Low Back Pain and Young Athletes

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Introduction

Young athlete definition.

In the United Kingdom there are a large number of children and adolescents who are participating in sport. The government is currently spending over £450 million on improving the quality of the Physical Education and sport activities that pupils are offered (7). Leading to high numbers of participants in sport, not only inside of school but outside as well, 96.7% of children aged 11-16 and 84.1% of children aged 5-10 participated in sport outside of school (8).

7) Policy - Getting more people playing sport gov.uk
8) Taking Part 2013/14 Annual Child Report

Low back pain (LBP) occurs in approximately 10% to 15% of young athletes (d’Hemecourt, Gerbino and Micheli, 2000). Schmidt et al 2014 found that competitive adolescent athletes compared to aged matched individuals have increased prevalence of back pain

Injuries encountered to the lower back in young athletes occur from either an acute traumatic event or repetitive trauma (overuse injury) and are commonly seen in individuals participating in sports such as football, rugby, gymnastics, ice skating and dancing (Purcell and Micheli, 2009). Evidence has shown LBP occurs is as much as 27% of college football players and between 50% and 86% of gymnasts (Semon 1981; Kolt 1999). Overuse injury can be as a result of repeated flexion, extension and torsion which is performed frequently in gymnastics, ice skating and dancing (Purcell and Micheli, 2009).

Assessment

Subjective assessment

There is usually poorly localized lumbar pain without any associated neurologic symptoms.
Specific area of pain and neurologic symptoms are more likely to show an underlying pathology.
Knowing the onset of symptoms can help distinguish between acute or chronic overuse injury, and postural and developmental abnormalities.

The clinical history of a patient should include an in depth description of:

Table:

Specific questions
Pain Location
Type
Aggravating and easing factors
Onset
Duration
Any night pain
Trauma Repetitive/overuse microtrauma
Acute macrotrauma
Specific movement of trauma
Body positioning in trauma
Mechanical symptoms Is the pain worse on movement?
What specific movement?
Does the pain cease during rest?
Inflammatory symptoms Is there any morning stiffness?
Does it get better with movement?
Neurological symptoms Radiculopathy
Pins and needles
Bowel or bladder dysfunction
Weakness
Systemic symptoms Does the patient have a fever, night sweats or recent weight loss?
Gait Does the patient have a foot drop?
Previous treatments Has the patient had previous treatment for the same or similar condition?
Was the treatment successful?
Lifestyle Does the pain have any effect on their psychosocial well-being? Does it interfere with school or interests?
Past medical history Does the patient suffer from any medical conditions such neurological disorders, scoliosis, malignancy, osteoporosis, chronic inflammatory joint disease or has any treatment with immunosuppressive agents? Has the patient had any previous injury or surgery?
Family History Is there any of family history of orthopaedic, rheumatic s or neurologic conditions? Psoriasis? Inflammatory bowel disease? Ankylosing spondylitis?

Specific Conditions

Spondylolysis and Spondylolisthesis

Links to relevant Physiopedia pages:

http://www.physio-pedia.com/Spondylolysis

http://www.physio-pedia.com/Lumbosacral_spondylolysis

Scheuermann's Kyphosis

Link to relevant physiopedia page:

http://www.physio-pedia.com/Scheuermann's_Kyphosis