Mechanical back pain in the athlete.

Effective management of mechanical back pain in the athlete requires an understanding of the significance of the nature and the location of the pain and which injuries are related to the age or sport of the athlete. Muscle strains and interspinous ligament sprains occur at any age and in all sports. However, the adolescent may have an iliac crest apophysitis rather than a muscle strain, and the gymnast or diver may have interspinous process bursitis or a stress fracture of the pars interarticularis rather than a ligament sprain. Similarly, the swimmer with upper thoracic pain, training in the butterfly stroke, may have Scheuermann's kyphosis, while the weight lifter with upper lumbar pain may have Scheuermann's changes in the lumbar spine. Athletes of all ages with persistent midline lumbar pain may have a disk injury or chronic instability because of a fracture of the vertebral body or posterior elements. If the physician performs the pertinent physical tests described and obtains the appropriate radiographic studies listed, correct diagnosis of the most common causes of mechanical back pain in the athlete will be assured.