Clinics in sports medicine
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1. Masters athletes may experience low back pain from multiple sources. Masters athletes with discogenic back pain should avoid or modify sports with combined rotational and compressive forces; individuals with facet-mediated pain should avoid or modify sports with excessive extension and rotation. 2. ⋯ Overall, the health benefits of continued sports and athletic participation outweigh the potential risks of spinal degeneration in middle-aged athletes. There is little correlation between radiographic appearance of the spine and symptoms; therefore, symptoms should serve as the primary guide when determining activity modifications. Overall, masters athletes should be encouraged to remain active and fit to enhance their quality of life and reduce the risk of cardiovascular disease.
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In summary, LBP is a common problem for the young adult athlete, with discogenic pain being the most common of all etiologies. Although rare, more serious etiologies such as tumor or infection should be included in the differential diagnosis until effectively ruled out. Regardless of the cause, nonoperative and conservative strategies should be the cornerstone of treatment, owing to the favorable natural history of most LBP etiologies. ⋯ Surgical intervention ought to be utilized as a last resort in this population. Return to play should be considered only when the athlete is pain free with full range of motion and daily medications have been discontinued. Careful monitoring of the training regimen should always be undertaken,especially with chronic pain or recurrent injuries.
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Surgical treatment of lumbar spine conditions in athletes can produce excellent outcomes. Professional and competitive athletes participating in both noncontact and contact sports can return to their preinjury level of performance and have successful careers after lumbar discectomy for LDH. NFL players, especially offensive and defensive linemen, may experience greater improvement with lumbar discectomy than nonoperative treatment. ⋯ There is great variability in published RTP criteria, which are based primarily on authors’ opinions and experience. Athletes must demonstrate resolution of preoperative symptoms, full range of motion, and successful completion of a structured rehabilitation program before returning to play. Physicians must ultimately base their decision to release an athlete back to sport on each individual’s condition and on the chosen sport.