Low Back Pain in Athletes: Physiological and Psychological Considerations

For 80% of people, an episode of low back pain (LBP) occurs at least once during the lifespan,⁽⁴⁾ and about 38% of people have an episode once a year.⁽²⁾ However, certain populations experience LBP differently. LBP in athletes is a serious condition related both to acute traumas (with nearly 5-10% of all athletic injuries related to the lower back) and injuries from repetitive heavy activity.⁽⁴⁾ As in the non-athlete population, LBP in athletes is a serious issue, causing between 13.7 to 25.6 missed days of training a year.⁽²⁾ 

Though the condition is complex, several studies help clarify what causes LBP in athletes and what may help athletes improve. The importance of muscle strength in LBP indicators and treatment is similar in athletes and non-athletes, as Catala et al. found. Their 2018 study compared two groups – one with LBP and one without – composed of subgroups of non-athletes and athletes. Participants performed maximal isometric trunk flexion and extension (involving the lumbar extensors) contractions to determine muscle strength, and researchers measured their trunk stiffness, trunk damping, and trunk muscle onset times as participants performed repetitive lifting movements requiring dynamic stability. Researchers found that both athletes and non-athletes with LBP had lower maximal trunk extension (indicating lower muscle strength), higher trunk damping, and shorter trunk muscle onset times than did athlete and non-athlete participants without LBP.⁽¹⁾ The results indicate that the muscles involved in back pain were deconditioned in athletes with LBP, and they imply that treatments focusing on training these extensor muscles are important for non-athletes and athletes alike.

Another important aspect of bringing clarity to treating athletes with LBP is understanding how athletes as a population subjectively experience and live with their pain. In their 2016 study, Heidari et al. focused on comparing LBP pain intensity, disability, and duration scores from both athletes and non-athletes with LBP. Using data from 276 participants, researchers found that athletes and non-athletes had comparable scores for LBP pain duration and intensity. However, athletes had lower scores on work-related disability. Athletes also had less LBP-related impact on their training volume than did non-athletes.⁽²⁾ While researchers considered the possibility of different definitions for “work” that may have affected their work disability scores,⁽²⁾ their study does not explain why athletes’ training volume and perceived work disability associated with LBP differ from non-athletes’. They do, however, indicate that these results should show clinicians the importance of approaching treatment programs for athletes differently than they would non-athletes.⁽²⁾ 

A 2019 study by Konietzny et al. examined the elevated risks of athletes to become depressed or even suicidal in response to LBP. Their study noted the research describing the elevated risks of athletes in pain to become depressed or even suicidal. Their hypothesis imagined that pain-related thought-suppression (PTS) – a cognitive strategy of avoiding thoughts about the pain one experiences – explains both a) why athletes with LBP endure their pain without avoiding as much sport activity as non athletes and b) athletes’ elevated risk for depressed mood when suffering from LBP. Their study indeed found that habitual PTS and chronic daily life stressors contributed to risk of depression and suggested that reducing PTS and stress levels could reduce depression in athletes with LBP.⁽³⁾ These results indicate that even though athletes’ report less disability associated with LBP than non-athletes, some methods of enduring LBP contribute negatively to the wellbeing of athletes. Clinicians should use this information to inform the way they treat and measure the health outcomes of these athletes.

O’Sullivan et al. (2019) outline for clinicians some implications of the research on physiological and psychological factors of LBP in athletes. They encourage those treating these athletes not to discourage them from participating in necessary sporting activities and to keep the athletes as active in pain-free zones as possible. They also urge clinicians not to ignore non-physical factors of LBP by avoiding giving athletes the impression that they should perform certain rehabilitation activities because they are ‘vulnerable’ and instead promote rehabilitation exercises as methods to improve their resilience, make them more robust, or improve their physical and psychological readiness. Paying attention to athletes’ sleep, energy, mood, and soreness are also important, they argue, for providing data on the athlete’s nervous system that could be useful in providing them with opportunities to optimize their health.⁽⁵⁾ These emphases on empowering athletes both physically and psychologically in treatment of LBP are useful suggestions to physicians treating athletes who seek health outcomes of wellbeing as well as sports performance and physical ability.

Esurgi’s Biostabilizer is a product designed with empowerment and rehabilitation in mind. The device is a Pressure Biofeedback Unit (PBU) which gives real-time feedback on a digital interface to users performing rehabilitation exercises. Its fast, one-button setup enables physical therapists in the clinic and their patients at home to quickly learn how to properly engage core muscles to stabilize the spine. How could a PBU help your athletes feel in control of their LBP treatments while remaining active and pain-free? 

Sources:

1. Catala, M., Schroll, A., Laube, G., Arampatzis, A. (2018 July, 03). Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population. Frontiers in Neuroscience 12(436). https://doi.org/10.3389/fnins.2018.00436. 

2. Heidari, et al. (2016 June, 16). Low back pain in athletes and non-athletes: a group comparison of basic pain parameters and impact on sports activity. Sport Sciences for Health 12, 297-306. https://doi.org/10.1007/s11332-016-0288-7. 

3. Konietzny, et al. (2019 March, 01). Depression and suicidal ideation in high-performance athletes suffering from low back pain: The role of stress and pain-related thought suppression. European Journal of Pain 23(5), 1196-1208. https://doi.org/10.1002/ejp.1387. 

4. “Low Back Pain in Athletes.” (2003). Low Back Pain in Athletes. University of Maryland Medical Center. https://www.umms.org/ummc/health-services/orthopedics/services/spine/patient-guides/low-back-pain-athletes. 

5. O’Sullivan, K., O’Sullivan, P., Gabbett, T., O’Keeffe, M. (2019 March). Advice to athletes with back pain – get active! Seriously? British Journal of Sports Medicine 53(5), 324-25. http://dx.doi.org/10.1136/bjsports-2018-099670.