Julie Henry-Kelly, MD

Lower back pain develops in a significant number of athletes, especially affecting women participating in sports such as gymnastics, dance, diving, tennis, golf and rowing.  Gymnastics, dance and diving are sports where female athletes hyperextend their backs in order to perform well in their sport. This backward bending of the spine increases the likelihood of developing pain in the lower lumbar region of the spine. Pain may be limited to the back or in some cases may extend into the hip and even to the leg region. When pain extends down into the leg, it is commonly referred to as sciatica. The presence of numbness in the legs and weakness in the legs is rare, but may signify a much more serious back problem.

When back pain is first noted, it is important to determine the root cause of the pain. While most lower back pain is muscular in origin, other causes may be stress fractures of the spine, a herniated intervertebral disc, arthritis or growth plate injuries in younger females whose spines are still growing. Low back pain may also be caused or aggravated by the female menstrual cycle. A stress fracture of the spine is called spondylolisthesis and if untreated can lead to chronic lower back pain.

A stress fracture may signify a more serious medical problem such as low bone density and may even be linked to eating disorders or poor eating habits. Hyperextension of the spine can accentuate pain and worsen conditions such as spondylolisthesis. 

Evaluation of an injured athlete complaining of back pain should include a thorough physical exam with special attention to the muscles in the lumbar spine as muscle spasm may be easily detected by the physician. Posture should be assessed with the athlete standing and seated and leg lengths should be measured for both lower extremities. Examination should also include evaluation of leg strength, reflexes and any abnormalities of sensation. Although xrays often do not show abnormalities when the muscles and soft tissues are affected, they should be performed by the evaluating physician to check for any bony abnormality or alignment issues. Additional tests may also be needed before the athlete returns to play. 

Core strengthening programs designed to increase muscle strength in the abdominal muscles, lower back region, hip area and pelvic region are effective in not only stabilizing the lower back region and improving athletic performance, but also lead to treatment for many of the conditions which cause lower back pain. These programs should focus on stretching and strengthening the abdominal muscles, but should avoid hyperextension of the back to avoid any further injury.

Alternative and adjunctive treatments in the treatment of lower back pain which may be considered include deep tissue massage, acupuncture, aquatic therapy programs and mind-body therapies such as yoga, biofeedback, and tai chi.