Low-back pain in the teenage athlete: Early intervention is the key

• by Dr. Dev Mishra , Mar 29, 2018

I’m seeing more young athletes with low-back pain, it seems that the incidence is increasing. Many times, mid-back and low-back pain is muscular. This is typical at the beginning of the season -- perhaps combined with the weight of a heavy school backpack. This type of low back issue is a mild to moderate achiness that will improve as the athlete’s conditioning improves.

But the tricky part is that sometimes the backache signifies an injury to the bone rather than the muscle. Repetitive stress to the bone in the spine can lead to an overuse injury such as a stress reaction (a bone bruise) or a more severe injury called a stress fracture (“spondylolysis”).

We keep a very close eye on our young athletes with low-back pain as the time to return to play from the different injuries is radically different. Early recognition and intervention is the key.

Current understanding is that low-back pain is a progressive injury: what starts off as a mild muscle injury can become a more significant injury to the bone if the athlete continues to play through the pain. An athlete who continues to play through muscular low-back pain can turn the injury into a stress reaction. An athlete who continues to play through a stress reaction can turn the injury into a stress fracture.

You want to avoid any of the more serious injuries by getting treatment and appropriate rest early on.

What To Do If You’re A Young Athlete With Low Back Pain

• If you’re having numbness or tingling in the legs, fever, sudden weight loss, or night pain see a physician immediately.

• If you’re having back pain without any of the above, then notify your trainer early. Athletic Trainers are skilled at helping you with treatment modalities, and can also work with coaching staff to modify training load or reps. You want to see improvement within two weeks.

• If your pain lasts more than two weeks I would recommend evaluation from a physician. My recommendation is a bit more aggressive than what you’ll typically find in the medical literature (many doctors recommend evaluation if the pain is three or more weeks). My preference for pain that’s lasted at least two weeks is for a proper examination by a physician and often an imaging study such as an MRI. Some doctors would recommend a bone scan or CAT scan as their preferred imaging.

Return To Play Timelines

The main reason I’m “aggressive” about early evaluation is that the return to play timelines and the lifetime outcomes are radically different depending on the diagnosis. Here is what I’ve been typically seeing based on real-life situations at our Northern California high schools:

• Muscular low back pain: Typically a week or two to resolve.

• Stress reaction diagnosed by imaging studies: Six to twelve weeks. No sports participation during this time. Physical therapy usually needed.

• Stress fracture diagnosed by imaging studies: Three to six months. No sports participation during healing. Physical therapy needed. Bracing often needed. Not all stress fractures will heal, so there is the possibility of having ongoing back issues into adulthood.

You can see that we go from a week or two up to several months, depending on the stage of the injury. It’s easy to think about brushing off a backache as a minor issue, but if you are having pain that’s present for more than a couple of weeks I’d recommend you get a proper evaluation and early treatment

Key Points:
• I recommend proper physician evaluation for low-back pain in the young athlete that’s been present for more than two weeks.

• Early diagnosis and treatment can prevent a mild injury from turning into a severe injury.

• A mild injury such as a muscle strain typically heals in a week or two.

• Severe injuries such as stress fractures can take 3 to 6 months to return to play.

(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury recognition and management at SidelineSportsDoc.com Blog.)