While the incidence of injuries to the back are relatively uncommon (when compared to other sites like the knee, ankle and hip) back pain is one of the most common reported complaints among athletes. While most of this is non-specific (and does not relate to a clear diagnosis) this is not always the case.

Compared with adults, back pain in child or adolescent athletes is relatively uncommon and should be taken more seriously. This is especially true when the athlete participates in sports where there is repeated flexion and extension of the lumbar spine. These sports include gymnastics, cricket bowling and rowing. These athletes may have a stress fracture involving the lumbar spine. These stress fractures generally happen at a region of the spine called the pars interarticularis. This part of the bone acts like a fulcrum during flexion and extension and is the most vulnerable to this repeated loading. For a variety of reasons, these stress injuries can be difficult to diagnose and treat. An early diagnosis is however important as the athlete is unlikely to get better without a dedicated treatment programme. This often involves a prolonged period of rest and time away from sport.

Younger patients who are referred to our clinic often require further investigation and evaluation. X-ray imaging is generally not useful and can be associated with a relatively high radiation dose. The imaging modality of choice (in almost all cases) is an MRI. This can help distinguish between the more benign causes of pain (sprains and strains) and the more significant causes (generally pars interarticularis lesions of disc injuries). As always it is also important to consider non-sports related causes of pain including inflammatory processes, infection and malignancy.

Depending on the extent of the injury a dedicated rehabilitation programme is needed. At Axis Sports Medicine Specialists we have a five-phase programme designed to help an athlete manage their symptoms, rehabilitate and return to normal function. Where an athlete enters this programme is dictated by their symptoms, clinical signs and radiological findings. Our specialists work with the athlete’s referrer to help plan their recovery.

When you next see an adolescent with back pain consider whether you think that they might have a bone injury. Do they play a ‘high-risk sport’, is their pain made worse by lumbar extension and/or has it persisted longer than you expected. Is the answer to one of these questions is yes you may wish to consider referring them on for a further assessment.

By Dr Mark Fulcher on