How to Treat Back Pain in Athletes

If you’re an athlete who has been sidelined by back pain, you likely want to return to your sport as soon as possible. But, where do you start?

As you may suspect, the smartest first choice is getting checked by your healthcare provider. Seeing your healthcare provider may help you separate out any serious health problems from the generic issues that often cause back pain in athletes. A clear diagnosis may help you get started sooner with treatment which may yield a better recovery payoff.

A wide range of treatment options is available, from simple things like heat or ice to more complex and riskier procedures such as back surgery. So which one is best? It depends on several factors.

The Best Treatments for Back Pain in Athletes

Some back pain treatments have a better track record than others, as revealed by medical research studies. In particular, using superficial heat, going to a chiropractor, physical therapist or osteopath for spinal manipulation, managing pain and swelling with anti-inflammatories, and/or addressing muscle spasms with muscle relaxants, e.g., Flexeril (cyclobenzaprine), seem to work the best, according to an article published in the journal Sports Health.

While there’s not a lot of research out on the following treatments, a range of therapies has been studied and evaluated.

Superficial Heat

Should you use ice or heat for an acute back injury? Experts don't always agree.

Whether you apply a bag of frozen peas to your sore back or use an ice pack purchased from the drug store, cold therapy may help reduce swelling and inflammation, as well as stem damage to tissues. Ice can be numbing, which may help with pain relief. Generally, ice is recommended immediately after an injury and for up to 72 hours.

For a long time, heat for an acute injury was given a bad rap. Critics felt that it would increase inflammation, which could make for prolonged pain and disability later, especially if the athlete did not go for further treatment. More recently, though, heat has been proving itself as a viable first-line treatment immediately following a back injury.

After culling data from several small studies, a 2006 Cochrane review found moderate quality evidence that heat therapy reduces both acute and sub-acute back pain immediately after the injury or incident, as well as for up to seven days.

Spinal Manipulative Therapy

Although generally associated with chiropractic medicine, spinal manipulative therapy, (spinal adjustment), may also be given by a physical therapist or an osteopath. An adjustment is a grade 5 mobilization, also known as thrust manipulation, and is often the most focused, forceful and quick of all the grades.

Mobilizations up to grade 4 may be given by any healthcare provider licensed to give manual therapy, which includes massage therapists. To legally give a grade 5 mobilization, though, your healthcare provider must be an M.D, chiropractor or physical therapist. Grade 5 mobilizations are the only type referred to as manipulations.

Spinal manipulative therapy has been the subject of many research projects and has established itself as a good short term reliever of acute low back pain.

For chronic low back pain, getting an adjustment can be as effective as anti-inflammatories and better than physical therapy in the long term. Improvements patients make tend to be on the moderate, rather than high, side.

However, a 2004 Cochrane review found no difference between spinal manipulative therapy and conventional, conservative treatments such as pain medications, exercise, physical therapy, back school or regular healthcare provider care. The measures the researchers looked at included pain reduction and the ability to perform daily activities.

Drugs

Non-steroidal anti-inflammatory medication, or NSAID, is the go-to pain reliever for many athletes and others who injure themselves. This class of drugs includes ibuprofen, among them, Advil and Motrin, naproxen (Aleve), celecoxib (Celebrex), and aspirin. Tylenol is not considered an NSAID because the active ingredient, acetaminophen, is a pain reliever only.

Some NSAIDs are available over the counter at drug stores, others by prescription only. Consult with your healthcare provider if you are unsure about how to take NSAIDs or other pain-relieving medication.

Advil and other NSAIDs with ibuprofen as the active ingredient may raise your risk for fatal cardiovascular events.

Skeletal muscle relaxers are another drug often used to manage pain. Have you ever had the experience of seized up muscles after a strain, sprain or other injury? While this can be tough to deal with, it’s natural. Muscle spasm lends protection to injured or insecure joints; the immobility it imposes limits further tissue damage to the area.

But this limitation may make it hard to give it your all in physical therapy. Left unchecked, spasms may also propagate muscle strength and flexibility imbalances throughout the body. Imbalances affect your posture, lead to pain and will likely affect your competitive advantage in your chosen sport. 

For these reasons, injured athletes sometimes turn to skeletal muscle relaxers for help.

Several studies have shown that muscle relaxants can be effective for managing non-specific low back pain. However, the authors remind us that adverse effects are associated with this class of drugs and that people should proceed with caution when using muscle relaxers.

Other Spine Therapies

Other spinal treatments include both holistic methods and traditional medical procedures.

Injections

While injections of steroids, local anesthetics, and other drugs are commonly used for back pain, a 2008 Cochrane review could not find compelling evidence for or against their use. A smaller, older study published in the American Journal of Sports Medicine looked at thirty-two athletes with back pain and sciatica who received injections and found that only fourteen (or less than half) enjoyed rapid improvement and a hastened return to play.

Exercise

While many people strongly advocate for exercise as the best way to relieve back pain, the research remains subdued. A 2012 meta-analysis found that core stability exercise may be an effective chronic low back pain reliever. The study also found that core stability may help improve physical functioning.

But these results were for the short term only. In the long term, no differences were observed between those who exercised in general and those who focused their efforts specifically on core work.

Acupuncture and Massage

Acupuncture is widely used, but results for athletes, are mixed according to a 2005 Cochrane review. While acupuncture may be better than nothing in the short term, other treatments, both conventional and alternative, have proven more successful at pain relief. That said, acupressure may be more effective than a regular massage, the review concludes.

Research also shows that massage may be helpful for subacute and chronic pain, but not acute, right-after-the-injury type pain. Massage therapy seems to do its best work when coupled with exercises and education.

Lumbar Corsets and Braces

For most spine conditions, belts and corsets will do nothing to help support your back or avoid pain. And there isn't evidence that they help prevent back pain, according to the Centers for Disease Control.

The one exception is in the case of adolescent spondylolysis, where several studies found bracing combined with restricted activity makes for an effective treatment.

Spondylolysis is a low back injury brought on by participation in sports that require repeated hyperextension and hyperflexion of the spine. Examples include gymnastics, football, soccer, and others. 

In young athletes, a group that is at a higher risk than others in the same age bracket, spondylolysis is understood as a weakness or other compromising problem at an obscure part of the back of the spine known as the pars interarticularis.

Left untreated, spondylolysis may progress to spondylolisthesis, where the spine becomes unstable.

Other than in young athletes who have sustained hyperextension injury, clear research-based evidence for lumbar supports is lacking, whether used as prevention, or as other treatments.

Treatment Duration

Some athletes play through their pain. Others start skipping therapy sessions as soon as they feel better. Whether or not playing through pain will be harmful to you likely depends on the nature of your injury, and on the types of tissue that have been affected. The possibility for further damage is significant if the spine is unstable. But with other types of injuries, the risk is often minimal.

An example of spinal instability is spondylolisthesis, a condition in which one spinal bone slips forward or back relative to the next one. Spinal discs are another structure that likely will need ample healing time before it’s safe to play again.

But if your chronic low back pain is due to soft tissue strain, with a little caution and some aspirin, you may do just fine.

The bottom line is that medical research does not support playing through pain. But it doesn’t support not playing through pain, either. If you’re unsure what to do, consider asking your healthcare provider or physical therapist for input.

A Word From Verywell

How quickly you get back to your sport is determined by your condition, your symptoms and the type of treatment you undergo, but generally, if your pain has been resolved and you’ve gotten your range of motion back, playing sports should be safe.