CAUSES OF LOW BACK PAIN AMONG VOLLEYBALL PLAYERS

Jonathan C. Reeser, M.D., Ph.D.,

Chair, USAV SMPC

Department of Physical Medicine

Marshfield Clinic

Imagine for a moment that you are a contestant on "Who Wants To Be A Millionaire?" You've studied your trivia for weeks in anticipation of the big moment when Regis asks the first "fastest finger" question...and here it is: Place the following four body parts in the order of frequency of injury among volleyball athletes.

A. Low Back B. Ankle C. Knee D. Shoulder

How did you do?

You can check your answers at the end of this article.

But first, let's discuss the subject of this article - low back pain. Are you surprised that low back pain is even on the list? Consider this: according to data compiled by the NCAA Injury Surveillance System, low back injuries account for between 7-11% of all time-loss injuries among women collegiate volleyball players. Some studies suggest that the incidence of back injuries among volleyball players might be even higher, particularly among elite level athletes. Why?

The "low back", like other parts of a volleyball player's body, consists of several different anatomic components designed to work together to perform a function. The lumbar spine (consisting of five vertebral bodies, the intervertebral discs which cushion them, and the accompanying ligaments and muscle/tendon units that provide stability and motion) serves as the "load bearer" for most of the body's weight as it moves in space. Walking, running, and jumping all produce considerable force that is transmitted through the lumbar spine. For volleyball players the lumbar spine plays an important role in generating and transmitting the force necessary to spike or serve. By arching the back prior to contact with the ball, then rotating and flexing forward at the waist at the moment of contact and during follow through, a spiker or server generates energy which is transmitted through the spine to the hitting arm and ultimately to the volleyball.

Given all that it is asked to do, it is perhaps no surprise then that injuries to the lower back are in fact quite common, not only among volleyball players but in the general population. It is estimated that more than 80% of all Americans will suffer at least one episode of back pain at some point in their lives. Most of these episodes are brief ones and do not require medical intervention. However, volleyball athletes may have an increased risk of back injuries because of the repetitive and excessive loading of the spine that is a natural part of the spiking action. Because of the many different tissues involved, the "differential diagnosis" of back pain among volleyball players is quite broad. In addition to relatively simple muscle strains and ligament sprains, trainers and volleyball team physicians should have a high index of suspicion for injuries to the intervertebral discs, as well as to the "posterior elements" of the lower lumbar vertebral bodies. This later condition, known as spondylolysis, represents a bony "stress fracture" which can occur on one or on both sides of a lumbar vertebral body (typically L4 or L5).

The clinical symptoms of spondylolysis include localized low back pain, which typically worsens with trunk extension (bending backwards). The injury is thought to occur due to repetitive trunk extension, flexion, and rotation - all of which place considerable stress on the bony components of the spine. Xrays, and possibly a bone scan or a magnetic resonance imaging (MRI) study of the lumbar spine, are helpful in confirming the diagnosis. Treatment of acute spondylolysis typically consists of restricted activity ("relative rest") to avoid provoking symptoms, an exercise program to improve lumbar stability, and may include several months of bracing. An appropriate rehabilitation program should emphasize trunk and hip girdle strength and flexibility, allowing the athlete to resume playing once he or she can once again perform volleyball specific skills in a pain free manner.

Thus, while not as commonplace as ankle injuries, low back pain does occur quite frequently among volleyball players. If you should experience an episode of back pain that does not resolve promptly on its own, seek out the advice and care of an athletic trainer or physician familiar with volleyball related injuries. Of course, the optimum treatment of any back injury is prevention. Maintaining flexibility, (particularly of the hamstrings and hip girdle musculature), and strength (particularly of the abdominal muscles) are the keys to withstanding the demands of the sport and preserving a healthy back.

(The correct answer to the question is B - C - D - A.) Did you get it right?

Let's review the answers. Most of you probably knew from personal experience - or from reading earlier issues of "Volleyball USA" - that ankle sprains are the leading volleyball related injury. Next come knees and shoulders, which also seems logical...volleyball athletes routinely overuse their shoulders through repetitive spiking, and "jumper's knee" is another common ailment treated by trainers and physicians who care for volleyball players. Which brings us back to number four on the list...the low back.)