Low back pain is very common in the general population, estimated at 85% of people. Adolescent athletes are thought to have more low back pain than age-matched peers. Spondylolysis, a lesion in the pars interarticularis of the neural arch, is more commonly injured in athletes (specifically gymnasts, throwing athletes, rowers, etc.). Athletes have also been shown to have a greater number of spinal abnormalities than nonetheless.
The spine generally serves three purposes in sports: force generation, force absorption, and force transfer.
Rehabilitation must focus on return to function. A breakdown at any link in the kinetic chain may adversely affect force development in distal sites. Rehabilitation should first restore range of motion and resolve any symptoms. This must be progressed, as the athlete will learn the tasks and demonstrate dynamic postural control. The activation pattern of
muscles has been studied and it seems the transverse abdominus is the first muscle activated during any movement, suggesting this muscle deals with stability. This muscle is also delayed in patients with low back pain. Studies suggest programs addressing the deep abdominal muscles improve low back pain quicker and maintain improved for 30 months follow-up.
In athletes with LBP, it seems imperative to correctly diagnose, earlier, rather than later. After diagnosis, core stability and multi-planar strengthening are necessary for improvement and preventing reoccurrence.
This review is mainly an anecdotal piece discussing the importance of the core. Unfortunately, more randomized studies on core stability and low back pain are necessary for complete understanding.
- Standaert CJ, Herring SA, Pratt TW. Rehabilitation of the athlete with low back pain. Curr Sports Med Rep. 2004 Feb;3(1):35-40. Review.