Lumbar spine (L-Spine) injuries in football are quite rare with an incidence of 6%. While the rate of injury is relatively low, 36% of players complain about low back pain. This makes back pain almost as common as thigh problems (40%) and even more common than hip and groin pain (24%).Spine injuries and chronic low back pain are responsible for between 15% and 22% of premature career ending in professional football players.
The lifetime prevalence of back pain in youth players already exceeds 40%. While back pain seems to be common in this group, recent data suggest that this rate is lower than the prevalence in school children with low levels of physical activity. As a result, football might rather have a beneficial effect on back pain in childhood.
In this module you will learn about the general role of the lumbar spine in football players from a biomechanical viewpoint. You will review the available clinical assessment and diagnostic tools. You will also learn about the three most frequent pathologies – soft tissue injuries, spondylolysis and problems arising from the intervertebral disc.
Low back pain is endemic in western industrialised countries with a lifetime prevalence exceeding 80%. What is true for the general population also counts for footballers. During one year around 36 % of footballers of different age groups and playing levels complain about an episode of low back pain.5 A genetic predisposition, injuries and muscular imbalances contribute to these numbers. Whereas injuries are rare (8-15.7 % of all injuries), muscular imbalances play a major role. Usually the muscles of the lower extremities are well trained whereas the back muscles as well as the important anterior-lateral abdominal muscle groups are often neglected. Most of the players also show a functional shortening of the psoas muscle. Week abdominal muscles and a short psoas muscle lead to a forward rotation of the pelvis and a consecutive hyperlordosis. This hyperlordosis can be accentuated further when kicking a ball, which in turn exerts a significant stress to the posterior structures such as the facet joints and the posterior part of the disc.
From a biomechanical point of view, the lumbar spine significantly contributes to the stabilisation as well as the flexibility of the trunk. Flexion/extension with a range of motion (ROM) of 70-80° and lateral bending (40-50°) are the main movements which have to be controlled by the active (muscles) and passive (ligaments, joints, discs) systems. Due to the orientation of the facet joints in a more sagittal plane, rotation movements are very limited which also protects the disc from shear forces.
During frequent and abrupt changes in direction, explosive acceleration and abrupt deceleration (which are typical for football), the lumbar spine has to tolerate and control extreme torsional, rotational and translational forces. Even with good muscular performance, there is still a considerable stress on the passive stabilisers such as the discs and the facet joints.6,7
With forceful stop and rotation movements, the compression forces on the lumbar disc can reach > 8600N which is > 60% of the maximum which can be tolerated by a healthy disc. Sagittal shear forces can reach up to 3300N which actually is supra-maximal.
The history should include a description of the athlete’s symptoms. It is important to determine when they started, the mechanism of the injury from the athlete’s standpoint, and how symptoms have developed since the time of injury. Predisposing factors such as a history of prior injury (and treatment) are important. The athlete’s training and performance history before the injury is important as it may highlight risk factors for injury.
An assessment of range of motion and for tenderness is important. Inspect for local signs of direct trauma (contusions, bruises, abrasions, scratches or similar). The presence of a hematoma should lead to further investigations to exclude fractures of the spinous or transverse process, muscle tears or even injuries to abdominal contents (for example a renal injury).