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Lower back injuries more common in young athletes who focus on sports, Loyola study finds

MAYWOOD, Ill. – Lower back injuries are the third most common injuries suffered in athletes under age 18, according to a study presented by Loyola University Medical Center Sports Medicine physician Neeru Jayanthi, MD.

Many injuries are severe enough to sideline young athletes for one to six months and put them at future risk for long-term back problems.

Jayanthi presented findings Oct. 28 at the American Academy of Pediatrics National Conference and Exhibition in Orlando, Fla.

The study included more than 1,200 young athletes who suffered 843 injuries. Lower back injuries accounted for 127 injuries (15.1 percent of the total). The only injuries more common were knee (31.1 percent) and ankle (16 percent). Other common injuries included head injuries and concussions (13.4 percent), shoulder (10.7 percent) and hip (6.4 percent).

Another 61 percent of back injuries were less serious, such as injuries in the lumbar facet and sacroiliac joints. But 39 percent were serious, including stress fractures and complications of stress fractures such as spondylosis and spondylolisthesis.

“If a young athlete has lower back pain for two weeks or longer, it is imperative that the athlete be evaluated by a sports medicine physician,” Jayanthi said. “If a serious injury such as a stress fracture is not properly treated and does not heal properly, the athlete could be at risk for long-term back problems."

Jayanthi said young athletes are at risk of back injury from hyperextension (arching of the lower back) and other improper techniques. Insufficient strength of the abdominal and back extensor muscles also may contribute to injuries. The greatest risk appears to be the amount of intensive training done by a developing young athlete.

The study found that young athletes with lower back injuries tend to spend more time playing sports than other kids who were injured. Those with back injuries spent an average of 12.7 hours per week playing sports, while the average for all kids who were injured was 11.3 hours per week, said study co-author Lara Dugas, PhD.

Between 2010 and 2013, Jayanthi, Dugas and colleagues at Loyola and Lurie Children’s Hospital of Chicago enrolled athletes ages 8 to 18 who had come in for sports physicals or treatment for injuries. Researchers are following each athlete for up to three years.

The study confirmed preliminary findings, reported earlier, that specializing in a single sport increases the risk of overall injury, even when controlling for an athlete’s age and hours per week of sports activity. "We should be cautious about intense specialization in one sport before and during adolescence,” Jayanthi said.

Jayanthi offers the following tips to reduce the risk of injuries in young athletes:

  • If there’s pain in a high-risk area such as the lower back, elbow or shoulder, the athlete should take one day off. If pain persists, take one week off.
  • If symptoms last longer than two weeks, the athlete should be evaluated by a sports medicine physician.
  • In racket sports, athletes should evaluate their form and strokes to limit extending their backs regularly by more than a small amount (20 degrees).
  • Enroll in a structured injury-prevention program taught by qualified professionals.
  • Do not spend more hours per week than your age playing sports. (Younger children are developmentally immature and may be less able to tolerate physical stress.)
  • Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play.
  • Do not specialize in one sport before late adolescence.
  • Do not play sports competitively year-round. Take a break from competition for one to three months each year (not necessarily consecutively).
  • Take at least one day off per week from training in sports.

The current study was funded by two research grants from the American Medical Society for Sports Medicine. Jayanthi is a member of an AMSSM committee that is writing guidelines on preventing and treating overuse injuries in young athletes.

Jayanthi is medical director of Primary Care Sports Medicine at Loyola. He is an associate professor in the departments of Family Medicine and Orthopaedic Surgery & Rehabilitation at Loyola University Chicago Stritch School of Medicine. Dugas is a research assistant professor in Loyola’s Department of Public Health Sciences.

Other co-authors are Cynthia LaBella, MD, and Brittany Patrick of Lurie Children’s hospital. Loyola medical students and research assistants who assisted in the study are Dan Fischer, Courtney Pinkham, Erin Feller and Peter Linn.
The study was originally supported by Stritch School of Medicine's Student Training in Approaches to Research (STAR) program.

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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