Lower Back Pain in Athletes
Yes, I seem compelled again to write about back pain. Perhaps that’s because we see so much of it. Today I’m going to write about one of the most common reasons people come to me with pain of any kind, and that’s lower back pain.
As much as we don’t like to admit it, as we get older, we do have degeneration in all the various joints in our body. The lower back, or lumbar spine, is just like many other joints, all of which have the potential for wear and tear from overuse.
However, the lumbar spine can’t be replaced like an arthritic knee, shoulder or hip. Especially if we don’t keep a good eye on it when we are young and can apparently get away with doing things incorrectly without feeling pain, the lower back can deteriorate quickly. Pain is a signal we’ve gone over the edge.
The spine is composed of many components, called vertebrae, all of which are stacked one on top of one another and have the potential for wear and tear from overuse. The vertebrae are connected to form a canal that protects the spinal cord. The spine isn’t straight, it curves in and out. The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine by protecting it.
But how do we get those? While our lower back undergoes a lot of strain from everyday activity, we don’t usually work it out in the gym like we do our other muscles. The muscle groups around the spine endure a lot of pressure, however, because they are the core stabilizing muscles. They’re called the posterior chain, and they start in the legs with the calves and hamstrings, move up the body to the glutes, and then into the actual little muscles that surround the spine, erectors and the lower and upper back muscles themselves. Most casual gym-goers and exercisers concentrate on exercising the front muscles– the arms, quads, and the abs without realizing that for a pain free life developing a strong back chain is even more important.
If your back muscles are not strengthened, you may wake up one day and suddenly find out you have sciatica or lumbar articular pain. Sciatica is an irritation of the roots of the lumbar and lumbosacral spine that can be caused by spinal stenosis (narrowing of the spinal canal in the lower back) or by lumbar radicular pain from a bulging disk. Yet another cause of pain is arthritis in the facet joints.
In the beginning, self-treatment is best. Start with anti-inflammatories, but take them with food as they can be very bad for the digestive system, and rest. After a few days, physical therapy and core strengthening exercises can help not only with the pain but to prevent recurrence.
If that regime doesn’t work, we can do other things like epidural steroid injections for sciatic pain that radiates into the legs. This is a quick procedure that takes a few minutes by a board certified pain specialist. If the pain doesn’t radiate into the extremities, we can do a lumbar medial branch block, or a radio frequency ablation of the lumbar branch. We can also numb the area caused by the facet joint.
These are some of the basic things that we can do in our office. But to avoid these issues in the first place, it’s important to learn proper lifting techniques and to strengthen your lower back when you exercise, just as you would strengthen any other body part.