Back Pain in Youth Athletes
Youth Sports in the Coachella Valley are becoming more prevalent and more competitive. On one hand, the benefits of youth sports are abundant, ranging from positive character building to developing healthier lifestyles. In the other, an increase in sport related injuries and non-sport injuries made worse by sport had become a main concern in our community. Although there are a range of sport injuries, this article will cover the most common among all sports, lower back pain (LBP) in youth. Lower back pain can be prevented.
Prevalence of LBP in Youth
Lower back pain has been associated with a condition that occurs in middle egged and older adults but it has never been associated with youth. In a PhD thesis, Young et al. Does it matter which exercise? Spine, 29(23): 2593-2602, 2003, discusses how LBP in people ages 6-17 have been treated by a physical therapist to manage and alleviate LBP symptoms. In his dissertation, Young provides an inferential statistical model that estimates 24% of youth having back pain in the United States. In 2005, Hayden Ya et at in a systematic review shows how the prevalence of low back pain increased from the projected 24% described by Youngs model to 78% of youth athletes experiencing a degree of back pain and 53% of them getting treatment meant for it. Although there is a lot of research to be done on child development and sport we can conclude that LBP is something that we cannot dismiss.
Preventing LBP
In underserved rural communities such as the ones in East Coachella Valley preventing low back pain in our athletes should be a priority. Prioritizing basic movement before developing complex sport specific skills will reduce low back injury.
1st step
Making sure the athlete has good trunk stability by developing the musculature of the core is the first step. To strengthen the core we recommend the supine Chinese plank - strengthen the erector group, the plank on elbows - strengths the transverse abdominis and rectus abdominis, and the side plank - strengthens gluteus Medius and obliques. It is important to start off with two sets of 30 seconds and then progress to three sets of 60 seconds. Avoid going over two minutes per set, research has shown that there is no benefit to going over two minutes in an isometric exercise because supporting muscles will take over the exercise and not the targeted muscle.
2nd step
In the last 15 years children have become more sedentary and as a result their gluteus maximus activation and strength has decreased mainly because of sitting. Weakness in the glute max muscle has compromised gait and posture in our youth and as a result over development in the quadriceps muscles and low hamstrings has occurred. Such compensations decrease hip extension when running leading to over strides and it also decreases flexibility in knee extension causing more hip flexion and or heel striking. Since running is involved in most sports, getting your athlete running better not only will get them faster but also keep them healthier. Out top exercise to retrain the gluteus maximus is the single leg bridge. Although it might seem simple to do, this exercise is challenging. We recommend starting with two sets of 20 reps each leg and increase reps as needed to reach maximum stimuli. The single leg glute bridge is a great exercise to activate the glutes before practice or before a weightlifting session.
3rd and last step
Remastering the squat is the final step in preventing low back pain caused by bad movement. To regain the squat pattern the athlete needs to be progressed appropriately by the coaching staff but your best bet is to seek out a Certified Strength and Conditioning Specialist (CSCS) to ensure the movement is being taught correctly. A good place to start is by practicing the lateral step down exercise and then progress to a high step up. Once the step up is mastered, progress to a Bulgarian split squat before doing any bilateral exercises (such as back squats, jump squats, cleans, snatches, front/goblet squats). Once again, having a second pair of eyes analyzing your form throughout these exercises is highly recommended.
What if my child already has back pain?
If your child is experiencing back pain it is important to seek medical attention to get the right diagnosis. Once a clinician (MD) understands what is the root problem of the back pain they will make a referral to the appropriate practitioner, often to a physical therapist (DPT) or chiropractor (DC). If you get referred to a chiropractor please note that adjustments are not permanent, to have more permanent results follow this chain.
MD -> DC -> DPT -> CSCS -> Sport Coach
Overall, this short blog was intended to spread awareness in the Coachella valley in the prevalence of youth lower back pain. Please remember that in Desert Barbell we have both PT, CSCS, and Sport Coaches that can help you keep you and your children healthy in and out the field. Thank you for taking the time to read this entire blog post.