Low Back Pain in the Aging Athlete

The term mature athlete carries different meanings in different contexts. For some, this term denotes a 35-year-old finishing a career in a professional team sport. For others, mature athlete refers to the 50-year-old “weekend warrior” playing golf. Finally, with increased participation among older citizens, this term can apply to active seniors in their seventies and beyond. This article concentrates on sports-related back pain seen in the second two groups.Back pain is pervasive, but usually benign and self-limited. In older athletes, transient back problems occur in the context of nearly universal, radiographic evidence of lumbar degeneration. These radiographic findings, and the increased likelihood of “dangerous” conditions such as cord compression, osteoporosis, metastatic disease and atherosclerosis, complicate the clinical evaluation in this patient group.The epidemiology of back pain and both known and suspected risk factors for back pain are examined. For example, the controversial relationship of sports participation in youth is addressed. The pathophysiology of back pain in this age group is related with a strategy for clinical and radiographic evaluation. For example, assessing mature athletes may require bone density or vascular testing. Finally, treatment and return-to-play issues are discussed. Standard recommendations of relative rest, graduated return to play, physical therapy and judicious use of anti-inflammatories apply in this age group. Interestingly, overall aerobic fitness and sport-specific technique should also be considered. For example, the mature golfer with low back pain may benefit more from swing mechanics instruction from a golf pro than from weeks of physical therapy.