Injuries of the lumbar and thoracic spine are common in the athlete. It is estimated that 9 percent of all sport-related injuries involve lower-back pain. In the United States, 50 to 80 percent of the general population will have at least one episode of lower-back pain in their lifetime. In professional sports, lower-back pain is the most common reason that athletes miss a game, match, or contest. Over 90 percent of incidences of back pain are self-resolving (i.e., they heal themselves), so the exact incidence of thoracic (mid-back) and lumbar (lower-back) spine disorders in athletes cannot be determined. Pain related to the middle to lower back can be generated by muscles, ligaments, discs, nerves, joints, or organs. There are 12 thoracic and 5 lumbar vertebrae. The vertebrae connect to one another through intervertebral discs and facet joints, allowing stability of the spinal column during motion.

LUMBAR ANDTHORACIC AREA CONTUSION

Common Causes

Contusion, commonly called a bruise, occurs frequently in the lumbar and thoracic area, especially in contact sports or sports involving falls at high velocities. Muscle and soft tissue contusion occurs as a direct result of focal trauma to the tissues. This can occur in contact sports such as rugby, American football, boxing, or martial arts or during a fall or when accidentally running into a blunt object while playing a noncontact sport. The force of the blunt trauma, if great enough, causes injury to the soft tissue, stemming from the rupture of the cells.

Identification

While pain from a lumbar sprain or strain peaks after about 24 hours, the localized pain from a contusion progressively worsens over the course of a few days. Pain is generally described as dull and nonradiating and is exacerbated by touching the area. Look for evidence of a bruise and tenderness in a specific area or signs of redness or black and blue discoloration (called ecchymosis).

Treatment

The treatment regimen is similar to the treatment for lumbar sprain or strain, including ice and anti-inflammatory medication initially. If the contusion or tenderness does not abate within a few days, consult a physician for further evaluation, including X-ray or other imaging, because serious injuries, such as organ damage, spleen rupture, bone damage, and rib fracture  can occur as a result of a contusion. Also, be aware that organ damage might mimic back pain. A collapsed lung and kidney contusion are prime examples; the athlete may feel discomfort in the flank area (in the lower back below the bottom of the rib cage) or in the chest. Physician consultation is critical if pain does not subside within a few days or in the case of accompanying abdominal pain.

Return to Action

Following a contusion affecting a ligament or muscle, the athlete may return to exercise or sports as soon as he or she has normal range of motion and is pain free. Typically, the return to play takes longer for an athlete involved in a contact sport than for an athlete in a noncontact sport. If there is no suspicion of flank injury, return to sport may occur in three to six weeks. If there is a significant flank injury and organ damage is suspected, the athlete may be out for several months as determined by the physician.

LUMBAR SPRAIN OR STRAIN

Common Causes

A sprain is a ligament injury caused by overstretching the ligament. A strain is a muscle injury involving a tear of the muscle fibers caused by overstretching. Pain from a sprain or strain is a result of the tissue being stressed beyond its pliable range. A sprain or strain can occur in almost any sport, from a contact sport such as rugby to a noncontact sport such as bowling. As previously mentioned, the lumbar and thoracic regions of the spine contain many layers of ligaments and muscles, so it is often difficult to determine the exact ligament or muscle in which the sprain or strain has occurred. Sprain/strain is the most common cause of mid- and lower-back pain in the athlete and is most commonly seen in individuals from ages 20 to 40.

Identification

Symptoms of a lumbar sprain or strain generally begin during an athletic event and grow worse over a 24-hour period. An increase in discomfort is often felt the day after the inciting injury. The most common symptoms are pain, stiffness, and spasm in the lower back accompanied by occasional radiating pain into the buttock. In this case, the pain radiating into the buttock is called referred pain and may or may not be caused by nerve irritation. Tenderness is usually felt in a small area of the lower back. Pain is exacerbated by certain activities, including bending or arching the back, and is typically improved by sitting or lying down. The largest muscles of the back, the erector spinae, run longitudinally along the spinal column and aid with extension (leaning backward). Other major muscles, such as the multifidi group, sit more deeply and nearer to the vertebrae, run laterally, and aid mostly with rotation and stability of the lower back. The smallest and deepest muscles of the spine run within shorter lengths and, for the most part, provide stability to the region along with the ligaments. The muscles of the abdominal wall and iliopsoas are responsible for anterior stability and flexion.

Treatment

The initial treatment for any sprain or strain includes applying ice to the painful area three or four times daily. Each time, the ice should be applied in five-minute increments—five minutes on and five minutes off—for approximately 30 to 60 minutes. If the athlete has no allergies or previous gastrointestinal sensitivity to such medications, an over-the-counter anti-inflammatory such as ibuprofen and an analgesic such as acetaminophen might be useful to alleviate pain and discomfort. These steps will assist in reducing inflammation. In general, relative rest—that is, avoiding activities that exacerbate the pain—is preferred to bed rest. A physician should be consulted if pain does not improve within 48 hours or if there is loss in sensation in the buttocks area, sensory loss, weakness in the lower limbs, or loss of bowel or bladder control. In general, no X-rays are necessary for the first month if the injury is not traumatic or significant. Once serious injuries are ruled out, other treatments such as a more potent prescription anti-inflammatory medication, muscle relaxants, physical therapy, osteopathic manipulation, chiropractic treatment, and acupuncture may be added to speed the recovery process. Physical therapy focuses on stretching exercises for the leg and lower-back muscles to restore a normal lumbar curvature and strengthen the abdominal and lumbar muscles. Ice, ultrasound, and electrical stimulation may be used as needed to reduce pain and inflammation. Exercises that focus on strengthening the core muscles and improving flexibility can further stabilize the spine and help prevent future injuries.

Return to Action

Once a full range of motion and simple activities of daily living can be accomplished without pain, the athlete may return to cross-training and sports activity, with pain as the limiting factor. Return to play typically occurs three to six weeks after the injury. And lower-back muscles to restore a normal lumbar curvature and strengthen the abdominal and lumbar muscles. Ice, ultrasound, and electrical stimulation may be used as needed to reduce pain and inflammation. Exercises that focus on strengthening the core muscles and improving flexibility can further stabilize the spine and help prevent future injuries.

HERNIATED DISC

Common Causes

Lumbar herniated discs are rather common in athletes, particularly for those between the ages of 20 and 35. Sports that involve heavy lifting combined with bending and twisting pose the highest risk for herniated and injured discs. Athletes in throwing sports and twisting sports such as tennis, golf, American football (quarterback position), and baseball (pitcher) are also at risk. Sports with extreme forward bending such as yoga and gymnastics also pose a high risk for these injuries. The intervertebral discs are made of a fibrous band of material along the periphery called the annulus fibrosis and a central gelatinous material called the nucleus pulposus. These discs function as shock absorbers and prevent direct bone-on-bone contact of the vertebral bodies. A disc is herniated when a disruption of the annulus fibrosis allows the gelatinous material from the nucleus pulposus to either bulge into the annulus or to ooze out (like jelly from a jelly donut). The protrusion of the disc causes irritation of the nerve root, either from the disc directly pressing on the nerve or from inflammation of the nerve root caused by chemicals released in response to the herniated disc.

Identification

Typically, athletes with a herniated disc are more comfortable standing than sitting. Pain is often worse on one side and may radiate down the leg. Athletes tend to lean on the painless leg and favor the nonpainful side to reduce pressure on the disc. Pain is usually worse when sitting and improves when standing and walking (the opposite is true when the disc is herniated in the area known as the foramen). Complaints also include leg pain, weakness, and numbness. Physical exam maneuvers that duplicate radiation of pain into the affected leg are helpful in confirming the diagnosis. Most discomfort related to a disc herniation is likely caused by inflammation rather than direct pressure of a disc on a nerve. Pain radiating into the lower extremity, numbness, or weakness is consistent with a herniated disc. If an athlete has back pain radiating into the legs with associated weakness, or if any of certain cardinal warning signs are present, a physician should evaluate the athlete as soon as possible as these symptoms indicate radicular pain or sciatica and may signify a significant disc problem. The cardinal warning signs are loss of bladder or bowel control, intractable pain, and progressive loss of neurologic function, i.e., rapidly progressing weakness. If symptoms of lumbar disc herniation persist, the best method to evaluate the degree of herniation and the compression of the nerve root is via MRI. However, the appearance of the spine on MRI does not necessarily correlate with the degree of disability; people sometimes have herniated discs revealed via MRI yet are not symptomatic. MRI often is too sensitive and picks up things which are not clinically significant. But when symptoms do correlate with the findings on MRI, there is likely an association between disc herniation and symptoms.

Treatment

Various methods can treat an acute disc herniation with signs of sciatica (pain traveling from the lower back or buttocks region into the lower limb). If a short rest and mild analgesic or anti-inflammatory medications do not alleviate symptoms, a physician might place the athlete on oral steroids to reduce inflammation of the nerve root; the physician might also prescribe muscle relaxants and analgesics to control pain. The athlete is then reevaluated within a week, or sooner if pain or neurologic symptoms worsen. Symptoms of concern include the cardinal warning signs mentioned previously. If any of these occur, the athlete should immediately consult a spine surgeon or neurosurgeon. If symptoms begin to improve and there are no special concerns, the athlete may begin exercising and start a course of physical therapy that focuses on extension-based exercises to reduce pressure on the disc. Abdominal and lower-back strengthening and stretching should help restore normal function. If symptoms fail to improve, if there is persistent pain and dysfunction, or if any signs of weakness in the legs occur, an epidural steroid or nerve block injection, under X-ray (flouroscopy), along with continued physical therapy might be attempted. If the athlete still shows no improvement with this conservative treatment, surgery might be considered to remove part of the disc. In the rare event that an injured athlete has a sudden onset of bowel or bladder incontinence or saddle anesthesia (numbness in the buttock region), MRI, steroids, and possible emergency surgery might be indicated. This is a sign of a serious neurologic condition in which the herniated disc has compressed the nerves in the spinal canal that supply the lower parts of the body. The only treatment in this instance is rapid surgical decompression of the disc. Early surgery is advocated only with this condition or with progressive neurologic deficits.

Return to Action

Return to sport-related activity depends on the symptoms. The athlete should be pain free and should have undergone physical therapy including progressive cross-training, strengthening, and a return-to-sports program. The athlete needs to continue performing a home exercise program created by the physical therapist with the aim of strengthening the core muscles, maintaining flexibility, and relieving pressure from the spine to reduce the chance of recurrence of the symptoms. With conservative treatment for a herniated disc, the athlete can resume competition in approximately six to eight weeks. With surgical decompression, the athlete is usually out for the season or for at least three months.

ANNULAR TEAR

Common Causes

Annular tears are caused by disruption of the annulus fibrosis (the outer disc layer) without a frank disc herniation . Annular tears can occur in the same sports as herniated discs but are more common in twisting and torque injuries and nonviolent flexion injuries. You often seen annular tears in athletes involved in tennis, golf, yoga, or Pilates.

Identification

Athletes with annular tears generally experience axial (local), nonradiating lower back pain. Pain is generally exacerbated by prolonged sitting, which causes pressure on the disc. Pain is generally worse when bending forward. No neurologic deficits (weakness, loss of sensation, or leg pain) are noted. Afew tests to stress the discs might reproduce the symptoms. Any activity that takes the pressure off the disc, such as lying down, might improve symptoms. MRI is the most likely imaging mode to show an annular tear but is not foolproof. The gold standard for diagnosis is discography, in which a needle is inserted into the suspect disc and a mixture of fluid containing dye is injected into the disc. If the pain is reproduced by injection of fluid into the disc, and a tear is visible, a diagnosis of annular tear is confirmed. In a less forceful disc injury, the outer disc layer (annulus fibrosis) might not be completely torn open but only the internal half. This creates a tear in part of the disc that contains a nerve that carries pain signals to the brain. In this case the pain is not from the nerves in the spinal canal or material causing pressure on the sciatic nerve roots but from the disc itself.

Treatment

First, treat the athlete to reduce pain. Medication, rest, and physical therapy, focusing first on pain reduction and afterward on nonpainful posture, is most beneficial. Follow up with core- and extension-based strengthening, stabilization of the lumbar spine, and long-term stretching. Medication may be prescribed to manage symptoms. If symptoms persist, more invasive approaches may be considered, such as a paravertebral nerve block, epidural steroid injection (although this is not as effective as for a herniated disc), or minimally invasive intradiscal procedures. These injections are done by skilled clinicians who inject both an anesthetic agent and a cortisone preparation, under X-ray (flouroscopy), directly into or adjacent to the spinal canal; they are relatively minor procedures. Surgery is a last resort.

Return to Action

The criteria for returning to play and exercises prescribed to avoid recurrence of symptoms are similar to those for disc herniation Annular tears can be more difficult to treat because they can be persistent, whereas the sciatica from a herniated disc tends to abate.

TRANSVERSE PROCESS FRACTURE

Common Causes

The transverse process (the bony protrusion on either side of the arch of a vertebra) is a part of the bony spinal column, which is a ridge of gray matter in each lateral half of the spinal cord also called the dorsal column. Posterior column fractures are usually caused by direct trauma. These injuries are common in contact or collision sports especially those in which contact is made on the back (American football, rugby, hockey and falls that occur in in line skating and horseback riding).

Identification

Transverse process fractures are stable fractures that usually have no neurologic symptoms. The direct impact that caused the fracture, however, might have been sufficient to cause organ damage. This depends on the level of the spine fracture. If it occurs in the upper spine area, the lungs, aorta, or pancreas may be affected. A fracture in the lower area may put the kidney or bladder at risk. Direct organ injury from transverse process fractures is rare. Nonetheless, it is crucial to assess any signs of abdominal discomfort. Ask the athlete if he or she has difficulties with urination (e.g., blood in the urine), which may be caused by kidney injury. Fractures are generally apparent on X-rays, but if the diagnosis is questionable, a CT scan might need to be performed. Physical examination reveals tenderness over the fractured area and sometimes a bruise is apparent. Pain may adversely affect spine motion. There typically is no neurologic damage.

Treatment

The treatment regimen consists of ice, analgesics, a soft brace, and physical therapy. The goals of physical therapy are to reduce pain, restore motion and strength, and improve flexibility.

Return to Action

Once pain is managed well enough that the athlete is able to move, begin gradual reconditioning. As pain subsides, the athlete can start sport-specific exercises with the goal of regaining complete range of motion and returning to participation once pain free. Clearance to resume participation is withheld if organ damage is present. The healing of the fracture takes approximately six to eight weeks for young athletes and three months for weekend warriors and older athletes.

COMPRESSION FRACTURE

Common Causes

Compression fracture is a fracture of the vertebral body in the anterior bony spinal column. It is caused in athletics by significant trauma that suddenly flexes the thoracic or lumbar spine. The flexion (forward bending) force is so great that the vertebral body collapses in upon itself. Fortunately, fractures of the spine are not common in sports. Sports in which you might see these injuries include tackling sports such as rugby and American football; falling sports such as horseback riding, gymnastics, and track and field; and sports that involve high-velocity crashes in which athletes might land in a flexed position (skiing or cycling).

Identification

The athlete with a compression fracture has constant severe pain that is made worse with nearly any motion but especially with extension. Usually, no neurologic deficits are seen after a compression fracture, unless there is a retro pulsed bone fragment (a fragment that travels near the spinal cord). In the event of transient paralysis of the leg during the trauma or neurologic findings such as numbness, tingling, or weakness in the legs, consult a physician to rule out spinal cord injury. Diagnosis is made by X-ray.

Treatment

Thoracic compression fractures in which less than 50 percent of the height of the vertebra is lost are treated with analgesics for pain control and 6 to 12 weeks of bracing in an extension brace that does not allow the spine to bend forward. In some cases, compression fractures greater than 50 percent of the height of the vertebra might require surgery, kyphoplasty, or vertebroplasty; in the latter two techniques a balloon is inserted into the collapsed vertebra and is then inflated with material to increase the vertical height of the vertebrae.

Return to Action

Rehabilitation focuses on a return to a full range of motion without pain. Strengthening of the core muscles and reconditioning exercises should be included. For noncontact sports, athletes can probably return to play within 12 weeks if they have obtained full range of motion without pain. For contact sports, athletes should be advised of the risks of a repeat fracture and must weigh the risk-to-benefit ratio. Repeat fractures or further collapse of the vertebrae could cause postural changes and lead to painful conditions in the future.

BURST FRACTURE

Common Causes

Burst fractures are caused by a combination of axial (top to bottom) loading and flexion of the spine. In a burst fracture the force of the trauma causes the vertebrae to burst apart rather than to collapse upon itself, as happens in a compression fracture. Because of the type of fracture, a fragment of bone might lodge in the spinal canal, thus involving the anterior and middle columns of the spinal column. This is most severe when a bone fragment propels into the spinal canal and injures the spinal cord. Athletes at risk are those who play sports in which high-force blows to the spine occur. Rock climbers, horseback riders, American football players (especially those who might get thrown airborne), ski jumpers, and cliff divers are all at risk of burst fracture.

Identification

Treat on-the-field spine injuries with great care and caution. These injuries should be viewed as emergencies. Any indication of weakness of the arms or legs or acute spine pain caused by trauma warrants immobilization on a spine board by trained professionals and immediate transfer to an emergency room. Athletes with a burst fracture that propels bone into the spinal canal will likely have spinal cord injury, which might leave them with paralysis of both legs and with bowel and bladder incontinence.

Treatment

Once at the emergency room, an athlete with a spinal cord injury will receive high dose intravenous steroids, immediate MRI, and surgical evaluation. If a spinal cord injury has occurred and surgery is performed, the athlete will likely attend an intensive inpatient rehabilitation center to recover to the best functional level that neurologic impairment allows. When appropriate, a rehab counselor, physical therapist, or physiatrist can recommend a disabled athletic program; such programs are available in larger communities.

Return to Action

Recovery from surgery depends on the degree of nerve injury and can vary from full recovery to permanent paralysis. Healing requires a minimum of three to six months and most often is ongoing for several years or a lifetime. High-impact and high-risk sports are usually not permitted after these injuries.

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

Common Causes

Spondylolysis is a stress reaction or fracture of the joint between two adjacent vertebrae. The injury is caused by repeated hyperextension (bending backward) of the lumbar spine and is common in high-level athletes, especially gymnasts. It is more common in females than males. It most often occurs at the lowest lumbar segment (L5) or second-lowest lumbar segment (L4). Spondylolisthesis refers to forward (anterior) slippage of one vertebral body over the one below it. There are various types of spondylolisthesis, but in athletes the injury is usually caused by a fracture (specifically a pars fracture, and most likely a type of stress fracture) on both sides of a vertebral body.

Identification

Symptoms are generally described as a dull lower-back pain, occasionally radiating into the buttocks. Physical examination tends to reveal pain with extension with no evidence of neurologic deficits. Spondylolysis must be suspected in any athlete with extension-based pain who does not respond to conservative treatment, including analgesic and therapy, within a short time. Early evaluation of spondylolysis is crucial to prevent advancement of the stress reaction to a fracture. Because X-rays of the spine might not reveal findings early enough, a bone scan is often required if spondylolysis is suspected. Symptoms of spondylolisthesis are similar to spondylolysis, except in spondylolisthesis there is a history of occasional sharp radiating pain into the leg caused by irritation of the nerve because of the bony slippage. Spondylolisthesis can be detected on a plain X-ray. Flexion and extension X-rays are needed to assess if the degree of slippage changes with spinal motion, which is believed to be a much greater source of pain. Spondylolisthesis is categorized into grades I to V with each progressive number representing further anterior slippage of an upper vertebra onto the one directly below it. Surgical treatment is considered in grades III, IV, and V or if the athlete continues to experience pain radiating into the legs despite conservative treatment.

Treatment

Athletes with acute spondylolysis will be braced in an orthotic that prevents spinal extension until they are pain free for at least six weeks. The duration of treatment depends on whether symptoms are acute or chronic, the degree of pain, and whether there is a stress reaction or fracture. Athletes for whom the problem is not caught early on might eventually develop chronic episodic recurring pain from spondylolysis or spondylolisthesis. These athletes will be treated with analgesics or anti-inflammation drugs (or both), muscle relaxants, and opioids, if needed. Physical therapy should focus on core stabilization, neutral spine pelvic floor strengthening, and biomechanics.

Return to Action

An athlete recovering from spondylolysis or spondylolisthesis is not allowed to participate in sports but may perform low-impact aerobic exercises such as bicycling with the brace. Physical therapy entails aerobic exercises as well as stretching of the lower extremity muscles and core strengthening. Maintaining the routine core-strengthening exercises given by the physical therapist is important in preventing recurrent symptoms. Return to athletic participation after a diagnosis of acute spondylolysis or spondylolisthesis can range from 3 to 12 months, depending on the progress of healing and stability of the spine as assessed on follow-up X-rays. Return to sport is usually limited to a level of participation that does not exacerbate pain.

SACROILIAC JOINT DYSFUNCTION

Common Causes

The sacroiliac joint is formed by the articulation of the sacrum and ilium. Although the sacroiliac joint is not a part of the lumbar spine, pain from the sacroiliac joint can be very similar to lumbar spine pain syndromes. Sacroiliac joint dysfunction stems from a change in the position of sacrum on the ilium caused by an imbalance of the muscles attached to the pelvis, a ligamentous injury to the joint, a fracture of the sacrum or pelvis, or occurrences such as masses in the pelvis or pregnancy. Athletes, such as gymnasts and dancers, who jump, bend, stretch, and twist a lot are at risk for this type of injury.

Identification

Athletes with sacroiliac joint dysfunction generally have pain and tenderness in the upper area of the buttocks. There is tenderness to touch at the sacroiliac joint. Pain might radiate into the lower buttocks, thigh, and down into the leg. Pain is worse with prolonged standing, sitting, turning on the side in bed, and stepping up on the painful side. Most often, an exam by a physician is sufficient for diagnosis. However, the gold standard test for diagnosis is performing a joint block. An anesthetic agent is injected into the sacroiliac joint. If pain subsides temporarily, a diagnosis of sacroiliac joint dysfunction is made.

Treatment

The initial treatment for sacroiliac joint dysfunction is rest and analgesics or anti-inflammatory medicine. Joint manipulation by a qualified practitioner such as an osteopathic physician, chiropractor, or physical therapist might help correct the muscle imbalance. Physical therapy that focuses on stretching of the muscles attaching to the pelvis, as well as strengthening the pelvic floor, abdominal, lumbar, and leg muscles, will also help. If symptoms do not improve, corticosteroids injections under X-ray guidance may be given. Some find relief with temporary use of a sacroiliac belt, which wraps around the hips to squeeze the sacroiliac joints.

Return to Action

The physical therapist should gradually increase activities and exercises during therapy sessions with the goal of preparing the athlete to return to sport-related activities. If no significant sacroiliac injury (fracture) has been identified and the athlete feels ready, he or she can return to sports as soon as one to two weeks after the injury. Stretching and strengthening exercises should continue long term.

FACET JOINT PAIN

Common Causes

Lumbar facet pain is caused by inflammation or arthritis of the facet joints (also known as zygapophaseal joints). Facet joints are located on the posterior aspect of the spine and they connect the posterior or rear portion of the adjacent vertebrae. The facet joint is a true synovial joint and when injured or inflamed can become swollen. This swelling can become large enough to cause pressure on the nerve root that passes through the joint. Athletes at risk for injuring facet joints are those involved in twisting activities, such as golfers, tennis players, and baseball pitchers.

Identification

Athletes generally complain of localized lower-back pain exacerbated by extension and rotation and relieved by flexion. Pain often radiates into the buttock on the same side. Diagnosis of facet joint pain is not always easy to determine. In such cases, diagnosis can be confirmed by a facet joint injection or blocking of the nerve that supplies sensation to the facet joint with an anesthetic agent.

Treatment

Initially treat facet joint pain with ice, analgesics, and anti-inflammatory medication. The athlete should avoid activities that cause pain. Spinal manipulation has been shown to help reduce facet mediated pain. These measures should be followed by physical therapy that focuses on strengthening the core muscles and stretching the leg muscles. Use ultrasound, ice, and moist heat to control pain. Avoid spinal extension at the early stages but introduce it as symptoms are controlled. The athlete needs to learn to use core muscles during activity to prevent hyperextension of the spine during motion and to avoid straining the facet joints. In cases in which these treatments do not resolve the pain, other procedures must be considered, including spinal-intervention procedures, such as fluoroscopic-guided facet injection or blocking and ablating the nerve that supplies the injured joint.

Return to Action

Athletes may return to sport once core muscles have improved to the point where there is no exacerbation of pain in practice and sport-specific training. This can occur in a relatively short period of time (two to three weeks) if only a synovitis is present but may take much longer (three months or more) if there are bony changes in the facet joint. Athletes with chronic facet pain may choose to continue to play sports but will need to modify their activity. If an athlete is willing to put up with a mild flare of pain for a day after sports and the condition is not deteriorating, there is no real health risk for continuing. Chronic patients sometimes preload with over-the-counter anti-inflammatory medications before an athletic contest.

LUMBAR DEGENERATIVE DISC DISEASE

Common Causes

Degenerative disc disease (DDD) occurs when one of the lumbar discs dries up and deteriorates so that the end plates or bones might rub against each other. This rubbing causes irritation to the remaining disc structures and can cause irritation of the bone. The pain is believed to emanate from inflamed fibers of the irritated disc. Although sports activities can aggravate the pain from DDD, they do not cause it. There is no specific cause. Clearly, people who have had a prior disc injury are at risk for having that disc deteriorate and become painful.

Identification

Athletes with degenerative disc disease experience tenderness in the lower lumbar spine. Pain is dull and might be located on one or both sides of the lower back; it may or may not radiate into the buttock. Pain is generally worse early in the morning, with stiffness and difficulty standing upright, and subsides as the day proceeds and returns at the end of the day. Spinal flexion might be limited by lower-back discomfort. Prolonged sitting is often uncomfortable. The pain is often not specific and difficult to describe. The condition can be confirmed by X-rays.

Treatment

Treatment of lumbar degenerative disease is similar to treatment for lumbar sprain or strain. The most important factor in treating this condition is athlete education and maintenance of a core-strengthening and flexibility program.

Return to Action

The progression of therapy is guided by the athlete’s pain and ability to tolerate activity. The athlete with lumbar DDD is prone to occasional bouts of severe back pain and thus needs to regularly perform core strengthening, lower-back and lower extremity stretching, and extension-strengthening exercises to minimize recurrence of pain. All exercises for degenerative lumbar disease, including Pilates and yoga, need to be performed with caution. Avoid excesses of range of motion that might lead to aggravation. Modify yoga and Pilates to avoid forceful flexion exercises.