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When back pain is a pain

​​​​​​​​​​Low back pain is a common complaint among student athletes. Causes vary from simple strain and overuse injury to serious structural injury. Muscles and ligaments of the back are usually involved.

An athlete’s core strength, or the strength of the abdominal and back muscles, is often connected to low back pain. Many young athletes lack the strength in their abdominal and back muscles and have less flexibility in the muscles opposing these. Combining stretching and strengthening excises can help prevent back injury.

Risk for structural injury, such as fracture, increases in different sports. Young athletes with ongoing low back pain that limits their participation in sports activities should seek referral to a medical provider for evaluation and diagnosis. Abnormal findings on X-ray or other imaging exams do not always explain the cause of the athlete’s symptoms.

Common causes of low back pain include spondylolysis, spondylolisthesis and Scheuermannn’s disease.


This is a fracture of the back of a vertebra in the spine. It is an injury resulting from overuse of the trunk, frequent twisting and overextending. Spondylolysis is not usually related to sudden trauma of the spine.

Sports in which athletes may be more prone to spondylolysis include gymnastics, weight lifting, track and field, and soccer. The injury is more common in adolescent athletes and in boys than in girls. Spondylolysis is commonly seen in the fourth and fifth vertebrae of the lower back.

Symptoms include pain:

  • In the low back
  • In the buttocks or thigh that increases with activity
  • With back stretching and rotating

No “one-size-fits-all” treatment is available. Rest is recommended. Once the athlete is pain free at all ranges of motion, an exercise program for rehabilitation can be started.


This injury occurs when one vertebra has slipped on another. It may be caused by spondylolysis, or fracture of the back of a vertebra. The risk of significant slipping increases with age and during growth spurts.

Usually spondylolisthesis requires rest from sports and monitoring by X-ray to keep track of the slip. This injury can be serious. Surgical treatment may be considered if the slip is large with persistent pain or involves a nerve.

Scheuermann’s disease

This condition is also known as juvenile kyphosis, or exaggerated slumping of the shoulders. It is usually diagnosed from an X-ray exam. Chronic mid- or low-back pain is usually present in the area of the deformity. Back fatigue and poor posture may also signal the condition. Irregularity of the spine bones in the middle back causes the pain.

Rest, medication, exercise, bracing and surgery may be considered for treatment.

Most athletes will improve quickly from low back pain and do not have structural injury. When rest does not improve persistent back pain symptoms, seek further medical evaluation.

Article submitted by Mohammad Yavari Rad, M.D., Marshfield Clinic Orthopedic Department Fellow

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