Understanding Back Pain in Athletes By Age
Low back pain seems to be something most people experience at least once in a while. Many studies have confirmed this fact. Up to 90 per cent of all adults report an episode of back pain once in their lifetime. Despite a high level of fitness and even flexibility, athletes from young to old are not exempt from this problem.

In this article, experts in sports medicine review the way to evaluate low back pain in athletes. Patient history is a key feature -- both the past medical history as well as the current history of the symptoms is important. Any recent or past injuries are recorded along with any medical conditions that could put stress and strain on the low back.

Physicians ask patients complaining of back pain many questions while listening for red flags that might tip them off to a more serious underlying problem. For example, extreme pain at night that is relieved by an aspirin or other antiinflammatory medication could be the sign of a bone tumor.

The presence of fever, chills, nausea, vomiting, diarrhea, blood in the urine, or chronic heartburn signals the need for a closer look. Anyone who is unable to stand and put weight on the legs without severe back pain requires immediate medical attention. Certain problems such as a urinary tract infection, cancer, or passing of a kidney stone can also cause low back pain.

Other factors that can contribute to low back pain include pregnancy, long-term use of corticosteroid medications, diabetes, or recent surgery. Infection or inflammation of any kind affecting the abdomen or pelvic area (e.g., appendicitis, diverticulitis, gastritis, pelvic inflammatory disease) may present as low back pain.

Sometimes the age of the athlete is a tip-off as to the cause. Children rarely have disc herniations or osteoarthritis. But these conditions are common in adults. Older adults tend to develop back pain as a result of spinal stenosis (narrowing of the space for nerve tissue). Unless present at birth, stenosis is not an issue with young athletes.

Trauma and repetitive motion (especially overextending the spine) are typical with younger athletes presenting with back pain. If you've watched any amount of sports or participated in athletic activities, you will agree baseball pitchers, football quarterbacks, and football offensive linemen are at risk for low back pain.

The type of physical movements repeated by throwers and the impact from tackles and falls on linemen is enough to increase the incidence of low back pain. Other sports participants are at risk too: gymnasts, divers, volleyball players, and dancers to name a few.

When the history and physical exam point to a possible problem that could be seen more closely with imaging studies, then X-rays, CT scans, MRIs, and sometimes ultrasound studies may be ordered. X-rays help rule out (or rule in) bone fractures. For infections, inflammation, and some types of tumors, additional lab work (blood tests or urinalysis) may offer helpful results leading to an accurate diagnosis.

For those health care professionals who conduct back evaluations (orthopedic surgeons, sports medicine physicians, physical therapists, chiropractors), the authors provide photos and descriptions of highly sensitive screening tests. Algorithms (flow charts) are provided for deciding when to order additional tests and when an inflammatory process may be present.

The bottom-line is to keep in the back of your mind that low back pain in anyone (including athletes) can be caused by mechanical, emotional, medical, or traumatic causes. Knowing what to look for in each age group can help speed up the diagnostic process. An early and accurate diagnosis is important when dealing with potentially serious health conditions. Early diagnosis and intervention is the key to a successful outcome for athletes young and old.
James M. Daniels, MD, MPH, et al. Evaluation of Low Back Pain in Athletes. In Sports Health. July/August 2011. Vol. 3. No. 4. Pp. 336-345.