Back Pain in the Adolescent Athlete

By Jason D. Cohen, MD, FACS


Low back pain in the adolescent athlete occurs in approximately 15% of the athletic population.  Athletes that are more at risk are those that play football, rugby, gymnastics, figure skating, weight lifting and dance.   In this younger population, back pain is usually attributed to a structural issue with the spine rather than a muscle strain or herniated disk.  The structural issues generally fall into two categories: Spondylolysis and Spondylolisthesis.

By definition:

         Spondylolysis: a stress fracture in one of the vertebrae

         Spondylolisthesis: when the vertebrae starts to shift out of place

The causes for these injuries are sometimes acute, but more commonly they are from overuse, especially hyperextension of the spine which occurs frequently with gymnasts and football lineman.  Some athletes are born with a genetic predisposition to these conditions.  The physical exam for low back pain includes an extensive history, an orthopaedic evaluation, x-rays and possibly an MRI and/or CT scan.

The initial conservative treatment is rest, physical therapy, non-steroidal anti-inflammatories and activity modification.  When conservative measures fail, surgery may be recommended.  During the rehabilitative process, muscle strength, muscle imbalances and flexibility must all be addressed.

Returning to play (RTP):  the doctor will consider several factors such as skeletal maturity of the athlete and the activity.  Other criteria for returing to play include pain-free range of motion, normal strength and a gradual sport-specific progression into their sport.

In essence, don’t delay any adolescent that complains of low back pain for more than three weeks.  These athletes need a full evaluation by an orthopaedic surgeon to get them back to the sport that they enjoy.