Low back pain is common in a lot of athletes. However, what is causing that low back pain can involve a multitude of functional issues. In this blog, we will discuss:
• What are common causes of low back pain in competitive athletes?
• What are some common mistakes seen in treatment for athletic injuries?
• What types of treatment are used at IHS for athletic injuries?
• A recent case of a baseball player with low back pain
1. What are common causes of low back pain in competitive athletes?
With over 30 years of combined experience at IHS, we have found that due to the competitive nature of athletes, playing through an injury can lead to issues down the road. Typically, return- to-play in a haste is the goal of the athlete. This is where muscle imbalances develop, compensations are made, and injuries result.
The most common cause of low back pain we see is a sprain/strain situation. Most people think of a sprained ankle or sprained wrist when they hear sprain strain. However, the back is comprised of numerous muscles, ligaments, and tendons that can also experience micro- tears and insult, leading to a sprain/ strain type of injury.
As this happens, and the athlete continues to compete, the healthy musculature will soon take over the task that needs to be completed, eventually resulting in an overuse injury and compensations.
An analogy to start off with would be a soda pop can. When the can is full, it is not crushable. When the can is empty, it can easily be crushed. This is the same when it comes to your core. Your core is not just a six pack of abs on the front of your stomach, it is the entire 360 degree area from shoulders to glutes.
If this area is not supported by intra-abdominal pressure (IAP), then muscles have to stiffen or compensate to keep your spine upright, otherwise we would flop all over the place.
Disrupting the breathing pattern leads to a shallow breath, lack of IAP, and can result in low back pain.
In our experience, it is common for a patient to immediately think a disc injury has occurred when there is low back pain present. A typical disc injury in your low back involves pain, shooting/numbness down the legs, and sometimes weakness.
Often, disc injuries are benign and happen more frequently than what we think. Surprising to many, disc injuries can be asymptomatic, meaning that they do not cause any of the symptoms listed above. In other words, discovering you have a disc injury should not lead you to think you will always be in pain.
That being said, should the disc be the root cause of your issues, conservative care can help return you to health, without any surgery necessary.
2. What are some common mistakes seen in treatment for athletic injuries?
At IHS, we focus heavily on functional assessments to guide us through our treatment plans. Too often are ice and stretching the number one focus for treatment in athletes.
While ice numbs the pain and temporarily reduces inflammation, recent studies actually show that ice delays the healing process by restricting blood flow. Blood flow is needed for healing, if it is restricted, it will take longer for the tissue to heal.
A sprain/strain, as mentioned before, is a tear in tissue. Stretching a tear is not going to heal tissue, again, it will more so be a temporary relief mechanism. It is important to decipher what the injury is, how it was caused, and correct the faulty movement pattern. Addressing the particular type of tissue may mean that rehab should focus on load, or possibly strengthening, or breaking it all the way down to the basics of core stability. Without a proper functional assessment and thorough history taking, it is extremely difficult to properly manage an athlete’s injury.
3. What types of treatment are used at IHS for athletic injuries?
Functional Dry Needling
We implement a medical approach to dry needling in order to stimulate blood flow to the injured area as well as to reduce inflammation. Each time a needle is inserted, up to 10,000 cells are damaged. Your brain senses this insult and begins the healing process to regenerate fresh, healthy tissue. This is no different than when you fall and scrape your knee, a scab forms as your body’s way of healing the insult it experienced. Dry needling not only leads to healed tissue, it causes pain relief, both short term and long term.
Soft Tissue Therapy
Soft tissue therapy typically follows dry needling. This can be in the form of Gua Sha for lymph flow and fiber alignment, or a form of active release where the chiropractor will use pressure as well as patient passive or active movements to further help elongate the fibers and heal the tissue.
In other words, the adjustment. The restrictions that are still present following dry needling and soft tissue therapy will be manually manipulated to improve joint health and range of motion. Manipulations at IHS are performed with high velocity, and low amplitude, to provide pain relief without heavy force.
We focus on the principles of Dynamic Neuromuscular Stabilization (DNS). DNS has been clinically proven to help reintroduce global stability to the body for optimal tissue health. The functional rehab portion is the portion that empowers the patient not only to expedite the healing process, but also to have options for how to self-manage the problem in the future. Each rehab protocol is tailored to the individual depending on what is found in the exam.
Our clinic is different than the traditional chiropractic clinic. We spend, on average, 40 minutes each treatment session with the patient in order to provide optimal, well-rounded care. We pride ourselves on returning each individual to an active, pain free lifestyle.
4. A real life case involving a college baseball player who presented with low back pain
Jeremy, a 19 year old baseball player, was in town for the summer for a summer baseball league. He has been competing almost daily in order to gain the attention of college scouts.
He called in on a Thursday afternoon for an acute onset of low back pain. He was lifting at the gym the day prior and felt a sudden back spasm that caused his back to lock up. As a result, he was unable to play in his summer league Thursday, causing him to miss scouting opportunities.
Upon digging deeper, Dr. Jen found out Jeremy had mild pain begin 2 weeks prior, also while lifting normal weights and performing movements that he is used to. He continued to lift weights and play baseball, like most athletes do, despite the “tweak” in his back.
On exam, Jeremy had difficulty flexing forward and extending backwards. This is common with a muscle strain since these movements involve use of the tissue that is inflamed and in protective mode, causing pain when used.
What stood out more was the instability Jeremy had with single leg stance. He then displayed a pattern of extreme right foot external (outward) rotation when assessing a body weight squat as well. These patterns repeated overtime can lead to low back pain. Each step we take is a single leg movement. Each time we reach down to tie our shoe, a squat is involved. Repeatedly performing movements without internal stability leads to “the final straw.” This is the body’s way of letting us know something is wrong, by giving us pain so that we no longer use the misused or injured tissue. This is how our body protects us from potential further injury.
Treatment began with dry needling and soft tissue work to begin to tackle pain relief. Pain is the last symptom to come to alert the body that something is “off.” However, it is also the first thing to go. In order to prevent continual recurrence of low back pain, further treatment is needed. Following soft tissue therapy, a light adjustment to help with thoracic extension (found lacking on the exam) was performed. The visit ended with ergonomic queues and more importantly, how to belly breathe to start right away on introducing stability. Jeremy experienced immediate relief following his first visit.
After a few more visits, Jeremy was completely resolved of pain. At our clinic, that is not enough. We want to address the functional root cause so that patients do not experience chronic recurrences of pain.
After introducing multiple progressions of dead bug, bird dog, side bridge, tripod, and more challenging DNS-focused rehab, we re-assessed Jeremy’s squat. There was still mild right foot external rotation. So we delved deeper into foot mechanics, ankle mobility, and full body stability.
Foot rehab included tri-planar positioning, great toe raises, intrinsic foot engagement, mobility rehab, and how to adapt a squat form that will keep the body in optimal position not only for increased strength but ultimately for pain free range of motion.
Jeremy completed care in 7 visits and demonstrated full understanding of the importance of what his visits have entailed, to continue to progress in his athletic career as a baseball player.
This blog was intended to give a quick glimpse at the thought process we have been trained many years to develop, in order to give a well-rounded approach to patient care. We pride ourselves on returning patients to an active, pain-free lifestyle, in a short-term treatment plan.
Each visit with the above patient involved at least 40 minutes of hands on treatment, fully dedicated to returning Jeremy to his baseball career, healed and empowered to manage his low back on his own.
Focusing on long-term health rather than quick relief with ice or stretching is important when formulating a treatment plan. Not only do we want to get rid of pain, but we also want to restore function so pain does not return.
Disc injuries, sprains, strains, and many other injuries are able to be conservatively managed when the focus is on the patients health and the time needed is dedicated to give patients well-rounded care. Dry needling starts the healing process by establishing blood flow and reducing pain. Soft tissue therapy further helps with tissue alignment and pain relief. Manipulations allow for proper joint mobility for improved range of motion. Functional rehab helps to establish and to reinforce the movement patterns and stability we need to live pain free. This is a complete treatment that has helped many patients here at IHS.
There are times where patients ask “do I have to do the full treatment?” Our response is always, absolutely not, you are never forced into any service. However, we have such high success rates due to the value we give to each patient by treating every aspect of dysfunction present, ensuring we provide the absolute best care, without taking shortcuts.
When it comes to athletic injuries, we have experienced a vast amount of cases. We have treated shoulder impingements, neck injuries, upper crossed syndrome, golfer’s elbow, tennis elbow, carpal tunnel, TMJD, rib irritation, low back pain, lower crossed syndrome, sciatica, disc lesions, knee pain, torn meniscus, sprained ACL, MCL, PCL, LCL, ankle sprains, plantar fasciitis, headaches, and many more.
If you feel like your pain is normal and “just a part of you” call us today to see how we can help. Our goal is to get you to a pain-free active lifestyle. We encourage patients to stay moving, stay healthy, and enjoy life!
Questions on how we can help? Call us for an exam and consult today!
Content provided by Dr. Jen Brenneisen
Disclosure: Jeremy gave his full consent to have his name and case used in this blog post.