Low back pain is a top musculoskeletal complaint worldwide, but athletic low back pain requires specialized assessment due to its unique features. First, athletes have the pressure to quickly return to high levels of physical performance. While most episodes of low back pain resolve in 6-12 weeks, many athletes attempt to return to play much more quickly. Another unique feature is that athletes likely fall on the far side of the “U-shaped” curve of exercise and low back pain. While too little physical activity is a risk factor for low back pain in the sedentary population, athletic low back may arise from too much physical activity or spikes in activity.

Lastly, when an athlete has low back pain, they usually cannot afford to be sedentary during their rehab process. They need to maintain their fitness as best possible in order to safely return to training and sport. Keeping these features in mind, our initial assessment should give us a working diagnosis, initial decision on referral, and timeframe for recovery (including how to train in the meantime).

Lumbar Range of Motion

Standing lumbar range of motion tells us how motor control has changed and informs our working diagnosis. First, we look at movement quality. For example, in forward flexion does the athlete posteriorly weight shift and get full segmental flexion? Or do they hip hinge and try to avoid flexion through the low back? As we observe these motions, the athlete’s pain response can suggest possible involved structures. Lumbar flexion tends to aggravate the disc, whereas extension tends to aggravate pars interarticularis and facet joint pathologies.