Though it is a common cause of back pain in the adult population, disc injury is relatively uncommon in the young athletic population. Back pain from a disc injury may or may not be associated with sciatica (pain that shoots down the leg). A careful history and examination is very important in determining if a disc problem may be the cause of the athlete’s complaints. Magnetic resonance imaging (MRI) can also be helpful in determining if a disc is a cause for the pain and to rule out other potential causes that may mimic disc injury in an adolescent.
Treatment is similar to treatment of a disc herniation in the adult population. (See the NASS Patient Education Brochure on Herniated Disc for more information about this condition.) Injections (epidurals) can be used but are not necessary in most cases. If symptoms do not improve with a comprehensive rehabilitation program, then surgery may be indicated. This is necessary only in a small percentage of young athletes with disc injury.
Scheuermann’s Disease (juvenile kyphosis)
Another common problem seen in the young athlete with back pain is juvenile kyphosis, known as Scheuermann’s Disease. Pain associated with this occurs during puberty and is in the mid back, rather than the low back. The athlete demonstrates a roundback deformity that worsens to a “dome” appearance of the back with bending forward. Diagnosis is made by X-ray examination that shows at least three consecutive vertebra show a wedging of 5° or more.
Treatment in most cases is aimed at relieving symptoms. Extension-based back exercises and postural exercises are essential. These can provide significant symptomatic relief, but it is important to note that the structural curve cannot be corrected with these exercises. For curves of 50° or greater, bracing can be helpful if the athlete is able to tolerate wearing the brace. For athletes with severe curves who continue to have debilitating pain despite bracing, surgical correction and stabilization may be required. It is important to note that this may limit the athlete’s ability to return to their given sport. As with all spine-based injuries, a complete rehabilitation program is essential prior to return to athletic competition.
