Wednesday, August 24, 2016

Why does my back hurt?
Back pain in the young athlete is very common. It has been reported that up to 75% of adolescents will experience back pain by the time they reach 18 years of age.  As more youth sporting activities are performed year-round, there is a greater risk of sports-specific repetitive activities over-loading the athletes back.  Too much activity applied too quickly to the back can cause pain.  In athletes less than 10 years of age, back pain is uncommon, for many reasons. However, as the athletes grow, add more muscle mass, generate more force and speed and training more (frequency, intensity and duration) the risk of back pain increases. In general, a gradual change in sporting activities and training will minimize the risk of developing back pain. The good news is >90% of back pain in adolescence is muscle-based and due to overloading the muscles.

Like many orthopaedic injuries the commonly recommended treatment is the "RICE" treatment, which partially applies here. Rest, ice, compression (hard to do for back injuries) and elevation (also hard to do) is recommended for the first 4-6 weeks after back pain develops. This is especially true when the athlete can relate the onset of back pain to an event in their sports. Over-the-counter pain medications (acetaminophen, ibuprofen or naproxen) can be helpful for pain control. Pain which came on without a known injury or activity, fevers, numbness in legs, bowel or bladder difficulties or other neurological symptoms is more concerning and should be evaluated by a physician early.  Depending on the amount of pain, the athletes level of participation and upcoming events a course of physical therapy can be helpful.  A course of paraspinal muscle strengthening, core strengthening and stretching can speed up recovery.  Back braces are not recommended, in general, because they can cause the back muscles to become too weak.  Similarly, narcotics and muscle relaxers are not recommended, except in extreme situations.
An evaluation for back pain is appropriate if the back pain has been present for longer than 6 weeks, there is lower extremity numbness or weakness, or bowel or bladder problems develop.

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