Case Summary: Professional Athlete with low back pain & possible stress fracture

Posted Oct 4, 2017 by Pinnacle Spine & Sports

These case summaries are examples of real people treated here at the clinic (names changed for privacy). They are not an exhaustive study of the whole condition, merely an opportunity for you to see the sort of things that we have been able to help with in the past, and how we may be able to help you if you’re suffering a similar condition.

“As a professional athlete, I can’t have back pain like this slowing me down. My performance and livelihood are on the line.”

James (name changed for privacy), a 25 year old professional A-League footballer (soccer player) presented to clinic with a 2-3 week history of lower back pain and stiffness. It had been bothering him on and off for the past few weeks and noticed it seemed to affect his professional performance. The pain seemed to be located on the lower right side but often travelled to the left side. James was concerned that he may have been suffering from a possible stress fracture due to the high intensity nature of his training and performance regime. He commented that he wanted to sort it out so he can return to full performance without pain and awareness of his back pain. James also admitted to taking over the counter pain killers and anti-inflammatories when the pain was at its worst, to help sleep and relax while recovering between training and competition days.

James trains two sessions a day, 4-5 days per week during the off season which he was currently in at the time of consultation. The two sessions are usually split into a gym work/weights training then on field squad training. Due to the professional level of James’ sporting participation he described his intensity of training as very competitive and often gets “knocks and bumps” but has not sustained any recent serious injury.

This was the first time James had experienced this pain and reports he woke one morning with excruciating back pain. He was unsure as to what may have caused this episode but reported that it had been bothering him ever since.

The pain was described as a dull muscle like pain which was hard to pin point, except when extending backwards. This seemed to aggravate the pain and cause it to become sharp and more localised to the right side. It stayed within the lower back area but varied in intensity from 2-3/10 to 7/10 post exercise and with movement. James was in unremarkable health otherwise. He commented the only notable thing was that he had recently been suffering from a chest infection which cleared up after a single course of antibiotics.

Examination

Safety tests were all negative (showed no issues). All neural tension tests were negative ruling out any disc or neural pathology. Lower limb strength tests were extremely strong and deep tendon reflexes were unremarkable. Observation revealed a slight anterior pelvic tilt indicating tight lower back and hip flexor muscles. The mid to lower back paraspinal muscles were also noticeably tight and enlarged. Routine orthopaedic testing revealed that the primary source of pain was in the right sided mid-lower back facet joints, likely sustained from repetitive high impact weight bearing activity.

Treatment

A trial of treatment at 2 visits a week was warranted for 3-4 weeks, dependent upon responsiveness. If no favourable results were seen in this period it was explained to James that we would likely refer him for diagnostic imaging to rule out any unlikely serious causes.

Initial treatment consisted of deep muscle release of the mid-lower back paraspinal and gluteal muscles on both sides, however focusing slightly more on the right side. There were a few areas of marked spasm, trigger points and tenderness. These were the areas initially focused on. The muscle release techniques were quite sensitive to James but he reported an immediate sense of relaxation to the lower back area. It was also made evident during these releases that James had widespread muscle tightness from consistent physical activity. Passive stretches of the hamstrings, hip flexors and gluteals were performed. Pain away heat cream was then rubbed into the lower R sided paraspinal muscles to help with post treatment tenderness and reduce present muscle tightness and spasm.

Adjustments

Thoracic extension adjustments were performed with an instant improvement in range of motion and reduction of stiffness. Lumbar spine rotational and sacroiliac extension adjustments were also performed on both sides also with an immediate improvement in mobility and reduction of stiffness. The tight spasming lumbar muscles immediately felt looser and were less noticeable while the patient was sitting up. James felt great following the initial treatment. He commented that he could feel slight tenderness on the muscles we focused but was extremely happy to have some relief.

Due to the professional nature of James’ life, scheduling appointments was an issue due to interstate travel and training commitments. We were able to book James in for a follow up in a week’s time.

Upon presentation for follow up treatment James reported that at only one or two occasions did he feel his back pinch and tighten up during competition games. Specifically, when landing after jumping for a ball. This was a huge improvement as it was bothering him quite consistently before seeking treatment. We continued to focus on releasing and lengthening the spasming paraspinal and gluteal muscles whilst improving lumbar and thoracic mobility with specific adjustments aimed at these areas.

Treatment was aimed to be continued twice a week for approximately 3 weeks with the occasional interruption to the schedule due to his sporting commitments. James reported that his lower back was no longer jamming up and the pain was basically completely resolved. He was able to participate and compete without pain or apprehension.

James was advised to continue treatment with the goal of preventing the issue from recurring. When in Sydney James calls and books in for appointments with the goal of maintaining mobility and functioning of his body.

By Grant Colombo, chiropractor