Back Injuries

It is remarkable that the back—a complex structure that is an essential component of effective athletic performance—is exposed to a variety of serious risks, and yet tends to be injured in a rather limited number of ways. The back consists of four regions: the cervical spine, the thoracic spine, the lumbar spine, and the sacral spine. Approximately 20% of all sports injuries involve either the lumbar spine (the lower portion of the back) or the cervical spine, which is the neck area. Outside of athletics, between 50% and 80% of all people will sustain a back injury at some time during their lives.

The injury commonly known as a lumbar strain, or low back strain, arises in one of two ways: a repetitive motion or a weight-bearing motion. A repetitive motion is when lumbar spine is required to perform a twisting motion that generates significant forces upon the spine and the supporting muscles, without a corresponding degree of control of the motion. The swing of a golf club or the motion required to produce a tennis serve are examples of this type of action. A weight-bearing motion can be a series of repetitive actions or a single movement such as when an athlete lifts a weight that is either more than the body is capable of lifting or the lifting technique employed places the lower back in a position where the strain of the weight overloads the lower back structure. Weight training or the movement of any heavy object, such as improper blocking technique in American football, may cause a lumbar strain.

Cervical spine injuries include neck injuries, which are more commonly caused by direct application of force to the neck, causing the neck to move when it and the supporting cervical structure are not in a position to bear or absorb the force applied. The common term "whiplash" is a description of a type of cervical spine injury. More serious cervical spine injuries occur when an extreme degree of force is applied, such as a blow to the head, or when the head is struck, causing it to move in one direction while the body is traveling in another, as often occurs in alpine ski racing crashes and motor vehicle collisions. A blow delivered to a receiver by a defensive back in American football or to a rugby player by an opponent as they move with the ball in a direction opposite to the force applied are also examples of the kinds of applications of force that can cause a neck injury.

Injuries to the thoracic spine, sometimes referred to as the upper back or mid back, are less common. As the purpose of this component of the spine is primarily to protect and to stabilize, there is little movement by the spine. What injuries do occur in this area are most often blows delivered to the muscles of this region in contact sports, or when there is a dysfunction in one of the joints.

A more debilitating back injury is a herniated disk. Any of the disks throughout the spine can become herniated; the most common is the herniated lumbar disk. This injury can occur through either repetitive stresses placed on the structure, such as in repetitive lifting or by direct trauma. The hernia arises when the soft gel within the disk ruptures and then pushes into a nerve root, causing pain. A herniated disk will often require surgery or other significant medical attention.

Other common injuries to the low back region are sciatica, an irritation of the sciatic nerve that radiates

Lumbar strain is a common injury in tennis, as motion required to produce a tennis serve generates significant forces upon the spine and the supporting muscles.
from the back into the buttocks; coxodymia, an injury to the coccyx, or tailbone; and fractured vertebrae, where a vertebra sustains a fracture as a result of a direct blow.

As with most sports-related injuries, there are a number of preventative measures that an athlete may take to limit the risk of a damaged back. Such measures are of added importance when the athlete has sustained a previous back injury. A stretching program, aimed at the improved flexibility of the back and its supporting structures, is essential. Back stretches should be performed on a daily basis, as well as part of a warm up prior to training or a competition. In addition to enhancing the flexibility of the structure, stretching will develop improved circulation in the back muscles.

For persons who wish to become active in sport generally or those who wish to seek an athletic outlet that represents a lesser risk of back injury, sports in which the back is not subjected to high impact or twisting motions include road cycling and cross country skiing. Moderate levels of back stress will be found in sports such as soccer, distance running, volleyball, or basketball. Sports such as Alpine skiing, American football, wrestling, and weightlifting all present a greater risk to the health of the back and spine.

Back injuries will require treatment commensurate with the nature of the injury. Minor back strain is often treated with minimally invasive measures such as ice, rest, and the use of an anti-inflammatory such as ibuprofen to reduce pain. For more serious spinal injuries, chiropractic manipulations have often been found to be helpful, as have deep-tissue massage and acupuncture. There are few drug therapies that provide any long-term assistance for a back injury, particularly lumbar injuries. Surgery is typically reserved for worst-case situations.

Low back stabilization exercises, designed to strengthen the lumbar region, are essential to aid in recovery from a back injury.

SEE ALSO Back anatomy and physiology; Herniated disks; Low back pain; Neck injuries; Skeletal muscle; Stretching and flexibility.