Lower back pain in youth baseball players: causes and prevention

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You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey, everyone. This is your host, Sebastian with the restoring human movement podcast. Thanks for joining the movement movement. This is your first time show. Welcome. We've covered a lot of topics in the past. I think this is around 260 something. I stopped counting on honestly, because there's so many and I'm not quite sure when they release anymore. Please go back in the archives and check out various topics that we've covered from low backs to hips to knees and shoulders and ankles and hamstrings and so on.

So we've covered a lot of things in the past. Today, we're going to cover the topic of lower back pain in baseball, specifically more so in adolescent baseball. This would encompass younger kids, although I never, I can't, I can't think of one young, young kid that I've met with lower back pain with baseball. Usually it'll happen more in the little league age, 12, 13, 14, 15, all the way on towards like college. So we're going to cover some diagnosis today, the ones that you may or may not have heard about, but also some ways that can be where you can mitigate the problems, best practices, if you will, to decrease the possibility of being one of these kids that have baseball, lower back pain.

Anyways, I played baseball personally for gosh, it's been probably 30 years now. I'm 40 years old, I still play recreationally. And just to give you guys some insight about me, I have dealt with lower back pain during baseball. When I was in high school, I was 15 years old, and I sustained a back injury as I was running the first base. I impacted the first base. I impacted the first base. I had lower back pain instantly. I came out of the game. And that was, I think it was, it was the beginning of the season, I think. I think I lost that entire season, if I recall. And I was actually out for four months at that point, not really having any answers to what was going on. I had x-rays and MRIs and bone scans and various things and suggestions people have given me.

And long story short, after four months of not playing, I went back to play. I had done some physical therapy at the time, some stretching, some foam rolling, some icing, some strengthening the lower back muscles. And I went back and I was a leadoff batter. First swing of the game, missed the pitch. I went down, crippling back pain again. Literally first game, first at bat, first pitch. Very defeating, to say the least. If this resonates with you or with your son or daughter, then just know there is some hope for you. I've been able to play successfully after that. It took me another month to really recover to the point where I can get back on the field again after that point.

And then I didn't have any problems the rest of high school. Just started in college, did not have any problems either. Didn't play for about five, six years and then went into adult league and still play weekly, if not two times a week. So still no problems whatsoever. Throughout this podcast, I'll give you just some ideas of what happened to me, just so you can get some insight of maybe what may be happening with you, your son or daughter. Everybody's different. Everybody is very different, but I don't think there's a big need for non-traumatic lower back pain with youth athletes, really at all.

I think a lot of them can be mitigated. Although we can throw around the term prevention, there's really no true prevention, but there's signs of things that may come. Trauma is a whole different wild card. Things like football or impacting somebody, in my case, impacting foot against the base with an extended leg. There's a lot of different types of trauma hitting a player as you're both going for a fly ball. Diving even would be considered more of a light trauma, although we can dive multiple times a game and still be fine. Trauma is a little bit of a wild card. With that being said, your kid needs to be screened for a fracture.

They really do. If they have trauma, they should be screened for a fracture. You need to usually have an image performed. It doesn't always show up right away if it is a small fracture. But having a large fracture usually is not super, super common. They say that a lot of back pain in baseball is from repeated throwing and hitting motions, the twisting or mechanical stress. There is a type of fracture that does happen that is one that most people, unless they've had a few kids already, do not know about. And certainly, if you're the player, if you're the adolescent, the person dealing with back pain right now, I can almost guarantee you haven't heard about.

It's because this is your first rodeo with back pain. It's not like you've decided to look it up over the years and just be ready for it. And that's, it's everybody's first experience with the problem. And so you need to consider the possibility that there's something called spondylolisis. Spondylolisis is a small fracturing that happens within a certain section of the spine. It's not trauma. It's repetitive load, repetitive use. It doesn't happen with everybody. And there are possible things to do to prevent it, at least in my opinion. There's signs of things that insinuate that you're using your back possibly too much with the repeated throwing, twisting, hitting.

Spondylolisis, at least I'm going to read off a couple of things that I found on the internet here, and you guys might find it too. Just know that there's spondylolisis, spondylolisthesis, and other spondylo types of things. So if you are looking this up on the internet, make sure you look up the one that is, it's a lysis, L-Y-S-I-S. And this one's more of a, it's the fracture category. It's not a movement category, although it can lead to the other one. So to say that back pain is common, back pain is common, a common occurrence in youth athletes. It's been reported that 2% to 4% of athletes between the ages 11 and 13, and 12% to 20% of athletes between the age of 14 to 17.

Of these people, of these athletes, 40% to 50% will have this fracture. I remember I went to a workshop one time where they were presenting current research on, and this was not current anymore, because this was probably about 5, 6, 7 years ago. But they brought up this paper where they were talking about the occurrence or how common it is to have this type of reason or diagnosis with back pain with adolescents, twisting athletes, tennis players, baseball players, and so on. And it's actually really, really high, really high, considering of the people that have the pain, there's a 40 to 50% chance that they will have this.

It's huge. And the reason why I'm bringing this up today first, and not to scare you guys and think that you have it, is that if you have this, your treatment is far different than if it was a disc herniation, a muscle spasm, a trigger point, or something like that. It's far different. You actually will probably have to take quite a bit of time off your sport to let the spine actually heal itself. Here's the thing, and I don't want to try to scare anybody with it, but I feel like every time we have a kid come into the office and our medical staff evaluates them, we give them an idea of not a scare tactic, but we want to give them a reality of the situation here.

Because we've seen people who have had this years ago, and then they present in, they present in now, you know, 10 to 20 years later, and they say, well, I had this experience, I had this back pain when I was in high school. It was from baseball, and you know, we weren't really sure what it was, and I kept playing, and long story short, they ended up finding that they had this. Now, their spine or their lower back pain is harder to manage. It's much harder to manage because there's sometimes movement in those segments, and you actually visually see it on a movement image like a flexion extension x-ray, which would be the thing we'd mainly want to see to see the movement later.

These types of cases are much harder to manage, much harder to manage. They happen in ballet dancers, by the way, just to note in case you are a bendy athlete, that does happen with them. I did a podcast about a year ago on, in the, it was a dance podcast, I'm trying to remember the name of the podcast now, Beyond the Point. And so we brought up this possibility that these young athletes may have a fracture in their spine. Some of the listeners, the show host reached out, and they said, some of the listeners actually took that to heart. They were dealing with back pain, and they went and investigated it further, and it was, in fact, this.

It was so nice to see that people took the information to heart, and they screened and ruled it out. Now, if you don't have this, the cool thing is there's a lot of things that can help you very quickly. Personally, for me, I dealt with a low back disc herniation. Keep in mind that the disc herniation will never really go away. I don't mean that in a bad way. It's just there. I actually have a, I wrote a book on this. There's, there's links in the show notes if you want it. I have an image of my own, an MRI that I took back when I was 15, and I took one about three, four years ago. I had a little bit of back pain that reoccurred, and I kind of wanted to see.

I was just generally curious. And I still had the same exact disc herniation, same location, same size, everything. But I had a good 20 plus years of really no back pain at all. And I'd been physically active. I lift weights. I run. I play baseball. And no real problem. The reason why I'm bringing this up is because that you could, you're going to have the problem, or sorry, the disc herniation still be there. But it doesn't mean that you'll feel pain. It doesn't mean you'll be physically disabled. It doesn't mean you won't be able to do anything. So keeping that in mind, it really opens up the possibilities of things you can do to manage your problem and make it so you feel good and still be physically active despite of the disc changes.

It's not going to change back. And I know everybody's looking for this quote unquote fix. There's no fix for it. There's nothing to go and surgically change in most scenarios. You don't need to fix it. You just need to make it so your body can adapt. Rehabilitation in the past is kind of focused on the idea that we need to fix the back or fix the problem. I think if we scale that back a little bit and understand a little bit more about what it is that we're trying to accomplish, we're trying to make it so we're physically able again. To fix the problem is really not, or fix the disc is not the goal.

If you fix the disc, it doesn't mean you'll actually accomplish the goal in being physically active because the reason why it happened is still probably there if it wasn't trauma. People all the time have disc herniations or walking around, they have no pain whatsoever, while some of them do. So it's important to know that the rehabilitation process is not really to rehab the disc per se, but it's to allow the body to find a new way to move despite its new physical abnormality. And that's okay. People over and over again will improve if you take this approach. So I covered spondylolisis, which is not the most common, but it's one that you mostly need to be aware about if you're a younger athlete.

A disc herniation is going to be probably the most common, in my opinion. We saw a bunch of them with youth athletes when they came out of the shelter in place a couple years ago. They were sitting a bunch doing their Zoom or schools in bed, and then they got up and tried to use their body for sport. A disc herniation is typically not from trauma. It's from usually rounding too much over the course of the day or weeks or months, and then the disc starts to speak up, starts to become a symptom generator. There doesn't have to be trauma. I can't stress that enough. There's different types of disc injuries.

A herniation is just one of them, but there's other types that are a little bit more severe, like a protrusion, extrusion, sequestration, and so on. It doesn't always necessarily create leg pain. A lot of times, it's back pain only, and sometimes into the thigh or leg. Moving backwards, actually, I realized I didn't describe the spondylolisthesis, or sorry, the spondylolisthesis. Most of the time, these people will have more pain with bending backwards. In sitting, you'll notice the kid will actually sit and slouch into the chair, and that'll actually feel pretty good. Rounding their back will feel good.

The disc herniation is quite the opposite. Extending their back and walking and running will probably feel okay. Twisting and hitting won't. Throwing may, while something like sitting with bad posture will. Usually, they're in pain first thing in the morning, having trouble putting their shoes on, and so on. Now, those are the two major diagnoses you need to be familiar with. I know there's a bunch of other ones. I covered in one of my books that I wrote, which is in the link description, all these different diagnoses associated with back pain. And I can tell you, probably with those two, you'll cover, sorry, with disc herniation, with youth athletes, you'll probably be covering well over half of the reason for back pain.

And this is covering a large range of athlete ages, because remember, we were talking about the prevalence of having the actual fracture. The other one is a sciatica or a nerve root impingement. Most of the time, it's a disc herniation or a spondylolisis, though. Interested in working with Performance Place? Perhaps pick our brains about your unique situation? You can. For a limited time, we're offering a $29 special 30-minute discussion where we can help answer any questions or concerns you may have before you start your recovery. We call this a discovery session. You'll learn if you want to actually work with us, and we get to learn if we should actually be working with your specific case.

We don't take on cases, we don't think we can help, and we don't want to waste your time and money. Call us or email us, 714-502-4243, or email info at p2sportscare.com. Now back to the show. Now, the other ones which most people will probably be familiar with is muscle spasms, trigger points. These are protective things. These are signs of the other things. They will be present with the fracture, but they'll also be present with the herniation. So don't be fooled. I'm sure stretching and massage will feel just fine, but if it keeps coming back and back and back, and you still can't swing, you still can't hit, then these things are just signs of something underlying, and you need to address the major problem.

The cool thing is that with something like a disc herniation, which I'll cover some of the easy things to do later, is that it's super, super manageable. It doesn't require surgery, injections or medications of any type most of the time. We had a kid recently that he was a second baseman, and so he had, he was about 12, he was pre-high school, so he was about 12 years old or so. We screened him out. We did all the exam in the office, and we made sure he didn't have the fracture, or at least the signs of the fracture. If he had the signs of the fracture, we probably would have referred him out for an image to make sure the fracture's not there.

But with a good thorough examination, you can figure out beyond reasonable doubt. If you're a healthcare provider that knows how to test the spine, you can figure out what's going on. For him, we deemed him with a disc herniation. He had a tournament that was coming up that they already had airfare tickets to. I think it was about three weeks out, and so they said, should we cancel it? And we said, no, I don't think you should. Like, the only thing you can't do right now is hit. You can bunt, you can throw, you can run. It hurts the round and bend over, but you can feel the ball, right? Yeah, so we're going to keep you in the sport, but let's make it so we can actually rehabilitate the body around this probable disc.

And so we did. And within the three weeks, he went on his trip. They played. I think he was only a little bit limited. We spoke with his coach to give him any limitations that we had during the first two weeks when they were still practicing. And he said he stole some bases. He said he felt good. So I was awesome to see how quickly kids can recover. I spoke to the mother originally when we were discussing the timeline, and I know it sounds ridiculous. You know, two weeks, two weeks are better with a back. Yeah, you can. And when I spoke to the mother, I said, look, realistically, kids will recover really fast if you do the right thing, except for if they have, like, the fracture, the spondylolisis, then it's a different game plan.

But they'll generally respond really well if you do the right thing. If you don't do the right thing, this thing will persist for a long time, such as it did with me. And it was the wrong thing we were doing. And when I got back into the sport, I was in pain very quickly because I deconditioned my body throughout time. I was completely pulled out of the sport while we're talking about this other case we worked with. We kept him in the sport, kept him physically active, and we just limited the thing that was the symptom generator. That's it. And that's the way you can manage somebody to keep them in their sport.

He wasn't afraid of losing his spot, but I've met kids before where they're like, look, I'm on the fringe of losing my spot. Like, if I take, you know, three, four weeks off, I'm going to lose his spot. In that case, don't pull them out completely if you don't need to, you know. And a good, skilled health care provider can guide you on if this is appropriate or not. Some people you will need to pull out. Either way, I told her the story of I have a teammate who's a fireman, and so we're talking about back pain. And he said, you know, I've been dealing with this thing for like half the season. What do I, like, what do you think?

I said, honestly, I think, like, you're, he's about 30. I said, I think, I think you need to find something better. And he said, well, what do you mean? You think it, you think it's something else? I said, well, look, here's the thing. Like, you're a fireman. If you show up to a house fire, and how long do you think you, it should be until it's under control? Like, not out, but under control. Things are going in the right direction. He said, about an hour. I said, well, what if it was a day? And he's like, well, something's wrong. Like, might be a chemical fire. Like, there's more fuel in there.

And so, and there's something going on, right? And I said, well, backs are the same. Generally, it should be two, three weeks. Four weeks is very generous to feel better. Like, two weeks is, three weeks is generally on par. If you're not feeling better, and there's not a bunch of other odd things going on, like, the older people get, the more oddities there would be. But if you're a high schooler, a college kid, generally, a couple weeks. And that's what I told the mother. I said, look, don't cancel your trip. A couple weeks is probably enough time to get him on track. But we got to do it now.

And the cool thing is, is we've given him some management strategies and some specific warm-ups that he can do prior to the game, which he still does today. So we covered three, four things, possible causes, which is the spondylolisis, which is the possible slow fracture. We covered disc herniations, which is very common with a side dish of possible nerve root impingement or sciatica. And then muscle spasm, trigger point, which is so very low probability, although most all of you will feel a muscle spasm or trigger point. Your back will feel tight. The glutes will feel tight. The hip flexors will feel tight.

Those are all responses to the other thing. Now, a couple things that you guys can do, at least with children, to make it so they possibly, I don't want to say prevent these things, because you really can't prevent, I think everybody throughout their time on earth, we can't say that you will never, ever have back pain. Or ankle pain or whatever, or a bird poop on you. It's going to happen, but you can decrease the probability in theory. Like don't walk outside when there's a flock of birds over your head. Like it would make general logical sense. Usually with kids with back pain, there's a few things that we can do to improve, I think, their probability of succeeding without disabling back pain, taking them out of the sport, and making them just physically disabled and depressed.

And so the first thing is, they need to make sure to have a strong core or stable core, plus having mobile hips. And I'm not saying they need to be Gumby with the hips, but I'm saying that if there's a hip that's not moving well in comparison to the other hip, they need to work on the mobility of that hip. The reason is because the hip is the power generator. The leg is the power generator. For hitting, swinging, running, the core is generally, the back is generally stable. It transfers energy to the upper half. With throwing, most of the power of throwing comes from the lower body and transfer of energy through the trunk.

It doesn't come from the arm. I think the estimation is 18, 20% comes from the actual arm itself. So if you make the arm work more because the lower body isn't working, then you're going to ask for a cuff injury or some type of shoulder pain. Same thing goes with the back. If your hips are not functioning well and your legs are not functioning well, then you need to improve the function. And I'm not talking about strength. We have one guy on our team who doesn't work out really at all. He's about 35 years old, so he hits the crap out of the ball. But his hips generally work okay. It doesn't mean he's not super strong.

He's a stringy guy, but he's got a nice swing. So when we talk about core strength, or sorry, functioning core, I'm not talking about doing sit-ups or rush and twist or any of that stuff. We're just generally talking about can they hold a position for a long, like, I don't want to say a long period of time, but long enough. Like doing like a front plank or a side plank or a bridge exercise, these things doing for about 10 seconds, 3 seconds off, 10 seconds on, 3 seconds off. Generally, they should probably be lasting a bit of time if they're a kid. Like a side plank is, I think, pretty fair as an assessment of how long can they hold it from elbows to feet.

It should be well over a minute. I remember this one kid we saw that he pretty much, he had a fracture going on. And so he didn't have any pain doing a side plank, but he couldn't hold it for more than 5 seconds. And he wondered why his back was hurting. And I think, like, this is a clear outlier here. Like, your cord can't function to protect your back. We didn't, I don't recall the hip assessment on him, but generally, if the hips don't move well, the core will have to move or the spine will move. And if the spine moves, there'll be a lot more movement in those areas to create a possible fracture.

I apologize, we got an airplane coming over here. The second thing is, you should eat. Kids should eat. If your kid doesn't eat like they're starving, I would try to tempt them with some type of sweet treat or something of that nature. The reason being is because eating disorder is not super common in baseball, but they are in some of the female sports. I'm sure even softball, track and field, dance, like a lot of them have, there's possible eating disorders. And I'm not saying that everybody has an eating disorder as a kid, but generally kids should just not care. Like, in my observation, they shouldn't care.

They should just eat what they want to eat. Not just saying you should give them what they want to eat, but they should want everything. They shouldn't push it away. The reason is because if we're trying to build a healthy body, we need to make sure it has the fuel to do so. And if you rob it of its nutrients and ability to build, then it won't build. It'll just deplete. So that's the second thing. The third thing is, there's obviously a lot of people who have written articles and brought to attention, like the overuse of throwing and not necessarily batting, but especially with pitchers. Pitch counts appropriate for age and days rest and so on.

If you feel like your coach is not giving you the rest that you need, you need to talk to them. And I know some people have one coach for high school and one for club, and then they got another hitting coach and a pitching coach. And you need to get your coaches all together and just say, look, here's what I'm doing. Or write it down on paper and give it to them. Say, look, I'm doing like 50 pitches this day, and then you want me to do like 70 pitches. And then I'm doing the volume per week matters, and the volume per day matters. So you need to make sure that gets all your coaches on board and make them understand that they're not the only person working with you.

They're fine-tuning you as an athlete, and you need to make sure to give them the information they need. The fourth thing is training with a strength and conditioning coach who can actually work on drills like anti-rotational drills. Not everybody knows how to do this. Not all coaches or trainers know how to do this. There's trainers just like people who are mechanics that work on cars. Some specialize in imports. Some specialize in Fords. Some specialize in Lamborghinis and so on. Strength and conditioning coaches, a lot of them, if they've gone through a lot of the certifications and work with some of the methodologies that are used at higher levels, they'll be familiar with things like anti-rotational or anti-movement drills, mainly to train the core as it's intended to be.

Not sit-ups, not a movement generator, but it's something that actually resists movement to protect the spine and transfer energy to the limb, to the leg, or the arm. So, a strength and conditioning coach is a really, really easy win. And it doesn't even have to be done multiple times a week necessarily, but generally kids, they just need to start, I think, understanding what a workout might look like. Because when they get into high school and college, they may be just doing what they want. They go to the gym with their friends and they do stuff. And so mitigating that risk may be a really easy thing.

The fifth thing and final thing is, be a kid. Do other stuff. And I know this is a really odd thing to request, but stop playing all of these sports with so much intensity. Do less. I remember when I was a kid, we had summers off. It was crazy. You could do what you wanted to. Obviously, I know that probably the argument with this is the parents are like, oh, you don't understand. It's so competitive now. I know. I get it. And I'm not saying it's going to be easy to do this, but this is part of the problem. If your kid is working all the time to get better and they don't have the rest, they don't have the mental break, how do you expect them to physically succeed?

Sure, their skills will get better, but this is a big problem. Early specialization in sport, they should just be a kid and do stuff. And I'm not saying play video games because that's a big problem too. And get rid of your phone, dang it. Put your phone down. Stop looking at your phone. There's a lot of shoulder, neck, and elbow issues that may arise from a lot of phone time. I have another podcast coming on that pretty soon. If you guys are looking for help with this and you want somewhere to go, we can help you. I'd love to help you. There's not a lot of places that specialize in working with low back and especially have experience working with athletes who want to get back into sport.

We would love to help you. You can reach out to us. There's a link in the description below. We perform a thorough physical exam when we have our clients come in and we don't keep them out of sport unless we absolutely need to. That's an important part. If you want to accelerate your sport, there's nothing that'll stop you faster than being taken out of the sport. So if you've been given like the general, ah, just rest it thing, come talk to us. Just call us, 714-502-4243. Again, 714-502-4243. Or check out our website, p2sportscare.com. We also have a really large YouTube channel, which is really fun.

If you're a parent and you want to read more of the information that I've written about low back pain, which covers diagnosis, treatment options, as well as how to weight train despite lower back pain and hip pain, I have all those links in the description below and they're books that I've written and they're very affordable. They're intended to be informational. And if you decide to work with us, we would love to make something custom for you. We'll see you guys next time. Subscribe to the show.