Back Pain and the Adolescent Athlete

There is a significant increase in the occurrence of Low back Pain (LBP) beginning as early as age 12 and spanning into the teenage years. Some studies have indicated as many as 50% of the population has experienced back pain at some point in their life and this can occur in adolescence. There are some defining risk factors for developing LBP even as a teenager. They include: Playing sports, watching television for more than 2 hours a day, significant height for the age group, diminished or excessive lumbar range of motion, poor muscle endurance and posture, muscular imbalances, and tightness in the hips and lower extremities.

Teens participating in soccer, hockey, football, golf, rowing, swimming, tennis, volleyball, basketball, and track are at risk for developing LBP. These sports are a mix of high impact, high velocity, extreme range of motion, requiring high levels of endurance and strength. Not only are most of these sports demanding, we are dealing with young bodies which may be developing quickly through growth spurts. They may have already developed poor postural habits from hours of television, video games, as well as long days sitting in school and studying at home. Lack of time in the day as well as simple physical education about their bodies are often culprits. Education to take care of themselves and the proper training for their sports are important for both preventing injury and excelling at their sport or sports.

A good screening or physical performed by a qualified physician is the first step. A thorough exam coupled with a simple history of the athlete can lead to prevention of future LBP or lead to an early diagnosis and the subsequent treatment for the young athlete. Prevention education and/or a precise flexibility and strengthening program can be started. This is normally performed by athletic trainers and physical therapists. This regimen can be implemented before or even during the season. (See attached exercises) Not only may a simple program prevent injury, it may also alert coaches to a possible problem. These exercises are designed to create no harm, but if they do it could signal a red flag.

One risk factor mentioned earlier in the article that affects adolescents is poor posture and problems brought on by wearing a backpack. Loading up backpacks and wearing them incorrectly can lead to LBP. A good rule of thumb is to wear the backpack evenly on your body using both straps and to have no more than 10% of your body weight in the pack.

As a coach, don’t hesitate to tell your athlete to see a trainer, sports physician, or a physical therapist if back pain is affecting the student-athlete's everyday life or sports performance. A precise diagnosis can be made to head off a potentially bigger problem. A specialized plan of care can be implemented to get the athlete healthy, return to sport and prevent future complaints or injury. Simple back pain can be the first symptom to alert a coach to some very serious back problems which have been on the rise in recent years. Believe it or not, disc herniation is becoming as prevalent as stress fractures and other problems such as spondylolysis (a defect in the vertebrae) and spondylolisthesis (displacement of a vertebra in relation to the vertebra below).

These derangements can occur, are very serious, and must be taken care of promptly. Other less common problems associated with back pain are Scheuermann’s Disease (curvature problem of the spine), SI (sacro-illiac) Dysfunction, certain Leukemia’s and possibly cancerous tumors. Though rare, these diseases should never be missed. Rule of thumb: Never ignore LBP in the adolescent athlete. It could be a sign of something serious or simple. Either way, once the problem is identified it can be rectified!

Download PDF - Lumbar Exercises

Brian Walker, DPT
Mercy Sports Medicine

There are four basic categories of knee braces:

1. Prophylactic Braces- used to prevent or reduce the severity of knee injuries during contact sports.
2. Functional Braces- provide stability to an unstable knee during activities.
3. Rehab Braces- used after injury during rehab to control motion and protect injury.
4. Patellofemoral Braces- used to control pain and the movement of the patella during activities.

Prophylactic braces lack objective data for preventing or reducing knee injuries during contact sports. The NFL has been using preventative bracing for linemen but this is expensive and some players complain it hinders  performance. Bracing does give the athlete a sense of protection but this is purely subjective. Whether bracing does prevent or reduce injuries is still to be determined.
 
Functional and Rehab bracing does deserve some consideration. Bracing during rehab gives some control over rotational and translating movements during activities. Bracing can also help to protect grafting, such as, after ACL reconstruction. Using these braces with an appropriate rehab program can be beneficial.

Patellofemoral braces appear to reduce patella tracking problems and decrease pain. It is inexpensive and seems subjectively helpful in controlling anterior knee pain. This is done by applying a force to the outside of the kneecap to keep it in place during activities. This brace should also be used in conjunction with a good rehab program.

We need more objective studies to determine how well knee bracing works. In the uninjured athlete the best prevention is a good program that incorporates strength training, conditioning, flexibility and technique refinement. For the injured athlete, knee bracing can be used in conjunction with a good rehab program. A good strength training program is still the athletes best bet in the prevention of injuries.

Prophylactic Knee Braces: (A) with a unilateral-hinged bar, viewed from the side; (B) with bilateral-hinged bars	Functional/Rehab Braces: (C) custom hinged with shell; (D) off-the-shelf hinged with shell comes in sizes	Patellofemoral braces intended to keep patella tracking properly and reduce pain

Terry Traugh
Mercy Sports Medicine

Mercy Health Center of North Canton
6200 Whipple Ave N.W.,
North Canton, OH 44720
(330) 966-8920

Mercy Health Center of Lake
11932 King Church Ave. N.W.,
Uniontown, OH 44685
(330) 877-5000