While most occurrences of low-back pain in athletes are self-limited
sprains or strains, persistent, chronic, or recurrent symptoms are frequently
associated with degenerative lumbar disc disease or spondylolytic stress
The prevalence of radiographic evidence of disc degeneration is higher in
athletes than it is in nonathletes; however, it remains unclear whether this
correlates with a higher rate of back pain. Although there is little
peer-reviewed clinical information on the subject, it is possible that chronic
pain from degenerative disc disease that is recalcitrant after intensive and
continuous nonoperative care can be successfully treated with interbody fusion
in selected athletes.
In general, the prevalence of spondylolysis is not higher in athletes than
it is in nonathletes, although participation in sports involving repetitive
hyperextension maneuvers, such as gymnastics, wrestling, and diving, appears
to be associated with disproportionately higher rates of spondylolysis.
Nonoperative treatment of spondylolysis results in successful pain relief
in approximately 80% of athletes, independent of radiographic evidence of
defect healing. In recalcitrant cases, direct surgical repair of the pars
interarticularis with internal fixation and bone-grafting can yield high rates
of pain relief in competitive athletes and allow a high percentage to return
Sacral stress fractures occur almost exclusively in individuals
participating in high-level running sports, such as track or marathon.
Treatment includes a brief period of limited weight-bearing followed by
progressive mobilization, physical therapy, and return to sports in one to two
months, when the pain has resolved.