Lumbar Spine Injuries

Low Back Pain in the Adolescent Athlete

“…Ossification of the posterior column of the spine progresses from anterior to posterior and may be congenitally incomplete in the area of the superior portion of the pars interarticularis of the lower lumbar vertebrae, particularly at the L5 level, predisposing to spondylolytic stress fractures. 1,11 The presence of spina bifida occulta at the lumbosacral junction seems to be an additional risk factor for spondylolysis. Traction from the dorsolumbar fascia and lordotic impingement may affect the growth cartilage of the facet joint and spinous process apophysis of the posterior arch.…”

“…1 Because of the considerable variance in the timing and tempo of growth among children, smaller, less mature athletes may be at higher risk for injury from contact from larger athletes, particularly in contact sports. 11,49 Several potential risk factors for spinal injury or low back pain in athletes have been identified. These factors include previous low back or lower extremity injuries, incomplete rehabilitation of previous injuries, decreased endurance, lower extremity muscle imbalance, high number of hours of participation per week, and the occurrence of stressful life events.…”

“…47,50 Training volume and intensity can also cause injuries, particularly when young athletes participate in a sport for longer periods, such as at tournaments and sports camps. 11 However, it is difficult to determine the appropriate amount of training for adolescent athletes, because of the variance in toleration of similar volumes of training. Overuse injuries present more often in athletes experiencing rapid growth, 1,11 suggesting that the volume and intensity of training that an athlete's body can tolerate vary as the athletes grow and mature.…”

“…11 However, it is difficult to determine the appropriate amount of training for adolescent athletes, because of the variance in toleration of similar volumes of training. Overuse injuries present more often in athletes experiencing rapid growth, 1,11 suggesting that the volume and intensity of training that an athlete's body can tolerate vary as the athletes grow and mature. 11 Poor technique, abdominal muscle weakness, hip flexor/hamstring/thoracolumbar fascia tightness, increased femoral anteversion, genu recurvatum, and increased thoracic kyphosis serve as additional risk factors for low back pain.…”

“…Physicians who attribute low back pain in young athletes to simple back strains, without investigations, run the risk of delaying the diagnosis and appropriate treatment of more serious injuries, such as spondylolysis or spondylolisthesis. 8,11 Therefore, it is imperative that the clinician is aware the development of the spine and subsequent variances in injury patterns and frequencies when evaluating the adolescent athlete.…”