Athletic Back Pain: Historical and Physical Examination Insights Low back pain is a topic that many professionals in the sports medicine world often feel uncomfortable evaluating and managing.
Athletic Back Pain: Historical and Physical Examination Insights Low back pain is a topic that many professionals in the sports medicine world often feel uncomfortable evaluating and managing. Despite this, it is a common clinical entity that almost everyone, athlete or not, will suffer from at some point in their life. Therefore, it is critical that the sports medicine physician is comfortable with evaluating and managing the athlete with low back pain.
Case Vignette A 23 year old baseball catcher presents to your clinic with acute back pain. He states he was trying to block a play at home plate when he collided with another player. He is having trouble ambulating and has been unable to practice the last few days.
Which of the following symptoms should prompt further investigation rather than standard symptomatic management? A) Pain radiating down the left leg B) Trouble initiating urination C) Exquisite tenderness to paraspinal muscles D) Antalgic gait As with any clinical evaluation, successful treatment begins with a detailed and appropriate history of the athlete’s presenting problem. Warning signs of neurological or organic disease should be identified and rapidly evaluated if warranted as the athlete could develop irreparable damage or even death in certain situations.
This is done by determining the location of the patient’s pain, whether it is midline versus paraspinal versus over the spinal muscles or in other common bothersome areas such as over the SI joints, associated muscles, or related to a hip pathology. Important questions include if radicular symptoms are noted by the athlete, the distribution of the radicular symptoms, associated weakness, if there was an associated injury, and maneuvers that provoke or palliate symptoms. Associated symptoms such as numbness and a brief review of the functional impact on the athlete should also be ascertained.
It is also important to note the age of the athlete as certain age groups are prone to certain types of injuries, such as avulsion injuries which are common to those younger athletes. Once history is completed, a detailed neuromuscular examination should be performed to confirm the postulated cause of low back pain for the patient. As with any musculoskeletal examination, the exam starts with inspection for any bruising or deformity of the involved area- in this case the lumbar spine, buttock region, and hip region.
If you are experiencing symptoms that may be related to important history and physical examination pearls of athletic back pain, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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