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Back Pain in Athletes

Dr. Lawrence is Resident, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT. Dr. Greene is Chief Resident, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine. Dr. Grauer is Assistant Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lawrence, Dr. Greene, and Dr. Grauer.

Reprint requests: Dr. Grauer, Department of Orthopaedics, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT 06510.

The athlete with back pain presents a clinical challenge. Self-limited symptoms must be distinguished from persistent or recurrent symptoms associated with identifiable pathology. Athletes involved in impact sports appear to have risk factors for specific spinal pathologies that correlate with the loading and repetition demands of specific activities. For example, elite athletes who participate in longer and more intense training have higher incidence rates of degenerative disk disease and spondylolysis than athletes who do not. However, data suggest that the recreational athlete may be protected from lumbar injury with physical conditioning. Treatment of athletes with acute or chronic back pain usually is nonsurgical, and symptoms generally are self-limited. However, a systematic approach to the athlete with back pain, involving a thorough history and physical examination, pertinent imaging, and treatment algorithms designed for specific diagnoses, can facilitate symptomatic improvement and return to play. There are no reliable studies examining the long-term consequences of athletic activity on the lumbar spine.

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