain for their enjoyment and game. However, sometimes damage to the normal anatomical structures of the back may lead you to lifetime exclusion from these sporting activities.
Common Causes of Lower Backache in Athletes
There are many causes of lower backache or lumbar pain in the athletes however, here we will discuss briefly the most common causes.
Strain to the Muscles and Ligaments
A term is used in the medical field, i.e. “musculoligamentous strain” for common back strain. This term denotes all the injuries to the soft tissues of the lumbar region of the vertebral column. Soft tissues include nerves, ligaments, muscles, blood vessels supplying the spinal column and tendons. Musculoligamentous is the most common type of injuries that occur in sports. Usually, it is a diagnosis of occlusion, i.e. the diagnosis is made after ruling out all the causes of back pain. Usually, these types of injuries are self-healing and self-limiting. It means that they do not get worse with time and heal with time. Treatment generally relies upon conservative management for pain and prevention of further stress and strain by lifestyle modifications.
Spondylolysis and Spondylolisthesis
There is no obvious cause of spondylolysis. Mostly, it is accepted that this defect appears in the children due to genetically predisposition of weak pars interarticularis which is conjoint with repeated and exaggerated stress and spine to the vertebral column due to physical activities in growing age. In athletes, this condition is most commonly happens in those persons who are the participants of sports having repeated hyperextension of the lumbar region of the spinal column, for example, pole-vaulting, football, and gymnastics. The people who practice weight lifting are also at increased risk of this disease due to extra strain to their spines. Many of the cases are symptomatic and do not cause any clinical problem. However, sometimes the intervertebral disc slips and presses the space of the spinal canal. This results in less room for the roots of nerves present there. The pressure is thus exerted to these nerve roots which results in pain in lower back, buttocks, and legs also numbness in one or both feet. If this problem is much severe, surgical intervention is needed.
Herniated Nucleus Pulposus
Sometimes the intervertebral disc of the spinal column of athletes become damaged because of excessive stress and weight bearing. Intervertebral discs are round, flat cushion like structures that are present between the vertebrae and absorb shock between the vertebrae of your vertebral column. The outer ring of each disc is called annulus fibrosis and inner jelly-like soft material is called nucleus pulposus. If this intervertebral shock-absorbing disc degenerates, it causes many problems with your back. Athletes exert more pressure to their spinal column than the other persons because of excessive body weight. If the pressure to the outer ring of the disc is much greater, it rips and disc herniation occurs, i.e. the inner jelly-like material comes outside of the annulus fibrosis. This bulging disc exerts inappropriate pressure to the spinal cord and nerve roots which leads to pain in the area of distribution of the nerve. You may also feel numbness and tingling sensations in your lower back, buttocks, legs, and feet.
Natural History of Lower Back Pain
Natural history is meant by the course of pain if you leave it untreated. Fortunately, the natural history of back pain is favorable. As you can see that
- 60% of the patients recover in the time period of one to three weeks.
- 90% of the patients recover in the time period of six to eight weeks
- Almost 95% of patient recover in twelve weeks.
- Serious cases are less common.
The onset of lower backache is due to the mechanical damage to the soft tissue (muscles, nerves, tendon, ligaments, etc.) due to heavy physical activity or the same posture for the prolonged time period. Mechanical lower back pain is defined as the pain which happens secondary to the overuse of a normal structure (muscle strain or stress) or the pain that arrives secondary to deformity or injury of a normal anatomical structure (for example pain in disc hernia). Thus, this definition of mechanical back pain is damn true for the back pain occurring in athletes.
The management is based on making the correct diagnosis of the cause of pain. This includes the following steps.
- Taking a proper history from the patient.
- Performing a good physical examination.
- Ordering relevant investigations, i.e. radiological investigations of the back. (X-Ray, CT scan, and MRI according to the severity of the condition).