Lower back pain is one of the most common complaints amongst athletes and recreational players in overhead sports. Have you felt increased stiffness in your back while tennis serving? Or perhaps you’re a fast bowler and noticed that you’ve been pulling up sore after matches? Lower back pain in overhead sports can present in a variety of ways (stiffness, soreness, pinching, and more). It’s important to know what's going on, to prevent more serious injuries.
Let me introduce myself, my name is Molly and I completed my PhD exploring the causes of low back pain in elite adolescent tennis players. I’ve spent the last 8 years as a sports scientist working with a variety of overhead sports helping athletes to optimise their techniques and prevent injury. Most recently I both studied and worked at Tennis Australia servicing our professional players in a variety of ways. My work spanned from 3D serve analysis to racquet fitting and customisation (like a bike fit – but fitting the racquet to the player). During my time with tennis, something I noticed was the hesitancy of players to report their low back pain to physiotherapists or doctors, either due to a fear of missing out on playing tournaments, or adopting an “it will be okay” mentality. This eventually lead to more serious injuries and made them more susceptible to re-injury. Below, I will discuss the prevalence, symptoms, and risk factors for lower back pain in overhead sports and what you can do if you find yourself experiencing it.
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Upper Limb Pain in Tennis: 4 Factors You Don't Usually Consider!
How common are lower back injuries in overhead sports?
Lower back pain is one of the most common musculoskeleta conditions experienced worldwide within the general population. In overhead sports, the prevalence of low back pain is also very high, with evidence demonstrating that low back injuries have a 24% - 55% prevalence among the elite tennis and cricket population1,2 and between 15%-55% in amateur and professional golfers3. Lower back injuries may also occur in sports like volleyball, softball, baseball and other throwing sports.
Lower back injuries are frequently found to be muscular or bone-related pathologies, with stress fractures being very common in males. Often these injuries result in extended time out of play, highlighting the importance placed on appropriate injury prevention and management. However, there are many different anatomical structures that can cause low back pain, which is why it is important you seek professional help to ensure you get the most effective treatment.
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Symptoms of low back injuries
Low back pain is generally considered to be back pain between your lower ribs and the top of your pelvis. It can present in a variety of ways.
Some of the most common symptoms:
- Feeling “stiff” in your low back
- Central or one-sided pain in your low back
- A “band” of pain spanning across your low back/top of your pelvis
- Pain radiating to your bottom and potentially also down your legs
- Pinching or sharp sensation on either side of your spine during particular movements
Other symptoms you may notice…
- Muscle spasms in your low back
- Trouble maintaining upright posture (e.g., standing crooked/bent might feel more comfortable)
- Altered sensation in your low back
Risk factors for lower back pain in overhead sports
The causes for lower back pain in overhead sports are multifactorial and therefore are not always straightforward. I’ve listed some of the key risk factors below:
The obvious risk factor for overhead sports is the high mechanical load placed on your lumbar spine (spine in your low back) during tennis serving, fast bowling, golf swings, or any overhead movement that requires high-velocity changes in movement across multiple planes.
- Specifically, during a tennis serve the lumbar spine endures substantial loading due to the combination of lumbar extension (leaning back), lateral flexion (leaning to the side), and rotation (twisting). These actions can impose forces of up to 8 times more than those experienced while running.2
- In cricket, excessive shoulder counter rotation (rotation/twisting of shoulders relative to back foot placement), as well as poor thoracic spine rotation has been highlighted as a risk factor for low back pain in fast bowlers.
Repetitive loading of the lumbar spine is a key risk factor for injury. An example of “load” could be the number of tennis serves, the number of bowls, or simply put, the number of overhead activities you complete each day/week/month. Whether you’re a weekend warrior or an elite athlete, it is important to gradually load your body to ensure that your tissues have adequate time to repair before your next load-bearing activity. Too much load, without enough recovery time, can result in tissue damage and potentially - pain.
Poor strength can result in the recruitment of other muscle groups in order to complete a movement. In overhead sports, sufficient strength is imperative to allow you to achieve high-velocity manoeuvres such as a tennis serve, whilst also facilitating joint stability and preventing soft tissue injury (e.g., muscle strain)
Equipment changes can influence the way you play and consequently can predispose to injury if not selected properly. This is something that can be commonly overlooked in overhead sports. You wouldn’t run a marathon in a pair of thongs – so why should you play tennis with a racquet that doesn’t suit your game?
We all get carried away sometimes, wanting to complete one last game, a few more serves, one more hole in golf, though the reality is that performing under fatigue can pose a significant risk for injury and should largely be avoided unless under supervision from your coach.
A sneaky risk factor that might exacerbate your pain is your current stress levels or mental health. The brain is an absolute powerhouse and has the ability to tell your body it needs to slow down when you’re experiencing high stress or also when your mental health has taken a hit. One of the ways it does this can be via pain or stiffness, consequentially, forcing you to slow down.
Common low back injuries in tennis:
Vertebral stress fractures.
- Stress fractures are particularly common in young male tennis players in the pars interarticularis (a small area of bone connecting your facet joints to the rest of the vertebra). These injuries typically present with stiffness in the early stages and progress to deeper, unilateral pain (either on one side or both).
Facet joint pain.
- The tennis serve requires ballistic trunk movement which consequentially results in substantially high loads being passed through the lumbar spine – particularly the facet joints. Therefore, it is common to experience pain in these joints
- Although not specifically a low back injury, abdominal strains are thought to be linked to the rapid change of eccentric-concentric contractions during the tennis serve – that is, the leaning back and leaning forward movement at high velocities.
Common low back injuries in Cricket:
Vertebral stress fractures
- Similar to tennis, stress fractures are extremely common in adult male fast bowlers, due to the rapid changes in movement and excessive mechanical forces being subjected to the lumbar spine.
Soft tissue injuries.
- Soft tissues such as muscles, ligaments, tendons, and discs are particularly susceptible to injury due to the rapid changes in lumbar movement during fast bowling
Treatments for low back pain:
There are multiple treatment modalities for low back pain, here are a few:
- Seek help from a physio (pick me!). Physiotherapists can help relieve your pain and provide advice on how to manage and prevent further pain/injuries. Here are a few other things a physio can help you within your session:
- Analyse your thoracic/lumbar/pelvic mobility to determine any imbalances or factors that may be influencing your pain.
- Providing exercises to increase thoracic mobility.
- Providing exercises to increase trunk strength.
- Load management – chat with your coach about appropriate load management strategies and create a training plan that will work for you. Your physiotherapist can also assist in a load management plan.
- Equipment – talk to a professional about your equipment choices (e.g. racquet, shoes, golf clubs).
- Technique – seek coaching advice about whether your technique could be contributing to your pain.
Who should I see for my low back pain?
A physiotherapist is a great place to start, so that you can get your pain under control and work together on a management plan moving forward.
A personal piece of advice ... find a physiotherapist who has an interest in your sport or activity. While most physiotherapists would be able to help you out, someone who understands the demands of your activity is going to be able to give more specific rehabilitation advice and they’ll likely be most passionate about getting you back on track!
If you’re an overhead athlete, come to PhysioTec and let me or another sports physio assess you and provide you with a personalised program for performing your best, and minimising injuries!
Download your FREE 2-page resource
Upper Limb Pain in Tennis: 4 Factors You Don't Usually Consider!
Do you you need help recovering from an injury? Improving your performance? Or just getting back to doing the things that you love? Visit us at PhysioTec, and let one of our physios assess you and provide you with a personalised program to help you get on-top of your condition, and feel at your best.
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This blog was written by Molly Connolly, one of our Sports Physiotherapists and Pilates Instructors. Molly's undergraduate degree was in Exercise and Sports science and she completed a PhD of the title: A multidisciplinary approach to understanding low back pain in elite adolescent tennis athletes. She also has a love of triathlon! Molly completed a post-graduate Masters in Physiotherapy at the University of Adelaide.
You can read more about Molly here.
Senington, B, Lee, R.Y. & Williams, J.M 2020, ‘Biomechanical risk factors of lower back pain in cricket fast bowlers using inertial measurement units: a prospective and retrospective investigation.’ BMJ open sport & exercise medicine, 6(1), p.e000818.
Campbell, A, Straker, L, O’Sullivan, P, Elliott, B & Reid, M 2013, ‘Lumbar loading in the elite adolescent tennis serve: link to low back pain.’ Medicine and Science in Sports and Exercise, 45(8), pp.1562-1568.
Smith, J.A, Hawkins, A, Grant-Beuttler, M, Beuttler, R & Lee, S.P 2018, ‘Risk factors associated with low back pain in golfers: a systematic review and meta-analysis.’ Sports health, 10(6), pp.538-546.