Low Back Pain in Young Athletes: When Should Parents Be Concerned?

Has your child or teenager started mentioning pain in their lower back during or after sport?

Perhaps it only appears when they run, kick, bowl, serve or arch backwards. Maybe it settles with rest, only to return at the next training session. It can be tempting to put this down to tight muscles, poor posture or a growth spurt, particularly if the pain is mild.

Most back pain in teenagers is not caused by anything serious. However, persistent or recurring lower back pain in a young athlete deserves proper attention. Growing bones respond differently to repeated sporting load than an adult skeleton, and one possible cause is a lumbar bone stress injury.

Recognising the pattern early can help prevent a manageable problem from becoming an injury that keeps a young person away from the sport they love for much longer.

The short answer: what causes lower back pain in young athletes?

Lower back pain in children and teenagers can have several causes. These include muscular irritation, a sudden increase in training, reduced strength or movement control, incomplete recovery from a previous injury and, in some young athletes, stress to a developing part of the spine.

Pain that repeatedly worsens during sport and improves with rest should be assessed, particularly when it is triggered by arching, twisting, kicking, throwing, bowling, running or jumping.

An assessment helps establish what is likely to be causing the symptoms, which activities are safe to continue and whether further medical investigation is needed.

Children are not simply smaller adults

A child’s skeleton continues developing throughout adolescence and into early adulthood. During a growth spurt, the bones, muscles and tendons do not always adapt at exactly the same rate.

At the same time, a young athlete’s sporting demands may be increasing. They may be training with more than one club, taking part in school PE, playing weekend matches and adding gym or conditioning sessions. A change of team, sports camp, tournament or return after the school holidays can also create a sudden jump in activity.

The issue is not always that a child is doing too much sport overall. Problems can arise when the demands of a particular week temporarily exceed what their body is currently prepared to tolerate. A young person’s capacity may also be reduced by:

• A recent growth spurt
• Poor sleep or insufficient recovery
• Illness
• Not eating enough to support growth and activity
• School or exam stress
• A previous injury
• A sudden increase in the amount or intensity of training
• Repeatedly training at maximum effort

This helps explain why a previously manageable training schedule can suddenly begin to cause symptoms.

What is a lumbar bone stress injury?

A lumbar bone stress injury affects part of a vertebra in the lower back. It can begin when repeated sporting movements place more stress on the developing bone than it can currently recover from.

In the early stages, the bone may become irritated and show a stress response. If the same load continues without enough time for recovery, this can sometimes progress to a small stress fracture called spondylolysis.

This sounds worrying, but these injuries can heal. The important factors are recognising the symptoms, adjusting the aggravating activity and following an appropriate rehabilitation plan. Continuing to repeatedly provoke the pain can delay recovery.

Which sports and movements can place more stress on the lower back?

Lumbar bone stress injuries are more likely in sports that repeatedly involve arching and rotating the lower back, high-impact landings, kicking or overhead movements. These can include:

• Cricket, particularly fast bowling
• Football and rugby
• Gymnastics and trampolining
• Dance
• Tennis and other racket sports
• Athletics
• Swimming, particularly repeated butterfly movements
• Golf
• Weight training when load or technique is not appropriate

Participation in one of these sports does not mean a child will develop an injury. Risk is influenced by their growth, recent training history, recovery, technique and the overall combination of activities they are doing.

Symptoms parents and young athletes should look out for

The symptoms of lower back pain can vary, but it is sensible to arrange an assessment if your child has pain that:

• Returns whenever they train or compete
• Becomes worse as a session continues
• Is aggravated by arching or twisting the back
• Appears during running, jumping, kicking, serving, throwing or bowling
• Settles with rest but returns when sport resumes
• Has continued for more than several days or is not improving
• Changes how they move or perform
• Makes them reluctant to train or take part
• Spreads into the buttock or leg

A young athlete should not be encouraged to simply push through recurring back pain. Pain relief should not be used to mask symptoms so that they can continue with an activity that repeatedly makes the pain worse.

What should my child do if back pain starts during sport?

First, they should stop the movement or activity that is provoking the pain. This does not automatically mean complete rest from every form of movement, but the aggravating sporting load should be reduced until the cause has been assessed.

Avoid repeatedly ‘testing’ the painful action each day to see whether it has gone. Pain may settle before an irritated bone or other tissue has regained the capacity to tolerate full training.

Depending on the symptoms, comfortable everyday movement or a lower-impact activity may still be appropriate. However, this should be decided individually. The right advice for a mild muscular problem may be different from the advice for a suspected bone stress injury.

An experienced clinician can help answer three important questions:

1. What is most likely to be causing the pain?
2. What can the young person safely continue doing now?
3. What needs to improve before they return to full sport?

Does a young athlete with back pain need a scan?

Not every child or teenager with lower back pain needs an X-ray or MRI scan.

A detailed history and physical assessment are normally the starting point. This should consider when the pain occurs, which movements trigger it, changes in training, growth, recovery, strength, movement and any symptoms that might require medical investigation.

Standard X-rays do not show every early bone stress response. An MRI may sometimes be considered when the history and examination suggest a bone injury, when symptoms are unusual or when pain is not progressing as expected.

The decision to arrange imaging should be made by an appropriately qualified healthcare professional. A scan is only one part of the picture and does not replace a thorough clinical assessment.

How is lower back pain in a young athlete treated?

Treatment depends on the likely cause, the young person’s symptoms and the demands of their sport. Their plan may include:

Adjusting sporting load The movements that aggravate the pain may need to be paused or reduced temporarily. This gives the irritated area time to settle while maintaining suitable activity where possible.

Rebuilding strength and control Rehabilitation may address the muscles of the trunk, hips and legs rather than concentrating only on the painful area. A young athlete needs sufficient strength and control to run, land, kick, throw, change direction or lift with confidence.

Reviewing technique Bowling, serving, kicking, lifting or landing technique may contribute to repeated load on the lower back. Input from an appropriately qualified coach can be valuable alongside rehabilitation.

Supporting recovery Sleep, nutrition, hydration and rest all contribute to recovery and adaptation. Growing athletes need enough energy to support everyday health as well as school, training and physical development. If there are concerns about a young person’s energy intake, unexplained weight loss, persistent tiredness, recurrent illness, vitamin deficiency or menstrual cycle, seek advice from an appropriate medical or nutrition professional.

Gradually returning to sport Being pain-free in everyday life is not the same as being ready for a full match, competition or high-intensity training session. Rehabilitation should gradually reintroduce the movements and demands of the sport. This may begin with controlled strength and technique work before progressing to running, jumping, throwing, bowling, kicking, contact or competition. The pace of return will depend on the diagnosis and severity of the problem. Adding several demanding activities at once makes it difficult to see how the body is responding, so progression should be planned and monitored.

How can future episodes be reduced?

No injury can be prevented with certainty, but these habits can help a young athlete build greater capacity:

• Increase training gradually after a holiday, illness or period away from sport
• Avoid placing every high-intensity session on consecutive days
• Include strength and movement training appropriate for the child’s development
• Keep a simple record of training, matches, school sport and gym sessions
• Vary the intensity of sessions instead of working at maximum effort every time
• Prioritise sleep and recovery, particularly during growth spurts
• Make sure food and fluid intake support both growth and activity
• Encourage children to mention pain early without fear of disappointing a coach or parent
• Complete rehabilitation fully before returning to unrestricted sport

Looking at the whole week is important. A child’s body does not distinguish between school PE, club training, playground activity, gym sessions and weekend competitions; they all contribute to the total demand.

When does back pain need urgent medical help?

Most lower back pain does not require emergency treatment. However, seek urgent medical advice through NHS 111, an urgent GP appointment or emergency care, as appropriate, if your child has back pain alongside:

• New weakness, numbness or tingling in both legs
• Numbness around the genitals or bottom
• Difficulty controlling or emptying their bladder or bowels
• Difficulty walking or a marked loss of coordination
• Severe pain following a significant accident or injury
• A high temperature, feeling shivery or being generally unwell
• Severe pain that begins suddenly or worsens quickly

Back pain that regularly wakes a child at night, is constant, is accompanied by unexplained weight loss or occurs in a younger child should also be discussed promptly with a GP.

If you are unsure how urgently your child needs help, contact NHS 111. If you’re particularly worried, read more here.

Children’s and teen sports injury support in Chandler’s Ford

At goPhysio, we help children and teenagers from Chandler’s Ford, Eastleigh, Southampton and Winchester manage pain, recover from injury and return to the activities they enjoy.

Our assessment looks beyond the painful area. We consider the young person’s growth, weekly activity, sport, strength, movement, recovery and individual goals before creating a tailored plan.

Connie and Sophie have completed additional training through Kids Back 2 Sport in the assessment and management of musculoskeletal conditions and sports injuries in children and teenagers.

If your child has recurring lower back pain during sport, an early assessment can help establish the right next step. No GP referral is normally needed.

Find out more about physiotherapy and rehabilitation for children and teenagers or call our friendly team on 023 8025 3317.

Frequently asked questions

Is lower back pain normal in teenagers? Back pain can occur in teenagers and is often related to muscles, joints or changes in activity. However, recurring pain during sport should not simply be dismissed as normal growth. An assessment can help identify whether the symptoms are likely to relate to muscular irritation, training load, a bone stress injury or another cause.

Can a child play sport with lower back pain? It depends on the cause and how the pain behaves. A child should stop an activity that repeatedly worsens their pain or changes how they move. Some comfortable activity may be appropriate, but a suspected bone stress injury requires different management from a mild muscular problem. Seek individual advice before returning to painful sport.

What is spondylolysis in a young athlete? Spondylolysis is a small stress injury affecting part of a vertebra, usually in the lower back. It can develop when repeated sporting load exceeds the capacity of the developing bone. Early recognition, suitable activity modification and progressive rehabilitation support recovery.

How long does a lumbar bone stress injury take to heal? Recovery time varies according to the stage and severity of the injury. Symptoms may improve before the bone is ready for unrestricted sport, so return should be based on an individual rehabilitation plan rather than pain alone. Some bone stress injuries can require several months of recovery and graded rehabilitation.

Does my child need an MRI for back pain? Not necessarily. Many episodes of back pain can be assessed and managed without imaging. An MRI may be considered when a clinician suspects a bone stress injury or another condition that requires further investigation. The decision depends on the history, examination and progress.

When should my child see a physiotherapist about back pain? Arrange an assessment if the pain repeatedly returns with sport, lasts more than several days, affects movement or performance, spreads into a leg or prevents your child enjoying their normal activities. Seek urgent medical help if the pain is accompanied by neurological symptoms, bladder or bowel changes, severe trauma, fever or rapidly worsening pain.