Study details key concerns for looking after the spines of elite athletes

Sports like American football can put particular stresses on the spine

Nearly one in three competitive athletes experiences low back pain. According to a literature review in the Journal of the American Academy of Orthopaedic Surgeons, low back pain among elite athletes who play varsity or professional sports requires additional important considerations to that of the general public.

“Competitive players stress their lumbar spine for hundreds of hours a month, thereby predisposing themselves to specific injuries that should be recognized by healthcare practitioners,” says Wellington K Hsu, lead review author and orthopaedic spine surgeon at Northwestern Memorial Hospital, Evanston, USA.

Athletes are at greater risk of developing lower back conditions when:

  • Intense training regimens start and continue between the ages 10 and 24 years. This may increase the likelihood that young athletes develop symptomatic lumbar disc degeneration—a natural degradation of disc, and narrowing of the space between vertebrae due to the aging process. Surgical management, considered as a last resort, includes removing the diseased disc, and fusion (locking one bone to another bone) or total disk arthroplasty (replacing the diseased disc with an artificial device). However, few studies have looked at the outcomes of surgically treated athletes with lumbar disk degeneration.
  • Participating in elite sports with intense, repetitive movements between the ages of 20 and 35 years. This may also increase the likelihood that athletes experience lumbar disk herniation.
  • Among the general population, more than 90% of patients with lumbar disc herniations improve within six weeks of injury with nonsurgical treatment. An estimated 82% of elite athletes were able to return to their sport after nonsurgical treatment.
  • Young athletes showing signs of notable or severe low back pain should be checked for spondylolysis. The condition is often noted in younger athletes who participate in sports that involve repeated stress on the lower back, such as gymnastics, wrestling, weightlifting, and diving. Early recognition of the symptoms could lead to healing of the injury.
  • Additionally, lifting heavy weights in unsupervised extreme sports training or without low back protection in any age group also could put athletes at greater risk of lower back injuries
NFL linemen may have a higher risk of lumbar disc herniation than athletes in other sports because of position-specific movements and demographic characteristics.

According to Hsu, nonsurgical therapy should be the first-line treatment in all athletes with lower back conditions because successful recovery rates from rehabilitation protocols are high.

Surgical management of lower back injuries among elite athletes generally be only considered after all nonsurgical treatment has failed. “Expectations regarding surgical outcomes should be tailored for elite athletes depending on sport, and to sport-specific demands” says Hsu.

After surgery, recovery time, performance, and career lengths of elite athletes depend on the sport and its physical demands. As with any persons with a lower back injury, elite athletes should complete a rehabilitation program and be individually assessed for medical clearance before returning to work or play.


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