Central Texans have joined millions of kids who now play organized sports. The National Institutes of Health estimates about 30 million children and adolescents are playing some form of sports across the nation. With the increase in the number of players, sports injuries also have increased. While only a small percentage are serious, sports injuries now account for about one out of every five visits to the emergency room in the under-25 age group.

"Young athletes are typically well-conditioned, have better flexibility and higher pain thresholds than the average person and typically don't tolerate limitations on their activities very well," says pediatric sports therapist Christine Scott, PT, Cert. MDT who works often with children who have back pain, including young athletes, at Dell Children's Medical Center of Central Texas. "That's true of young athletes no matter what sport they play."

Back pain occurs in 20 to 50 percent of children and adolescents in the general population and about 30 percent of athletes. It can be caused by a variety of factors, including lack of conditioning, poor posture, repetitive motions - particularly bending and lifting - and trauma. Many young people develop back pain from hauling around backpacks filled with heavy books, generally slung over one shoulder.

"One reason back pain sometimes affects athletes more is because they have a higher pain threshold. They ignore warning signs and often enter a competitive event with pain, then keep playing because they want to win," continues Chris. "Pain can be worsened by the additional pressures and stresses placed on the body from twisting, turning or impact. Quick turns and cutting can affect the entire body."

Athletes involved in impact sports also have risk factors associated with loading and repetition demands. "The good news is that recreational athletes may be protected from back injuries through improved physical conditioning," adds Chris. "The bad news is that elite athletes with longer and more intense training schedules are more likely to suffer from degenerative changes in their spine."

Sports injuries of the spine generally occur as the result of trauma (a single blow or a twist that causes a strain, sprain or fracture) or overuse (repetitive movements that can cause inflammation or stress fractures).

Risk Factors for Back Injury in Young Athletes

"Certain factors - including both conditioning and behavior - make it more likely a young athlete will suffer from back injury," adds Chris. "Poor conditioning, flexibility or excess body weight can be contributing factors." Other risks to watch out for include:

• Prior back injury
• Decreased flexibility
• Excessive or repetitive axial loading
• Poor playing technique
• Abrupt increases in training

Mechanical Back Pain Is Most Common

"About half of all adolescent back pain is mechanical. Sprains and strains are most common, resulting in muscle or skeletal pain. Disc herniation can also be possible," continues Chris. "Young players often ignore warning signs, including generalized low back pain, twinges or sciatic pain (numbness or tingling in the buttock or leg), but they kept going. They may not perceive it as serious or even as back pain, but instead think it is a hip or leg injury." Signs and symptoms to watch for include:

• Acute pain, which is the greatest in the first 24 to 48 hours
• Chronic pain, which is gradual in onset and lasts longer
• Pain that changes with position
• Pain that can be changed with repetitive movements or activities.

"Pain that doesn't go away, severe numbness or tingling, pain that is worse at night or severe symptoms such as loss of bladder or bowel control may signal some other cause."

Treatment for Mechanical Back Pain

Common treatments include:

• Rest
• Improving posture
• Developing good body mechanics
• Core strengthening exercises
• Training for proper playing technique
• Some physicians prescribe anti-inflammatory medications

"No one exercise works for everybody," says Chris. "Treatment must be based on an individualized physical assessment and evaluation.

Treatment goals

"The goals for treating back injuries in young athletes include restoring full range of motion, developing good core strength and achieving normal leg flexibility (especially hamstrings and hip flexors). Young athletes often cause themselves more pain because they want to keep playing. Most are able to return to play if they have been pain free for one week at a regular activity level," says Chris. "Just watch out for repetitive injuries that can occur during drills or with intense practicing."

"Smart training will help young athletes prevent back injuries and pain if special attention is focused on a conditioning program, proper posture, good body mechanics. Warm up adequately before games or practice and make sure to cool down. For the most part, sports and athletics are good for overall health and the benefits far outweigh the risks."

Christine Scott, PT, Cert. MDT
Dell Children's Pediatric Therapy Program

Dell Children's Pediatric Therapy Program is a special place for children that offers evaluation and treatments to enable them to reach their full potential, physically, cognitively and socially. We treat both inpatients from Dell Children's and outpatients, upon referral from local pediatricians and specialists.

Dell Children's physical rehabilitation department is equipped with enhanced space and equipment. The new sensory gym offers large, wide-open floor spaces for both indoor and outdoor therapy. The rehabilitation therapy pool is custom-designed to challenge both neuromuscular patients and athletes with sports injuries. It has a variety of depths that range from six inches to six feet to accommodate children of all heights.

Learn more about sports safety in the Dell Children's Health Encyclopedia.