Baby Got Back: Diagnosing and Treating Back Pain

“Oh, my aching back!”

This is a complaint we hear often. In a short column, I cannot go over all the possible causes and treatments. But there are some common reasons for back pain that I would like you to consider when the ache strikes.

As you all well know, trauma to the back from hits, falls, and twisting gives many skaters back aches. Usually, icing and rest will bring prompt relief. Deeper contusions of the back muscles will nag at you for a week or more.

A frequent scenario is the skater with poor core (abdominal) strength trying to skate low, bending at the hips and back instead at the knees and hips with the back relatively straight. The back muscles and ligaments are strained to pain.

A fairly common problem is an increased lumbar lordosis and decreased flexibility of the back ligaments and muscles. Lordosis is the normal slight bow of the lower back to the front. If there is a normal lordosis, when you bend forward and touch your toes, the lower back reverses the curve so the whole back assumes a “C” shape. If the lordosis is not reversible, the ligaments and muscles of the lower back “bowstring,” causing pain. While you can’t change the way your back is built, working on the strength of the core muscles and the flexibility and strength of the back and hip muscles helps.

Abnormal biomechanics of the lower leg, such as knee or foot problems, may cause unusual strains on the back. Dealing with these will generally solve the back pain.

Although skaters are young and healthy in general, we have seen several in our league with herniated disks. Vertebral anomalies and fractures are not common but can result in chronic pain. These problems will likely require x-ray or MRI imaging to find.

Don’t forget, internal abdominal problems can cause pain referred to the back. Common ones are kidney injury or infection and some gyne problems such as endometriosis.

How do you know when to see a doctor?

The answer is simple: if you have recurrent or persistent pain not easily relieved with rest and icing, consult your medical advisor. If you are using pain medication frequently (i.e., several times a day most days), you need medical advice. If you have pain down into your leg or weakness or numbness in your leg or foot, see your doctor. If you have urine abnormalities (pain, blood, foul odor, frequency) along with fever or have gyne symptoms (abnormal periods, abnormal bleeding, pelvic pain), see your doctor promptly.

Specific treatments for each are too complicated to put in a short column. As in most sports, prevention is better than treatment. Work on core muscles and back flexibility and strength before you develop pain. For the skating position and technique, your coach or trainer should be able to help. In the case of an abnormal back structure, much of the treatment involves physical therapy measures along with icing and some pain medications. Some problems will require an orthopedist to diagnose and treat.

Remember, back pain is not a price you should pay for skating - dues are bad enough.