Low Back Pain and the Athlete

In the general population, low back pain is the number one cause of missed workdays. Back pain affects the athletic population too. Although, we are not sedentary individuals who may hurt the back because of deconditioned bodies, we do ask much of our bodies in training and competition. Sometimes, we may strain the low back because the tissues are not ready for, or made to do the things we ask of our bodies. Back pain will continue to be prevalent in sports, but there are many simple things an athlete can do to prevent and alleviate back pain.

A triathlete spends many hours in the saddle with the back in a flexed position. This position puts much stress on the lower part of the spine especially the intervertebral disc. An analogy can be made with office workers. It has been shown that spending hours seated at a computer can precipitate back pain. Triathletes and cyclist are also at risk for back pain due to this stationary position in the saddle. It is therefore important to build extension exercises into a preventive program. This can be simply done by lying on the stomach and propping the elbows underneath the chest. Hold this position for 3- 5 minutes. To make the exercise more dynamic, simply press the chest away from the floor and hold for 5 seconds. Do 10 repeats of the exercise.

Hours of training also leads to tight muscles. The cat /camel stretch, prayer stretch and hamstring stretching are crucial to preventing low back pain. To perform the cat/camel stretch, attain a hands and knees posture then alternate arching your back toward the ceiling and then pushing your stomach toward the floor. Hold each posture 5 seconds and perform 10 times. Start the prayer stretch by sitting on your knees and placing a pillow on the back of your heels. Next, sit back on the pillow and at the same time reach your arms to the floor and push them forward till you feel a stretch in the low back. Hold for 5-10 seconds and do 10 repeats. Hamstring stretches are safely done by sitting against a wall with the legs stretched in front of you and then reaching gently for your toes till a stretch is felt on the back of the thighs. Hold for 10 seconds and do 10 repeats. All of the above stretches should be performed slowly and rhythmically.

The last piece of the puzzle is to strengthen the appropriate muscles. Many athletes have strong abdominal muscles and trunk muscles. But often, specific muscles that are needed for a stabile and pain free back are neglected. The deep layers of the abdominals, transversus abdominus, and a group of intersegmental spinal muscles, the multifidii, are very important for trunk stabilization. Physical therapists utilize a system of strengthing called lumbar stabilization exercises to target these “core” muscles.

To start a lumbar stabilization program, start by learning to co-contraction these two muscle groups. Lie on the back with the knees bent, then draw the naval toward the spine and hold the muscle contractio. Perform a 10 second hold and repeat 10 times. Once you master this simple exercise you can increase the level of difficulty by adding arm and leg motions such as alternately lifting the opposite arm and leg slowly while holding the contraction. This can be progressed to alternately lunging the legs while on your back or you can perform double and single leg hip lifts. These exercises can be performed on a stability ball once the floor exercises are no longer challenging.

An advance lumbar stability program is beyond the scope of this article. But, if you are ready to be challenged, most physical therapists or athletic trainers with a sports background can take you through a tough core workout to build the muscles necessary to support the spine. By putting a little extra time into “core” workouts your spine will be able to withstand the rigors of your sport and keep you on the competitive field.

Steve Elton is a physical therapist, strength and conditioning specialist and triathlete. He received his MS from the University of South Carolina and holds certifications through the NSCA, NASM. Steve is a former elite triathlete with racing experience from sprint to Ironman distance.