Lower Back Pain in Lacrosse Player

[smay139]

Hey there, I am a senior in high school and plan on playing lacrosse in college. I have had lower back pain (left and right side, although it is much more prominent on the right side) for about 6 months now. The pain seems to fluctuate on a weekly to monthly basis (i.e. I will have months where the pain is intense and others where it is not so bad) but the pain does not seem to change much from day to day. The pain is worst during explosive twisting motions, namely shooting for me. When I shoot left-handed (same motion as a baseball pitcher in lacrosse) I have pain on the right side of my back and vice versa.

I have gone to a chiropractor, which did not help with the pain. I recently went to Physical Therapy, where I was diagnosed with a lower back sprain and was given several stabilization exercises for my lower back. The Physical Therapist also noticed that my spine was hyper-mobile and told me to stop cracking my back because of this. I have been doing that and it has not made a difference either. The PT seemed to think that the pain would just go away after a while, but this has not been the case for me.

Just wondering what you guys think the problem could be, the official diagnosis was a lower back sprain, but there seems to be more to this to me.

Thanks for taking the time to read, any advice, comments, or questions are greatly appreciated!

[Heidi]

I agree that it doesn't sound like a lower back sprain.
What exercises were you given?
Anything for flexibility, core strength or back strengthening?
Have you had any soft tissue treatment? This may help.

[smay139]

I was given 3 exercises, all on a swiss ball:
1. Lying face down on the swiss ball, alternate raising arms out in front w/ dumbbells
2. Lying on my back, raise a dumbbell from an outstretched position (to the side) to an overhead position.
3. Single leg glute bridge w/ leg curl

For flexibility I was not given anything from PT. However, I previously believed that tight hamstrings were causing the pain so I stretched multiple times a day for ~ 1 month and I can now touch my toes easily, but this did not help with the pain.

As far as core and back strength, I have lifted weights for the past 3 years including lots of weighted planks, back extensions, sit-up variations, and other core/back exercises.

I have not had any soft-tissue treatment, although it does not feel sore to the touch.

[Heidi]

Your back may not be sore to touch, but the muscles may still be tight and when really worked deeply I bet you find that there is an area (possibly upper glutes) which is pretty tender!
The 'core' exercises you have been doing were not exactly what I was thinking of.
You need to be learning how to contract and isolate your core muscles and then doing this whilst adding in small movements. No weights involved! Read our section here: http://www.sportsinjuryclinic.net/cybertherapist/corestability-training1.php

[smay139]

Thanks so much! I'll try that and see how it goes.

[smay139]

I got a 30-minute massage as well as foam rolled + rolled w/lacrosse ball on my glutes and lower back. Neither seemed to do anything.

I'll keep doing the exercises you posted and see if that makes a difference.

Also, the pain seems to change and evolve over time. What I mean by this is that although it always hurts when I shoot, sometimes other activities cause pain, and these activities change over time.

For example, in July (about 1 month after it started hurting) my back was really stiff and sore when I would begin to run. After warming up, the pain would go away but still be present when shooting. A month after that, there was no pain while running, but I got intense pain during the eccentric (lowering) portion of 45 degree back extensions (http://www.youtube.com/watch?v=OJOjy1hl5NA). I have no pain during any other back exercises, however, including deadlifts (don't worry, proper form). Up until a few days ago, I had pain when twisting to the left (e.g. cracking my back in a chair) but now that pain is gone. The pain now when shooting is just as bad as always though.

One more thing, the time when my back felt the best in the last 6 months was just after a weeklong camp in late July. During the camp, I was in a lot of pain, but kept shooting because college coaches were watching me and I didn't want to miss a chance to play in front of coaches. About two days after the camp, my back felt almost like new, however the pain gradually came back after that.

Thanks again for reading!

[smay139]

Hey again, just an update as well as a few questions.

I've been taking the past few weeks off, and the pain is the worst its been in the past 6 months. I've seen another physical therapist and a sports massage therapist since then also. The physical therapist noticed that my right leg was slightly longer than the left and said this was due to incorrect pelvic rotation. He gave me a few exercises to correct this. Today, I saw a sports massage therapist. She also noticed the pelvic rotation and believed that the cause of the pain was a pinched nerve. She worked on my psoas, glutes, and low back today, but said she wants to wait until next week to really go deep and pull my pelvis back.

The pain is the worst its ever been and I'm getting very discouraged and depressed. To recap I've had four different diagnoses (sp?)

1. Chiropractor - Lumbar spine not curved enough
2. Physical Therapist #1 - Strained ligaments
3. Physical Therapist #2 - Incorrect pelvic rotation
4. Sports Massage Therapist - Pressure on nerve

I don't know what to do and nothing, including rest, seems to make the pain better. Any help is greatly appreciated.

Thank you

[smay139]

I've been resting for the past 6 weeks and as of now the pain is no different than before. I recently had two deep tissue massages with a sports therapist which did nothing to help. The pain is predominantly on the right side but is becoming more and more pronounced on the left. I have been stretching my glutes, hamstrings, hip flexors, quads, and lower back as well as doing stabilizing core exercises but that has not seemed to make a difference. It feels slightly better after icing/contrast showers but I'm not sure if that is helping.

Any help or suggestions are greatly appreciated.

Also, I have a PT appt this Monday and I think I will ask for an MRI. Any other suggestions for the appt would also be appreciated.

Thanks for taking the time to read!

[backdouk]

At this stage it may be worthwhile getting an MRI scan; a preliminary x-ray might be beneficial as well, although this will not tell you if you have a disc tear. It sounds like to me like you either have a disc tear or sacroiliac joint dysfunction. Discs require long term rehab and are unpredictable. They can be up and down. Sacroiliac dysfunction can usually be put right by a chiropractor, but you will need to undergo a treatment program. Expect to feel a difference within 4-6 treatments. So if you only had one treatment with the chiropractor maybe you should try again. But if you have already had a course of treatment then the MRI is probably the best bet. Good luck!

[smay139]

I had a course of 12 chiropractic visits which did not help. Both PTs I have seen seemed convinced that it is not a disc problem because spinal compression and extension were not painful at all. Also, radiating pain (ie down the legs) seems to be a problem with disc tears and my pain is very localized.