Lower back pain is a common issue among gymnasts, cheerleaders, and athletes who perform repeated lifting, leaning, and twisting. Movements that require spinal hyperextension such as back handsprings and walkovers, and skills that place a lot of force through the spine such as landings and rebounds place significant stress on the lower back. Understanding how to prevent and manage lower back pain is essential for long-term athletic performance and spinal health.
Common Causes of Lower Back Pain
1. Repetitive and imbalanced back movement patterns
This is the most common cause of back pain that I encounter. The spine stays its healthiest when it can move freely and frequently through all ranges of motion. Repetitive flips, landings, and lifting places stress in the low back flexion plane of motion. Repetitive end range hyperextension such as back walkovers and aggressive taps on high bar place stress consistently in back extension plan of motion. Over time the repetition causes pinching and irritation and creates a block to movement.
2. Disc Injuries
Repeated compression of the spine from hard landings or improper technique into a forward flexion or rotation position can contribute to disc-related issues, such as bulging or herniated discs. When symptoms are symmetrical then the bulge is typically posterior. When symptoms are primarily one sided then the bulge is typically posterior and lateral (off to the side). Rarely do bulges occur anteriorly (forward), although it is possible.
3. Lumbar Hyperextension Injuries
Excessive or a sudden severe arching of the lower back (bending backwards) can lead to a stress fracture (spondylolysis) of a vertebrae. When this happens the athlete must avoid end range back extension for a time to allow the bone to heal, then must restore the end range of motion once symptoms are stable.
4. Back Weakness At End Ranges of Motion
Core strength is often completed in close to a neutral position in the back, but sports require wide ranges of spine movement. If your sport requires a lot of forward flexion, then you should strengthen your back through that range of motion. If your sport requires a lot of spine rotation, then you should complete resistance training into those patterns of movement.
Risk Factors for Lower Back Pain
- Frequent Spinal Hyperextension, Hyperflexion, or Rotation: Repetitive and imbalanced movement patterns can overload the vertebrae.
- Back Weakness at End Ranges of Motion: The lower back needs to be strengthened through the ranges of motion it experiences during sports participation.
- Poor Landing Mechanics: Hard landings without proper absorption increase spinal compression.
- Overtraining: Insufficient rest between training sessions can put too much stress on the spine.
- Insufficient Nutrition: Insufficient nutrition between training sessions prevents the spine from fully recovering before more stress is applied at practice.
Prevention Strategies
1. Maintain Full Spinal Mobility Each Direction!
Once a week complete a general range of motion assessment for the low back. And while you’re at it check the range of motion for your neck and mid-back too! Most athletes are the most stiff or lack full range of motion into the extension position. Proper mobility allows for safe movement mechanics and reduces excess stress on the lower back. Athletes should:
- Find a gentle stretch that helps restore any restricted movement directions. Focus on one direction at a time and complete the stretch frequently (1-3 times per day) until range is full and pain free.
- Complete gentle end range mobility into all ranges of spinal mobility once or twice a week if there are no obviously restricted ranges. This helps to maintain mobility and becomes a weekly check to find out if any new restrictions have developed so they can be fixed before they become an issue.
2. Strengthen the Back at End Ranges of Motion
Exact movement patterns to strengthen should be based on the required movement pattern of each athlete’s sport. Additionally, end range of motion strengthening must start gently and get heavier resistance over time. Starting too heavy can cause injuries. However, a good start is to include:
- Reverse sit ups / arch ups (hang over the edge of a block or bench with a teammate holding your legs. Extend your back to lift to a fully extended position).
- Jefferson Curls – First try without weight, then when you’re ready hold weight 5 – 15 lbs and round your back to reach down into back flexion. Repeat 5-15 times or until moderate fatigue.
- Use a resistance band for resisted back rotation. Can be done standing, sitting, or diagonally into any pattern that imitates your sport.
3. Improve Landing Mechanics
Practicing proper landing techniques—such as bending the knees adequately to absorb force and avoid collapsing knees or trunk. Be sure to practice good landing mechanics when momentum is going forward, backward, left, and right. Landings need to be safe no matter the angle an athlete comes down from.
4. Avoid Overuse and Prioritize Recovery
Overtraining can lead to cumulative stress on the spine. Athletes should:
- Vary the focus of movement patterns in training.
- Listen to their bodies and modify training if experiencing discomfort.
- Take rest days every week and a few rest weeks each year.
- Understand the number of calories and carbs they need to stay fueled. Hint: it’s a lot more than the generic recommendation for a non athlete. The true amount varies depending on many factors and seeing a sports nutritionist for guidance is helpful.
Treatment and Recovery
If lower back pain develops, early intervention is key to preventing more serious injuries.
Immediate Care
- Stop, drop, and prop! Most immediate back pain is from a forward strain on the back. Stop what you’re doing, drop on the ground to lay flat and decrease pressure between vertebrae. Lay for 1 minute, then prop on your elbows for 1 minute. Alternate between your elbows and flat for as long as needed, and repeat often through the day of the injury. Hint: In my experience this helps 80-90% of people, but if you experience worsening of symptoms with this sequence then stop.
- Ice or Heat Therapy: Ice or heat can relieve muscle tension and help relieve pain.
- Use KT Tape: Often applying KT tape can help support a better back position, and can help provide pressure over most painful areas which can be a good pain reliever.
Rehabilitation and Return to Training
- Progressive return to full mobility: The biggest art of back treatment is discovering which movements worsen symptoms, and which improve symptoms. There are many variations of back stretches, and not everyone follows the same progression.
- Manual Therapy: Massage or joint mobilization can help provide pain relief and can sometimes speed up recovery.
- Gradual Return to Sport: Reintroduce skills progressively, ensuring proper form and pain-free movement.
Protect Your Spine and Stay Strong
Lower back pain can hinder athletic progress, but with proper prevention and rehabilitation, athletes can stay pain-free and perform at their best. If you experience persistent lower back pain, consulting a sports physical therapist can help you address underlying issues and keep you moving safely.
Need expert guidance? Contact us today for a personalized plan to protect your spine and optimize your performance!