A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games

Abstract

Objectives: To observe the prevalence of lumbar intervertebral disc degeneration in elite athletes as compared with published literature of changes seen in non-athletes-that is, normal population. Methods: The lumbar spines of 31 Olympic athletes who presented to the Olympic Polyclinic with low back pain and/or sciatica were examined using magnetic resonance imaging. Three criteria were looked at: (a) the loss of disc signal intensity; (b) the loss of disc height; (c) the presence of disc displacement. The results were then recorded and correlated with the lumbar levels. Results: The disc signal intensity was progressively reduced the more caudal the disc space. It was most common at the L5/S1 level, and, of the abnormal group, 36% (n = 11) showed the most degenerative change. Disc height reduction was also found to be most common at the L5/S1 level. However, the most common height reduction was only mild. A similar trend of increased prevalence of disc herniation was noted with more caudal levels. At the L5/S1 level, 58% were found to have an element of disc displacement, most of which were disc bulges. Compared with changes seen in the normal population (non-athletes) as described in the literature, disc degeneration defined by the above criteria was found to be significantly more severe in these Olympic athletes. Conclusions: Although the study was limited, the results suggest that elite athletes have a greater prevalence and greater degree of lumbar disc degeneration than the normal population. A more detailed follow up study should be considered to investigate which particular training activities have the most impact on the lumbar spine, and how to modify training methods so as to avoid the long term sequelae of degenerative disc disease of the lumbar spine.B ack pain appears to be more common in elite athletes than the normal population. It has been reported that up to 75% have had one or more episodes of back pain.

Low Back Pain and Injury in Athletes

“…The repetitive mechanical loading on the spines of athletes in these sports, often in positions involving end range of motion and the increased volume of training required for elite athletic performance is likely to result in tissue overload and subsequent injury. This, combined with a lack of full recovery between episodes of pain and injury due to many athletes not wanting to miss time off training or competition, may explain why athletes may have more persistent, chronic and recurrent low back symptoms, frequently associated with degenerative joint disease (Ong et al, 2003).…”

“…A strong correlation between common lower limb soft tissue injuries, including hamstring and calf injuries, that involve L5 and S1 nerve supply, with increasing player age has been clearly demonstrated in the AFL's injury survey (Orchard & Seward, 2002). Orchard et al suggest that on the basis that low back injuries are very common in elite athletes with increased levels of lumbar degenerative changes at the L4/L5 and L5/S1 levels (Ong et al, 2003), that subtle pathology may be present, which increases with age and which predisposes hamstring and calf injury . The association between low back injury and pathology and hamstring injury has extended into treatment approaches with authors documenting the use of mobilisation (Baquie & Reid, 1999) and slump stretching protocols (Kornberg & Lew, 1989;Turl & George, 1998) in the management of hamstring injured athletes with signs of lumbar injury.…”

Outcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence

“…Elite athletes undergo intense training regimens at early ages, which may lead to an increased risk of lumbar disc degeneration and back pain compared with the general population [12]. Furthermore, athletes in certain sports such as American football are more prone to developing spine injuries as a result of high biomechanical forces on the spine during play [28].…”

The layer concept: utilization in determining the pain generators, pathology and how structure determines treatment

“…In this case, an existing low back or hip pathology affecting muscle function at the pelvis may change the mechanics from the trunk down and affect how the foot is impacting the ground. Low back pain in athletes is not uncommon and often involves injury at the L5-S1 level [61,62]. The local response to such an injury is inhibition of segmental stabilizers, multifidus and transverse abdominus [63].…”