I am currently an MPH student at Northwestern University studying Community Health Research, and I hope to become a physician who works with young athletes in the future.
At 14 years old, I was a level nine gymnast with a broken back. Well, I had stress fractures on the lumbar vertebrae of my low back. Like many other young athletes, I was later diagnosed with "repetitive trauma.” In fact, amongst the many athletes I met during my time as a Big Ten student-athlete, almost all who had been high level gymnasts at a young age but switched sports cited that a fractured back was the reason for the change.
To this day, nine years later, I still have pain from the stress fractures I obtained at 14. That has led me to wonder, what can be done to prevent these lower back injuries from occurring in young athletes?
Out of all young athletes, 10-15% (1) will have low back pain with certain sports, such as gymnastics, having low back pain rates of 50% (2) or more. The most common cause of low back pain in young athletes is overuse and traumatic injury to growth cartilages in the lower spinal vertebrae also called spondylolysis (2,3). Spondylolysis can be challenging to diagnose since the fractures only appear on MRI or bone scans rather than standard x-rays (3,4).
Treatment of low back stress fractures is typically 2-3 months of rest (5) along with physical therapy practices (4) focusing on core stabilization through progressive strength and flexibility. However, 2-3 months of rest is a long time to refrain from training and low back injury can impact long-term athletic outcomes. That is why it is important for young athletes as well as their parents and coaches to understand and follow low back pain prevention methods.
Prevention of low back injury can be challenging when repetitive trauma is the cause and simultaneously the foundation of the sport. Gymnastics, football, and soccer all rely on high impact skills, whether contact or noncontact, and have the highest rates of low back pain (2). It is also tricky to understand what constitutes “overuse” since each athlete has a different tolerance for high intensity training over a long period of time based on age, gender, height, weight, physiology, and more (2,4).
One area to examine for prevention tactics are modifiable risk factors at the intrinsic and extrinsic levels. Some intrinsic risk factors include fitness level, warm-up style, muscle strength, joint stability, biomechanical factors, and balance (6). Modifiable extrinsic risk factors are rules/regulations and coaching education (6).
Recognize risk factors for low back injury.
Some common risk factors are prior injury, muscle weakness, and inflexibility (2,3).
Coaches should ensure proper technique is utilized by athletes and take their athletes' pain seriously.
Low back pain is not part of sport (2).
Watch for pain from traumatic events, persistent pain for over two weeks, numbness extending down one or both legs, and sudden weight loss (3).
Avoid excessive training.
Age Rule: Age of the student-athlete = total hours of training per week (3).
Reduce the amount of training and repetitive motions during growth spurts (2).
Parents and coaches should be mindful of periods of rapid growth (7), and growth can be monitored with yearly annual physician visits (1,2,4).
Set aside time for weekly mobility and flexibility training.
Hamstring and hip mobility are associated with reducing low back injury incidence (3,7).
Establish proper nutrition habits to avoid athletic energy deficits (3).
NFHS Learning Center has a free online education course specific to Sports Nutrition at www.NFHSLearn.com.
Educate young athletes about steps to take when they feel pain.
When an athlete feels pain, they may keep it to themselves for fear of being withheld from play or performance. Early and consistent education (from coaches, parents, and physicians) about the benefits of early diagnosis, prevention, and treatment to the athletes’ health and athletic performance is necessary.
Pain is not a normal part of sport. Pain in young athletes should be taken seriously and addressed early to reduce long-term impacts on health. Be aware of risk factors and listen to your athletes, so we can continue to develop excellent athletes and proud coaches and families.