Treating Back Problems in Athletes Versus Non-Athletes

Most of us have had a ‘bad back’ as some stage and will know how when it hits, every movement, step, lift or sneeze can be excruciating, with few positions being comfortable. If we were lucky it will have only lasted a few hours our a few days, however the reality is that back pain is one of the biggest causes of ‘time off work’ and many people will have prolonged and recurrent episodes.

A recent article in the British Journal of Sports Medicine [1] points out that amongst the general population, psycho-social links to low back pain along with the complexity of the back's structure make specific patho-anatomical diagnosis of back injury difficult. On the back of this the majority of patients within health services are labeled as having ‘non-specific back pain’ (NSBP). That being the case, the author, a respected back pain researcher and practitioner, advocates a bio-psycho-social model of care addressing behavioral as well as physical issues.

In the last 10 years I’ve been working in international cricket, athletics and now rugby, sports where back injury is always in the top three problems resulting in lost training and competition time. My belief is that the influence of psycho-social risk factors linked to back pain such as low levels of job satisfaction, psychological distress, smoking, obesity and heightened fear of activity are much less of an influence on back injury in the athletic population.

If a sports person has significant injury then it can usually be attributed to a specific mechanism with identifiable structural damage. For example, fast bowlers in cricket are prone to lower back stress fractures due to repeated extreme bending of the spine during the delivery stride, and front-row forwards in rugby have a very high rate of neck pain attributable to disc damage, associated with flexing and compressing the spine in the scrum.

Rare is the athlete who will accept a diagnosis of ‘non-specific lower back or neck, pain’ and those managing their care will be expected to provide a clear diagnosis and treatment plan. The danger of an approach that doesn’t prioritise relevant anatomical injury is that it can, and has, led to a shift away from the use of some valuable diagnostic tests and interventions. Rather than simply not offering what could well be very useful types of scans, therapies, injection procedures and even surgeries to wrongly homogenized groups of NSBP patients, better outcomes might be obtained by researching and providing specialist services based around practitioners who are able to recognize both psycho-social and patho-anatomical factors in order to direct patients to the most appropriate investigation and treatment.

As pointed out in another recent paper, [2] as the name suggests, ‘bio’ should be at the forefront of a bio-psycho-social approach to managing back injury, particularly in athletes.

Craig Ranson

1.  O'Sullivan, P., It's time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 2011.
2.  Hancock, M.J., C.G. Maher, M. Laslett, E. Hay, and B. Koes, Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2011.