It’s estimated that 26% of American adults live with low back pain at any given point in time and that 80% of people will experience this condition at some point in their lives. While a higher-than-average activity level may put some athletes at lower risk of experiencing low back pain than the general population (meeting minimum movement guidelines is associated with an overall decrease in low back pain), other athletes may find themselves at higher risk of developing lower back injuries or issues due to the demands of their sport.
Rowing and cross-country skiing are the sports with the highest lifetime prevalence of lower back pain, but athletes in a vast range of different sports require treatment for the condition every year. Conservative treatment options for low back pain are typically recommended before surgery is considered and may include physical therapy, lifestyle changes, and/or pain management techniques such as medications or injections.
Physical therapy is highly effective for many athletes suffering from low back pain. But what happens when it isn’t, and lower back pain continues to persist, impacting athletic ability and quality of life?
At the New Jersey Spine Institute, we frequently work with athletes in this situation who struggle with lower back pain, even after trying physical therapy and are frustrated and discouraged as a result. In some cases, exploring spine surgery is the next step. In others, the solution involves something as fundamental as properly diagnosing the underlying cause of the pain and/or ensuring that the patient is consistently performing stretches and exercises as recommended.
In this post, we consider the reasons athletes experience back pain, provide some keys to successful physical therapy treatment, and explore why physical therapy may not always resolve the condition. If you are an athlete living with lower back pain, the world-class team at the New Jersey Spine Institute is ready to provide an accurate diagnosis and a customized treatment plan that will put you on the fastest road to recovery. Contact us today to schedule an initial consultation!
Why Do Athletes Experience Back Pain?
Athletes across a wide range of different sports may experience low back pain for numerous reasons, including one or more of the following:
- Traumatic Injury – Heavy lifting, sudden twisting movements, high-impact collisions, and more can all lead to low back injuries.
- Tight Hip Flexors – Tight hip flexors can result from poor movement and/or sleeping patterns, weak core and hip muscles, or prolonged periods of sitting and can cause the psoas and iliacus muscles to pull on the lumbar spine, resulting in low back pain.
- Insufficient Core Stability – Many athletes possess core strength but lack core stability, which prevents spinal motion and helps to maintain the spine in a neutral position. Exercises that increase core stability include planks, bird dogs, woodchoppers, and more.
- Poor Lifting Technique – Lifting with the back instead of the core and legs can increase pressure on the lumbar spine and lead to lower back pain.
- Poor Sleep Quality – Getting enough sleep and sleeping in a back-healthy position (on the back or side with a pillow between the knees) can greatly reduce lower back pain for some athletes.
- Long Periods of Sitting – Athletes who sit for prolonged periods of time outside of training may experience tight hip flexors and other imbalances that lead to poor posture, impaired movement patterns, and lower back pain.
- Weak or Lax Spinal Ligaments – Weak or loose spinal ligaments can cause vertebrae to slip out of place and cause lower back pain, even if core muscles are strong.
In addition to the list above, two of the most common causes of low back pain we see in athletes at the New Jersey Spine Institute are ineffective warmup routines and continued strain on existing injuries:
Ineffective Warmup Routines
Warming up properly is critical to reducing the likelihood of injury during athletic activities. From basketball to curling to rhythmic gymnastics, every sport places its own unique demands on the body, and an athlete’s warmup routine must reflect that. When time is short or training poor, warmups may be performed inadequately or even skipped altogether. Unfortunately, this can increase the risk of injury, and the lower back is particularly vulnerable.
Continued Strain On Existing Injuries
While playing through pain may be accepted or even encouraged in certain sports, ignoring lower back pain can have detrimental results and is never recommended. In particular, it is important for athletes to listen to their bodies and take proper precautions in cases where a lower back injury or condition is suspected or has previously occurred. Risks of playing through lower back pain include worsening the pain and/or causing a more serious injury or condition to develop. Persistent lower back pain in athletes should always be evaluated by a medical professional.
The Keys To Successful Physical Therapy
Physical therapy can be a game-changer for athletes experiencing low back pain, but in order for it to be successful, certain criteria must be met. The keys to successful physical therapy include:
- Goal-Oriented – A successful physical therapy program must be individually tailored to the treatment goals of the athlete.
- Appropriately Challenging – A physical therapy treatment plan that is too hard or too easy for the patient may result in less-than-ideal progress, continued pain, and the potential for further injury.
- Targets Symptoms and Their Underlying Causes – Understanding and targeting not only the symptoms but also the underlying cause of lower back pain is vital to permanently resolving it.
Strengthening Ligaments And Muscles
Muscle strengthening is a core element of most physical therapy programs, but when it comes to lower back pain, spinal ligaments must also be factored into the picture. Spinal ligaments are connective tissues that help to stabilize the spine. When they become damaged or loosened, the vertebrae may continue to slip out of place, leading to low back pain, even if the surrounding muscles are strong and stable. Spinal ligaments can be stabilized through targeted core training exercises provided by an experienced physical therapist or spine specialist. In some cases, prolotherapy may also be recommended to further tighten and strengthen spinal ligaments.
How To Tell When Physical Therapy Is Working
Progress with physical therapy is rarely rapid and may not be linear, but that doesn’t mean a patient isn’t experiencing positive benefits with the treatment. Athletes who feel stronger and are able to do progressively more physical activity over time can generally assume that physical therapy treatment is working for them, even if the resolution of symptoms is slower than hoped for.
That being said, it’s also important for athletes to monitor their progress closely and critically evaluate their recovery process while undergoing physical therapy treatment, as not all lower back pain responds positively to physical therapy, and other treatment options do exist.
Why Does Physical Therapy Fail At Times?
Physical therapy may fail to resolve lower back pain in athletes for a variety of different reasons, including the following:
- Patient Non-Compliance – The patient is not adhering to their exercise program as recommended.
- Incorrect Diagnosis – Something has been misinterpreted or overlooked during the diagnostic process.
- Poor Treatment Plan – The treatment plan doesn’t align with the goals, abilities, or symptoms of the patient.
- Wrong Treatment Option – Conditions such as advanced arthritis of the spine, spinal fractures, severe nerve compression from a variety of causes, spinal cysts or tumors, and more may not respond effectively to physical therapy.
What To Do If Chronic Low Back Pain Persists After Seeing A Physical Therapist
Athletes who continue to experience low back pain even after consistent adherence to a physical therapy program should seek further evaluation. In some cases, changing physical therapists may help. It may also be time to seek a more comprehensive diagnostic process and explore other potential treatment options.
At the New Jersey Spine Institute, our team of board-certified spine experts specializes in working with athletes to uncover the underlying causes of lower back pain. With decades of experience as leaders in spine pain relief, we listen carefully to our patients and use a combination of in-depth physical examination techniques and advanced imaging tests to ensure an accurate diagnosis. Once we’ve identified the source of your low back pain symptoms, we’ll develop a personalized treatment plan to help you get back to peak athletic performance as quickly as possible. In addition to physical therapy, we may recommend lifestyle modifications, pain management options, and/or surgical treatment to get you back to a pain-free reality.
Speak To The Expert Orthopedic Spine Surgeons At The New Jersey Spine Institute About Your Next Steps
Seeking lower back pain treatment in New Jersey? The spine specialists at the New Jersey Spine Institute are ready to provide an accurate diagnosis and tailor a treatment plan to your specific needs and circumstances. We’ve helped numerous athletes resolve low back pain, even in cases where initial physical therapy treatment did not yield the hoped-for outcomes. Contact us today to book an appointment and learn more about our minimally invasive solutions and unique two-surgeon approach. We look forward to working with you!