Low back pain is unfortunately a not uncommon issue that can plague athletes' seasons and even their careers. Watching the New York Knick's sixth draft pick battle persistent back discomfort provides us with an "all-too-close" reminder of this point. Back pain in basketball players is very complex and can span a number of possible issues, ranging from simple muscle strains to stress fractures and nerve root irritation. Sorting out the source of discomfort is difficult and paramount to the success of any treatment plan.
The purpose of the spinal column is to help us stand and sit straight, move, and, most importantly, provide protection to the spinal cord and nerve roots. The spinal column is deeply encased in muscles that act in a coordinated fashion to stabilize and move our trunk and extremities. Frequently, back pain in athletes result from strains, spasms, or bruises of these core muscles during practice or competitive play. Most of these injuries resolve with a period of rest and activity restriction followed by a rehabilitation program.
Occasionally, however, injuries can occur to the spinal column itself. The spinal column consists of bony vertebral bodies separated by cushions known as intervertebral disks. Repetitive hyperextension of the lower back, as is frequently required of gymnasts, swimmers, and basketball players, can put unusually high stresses on the spinal column and result in stress fractures of the vertebrae.
Chronic injury or trauma to the lumbar spine can also result in disk degeneration, loss of elasticity, or even rupture. According to Frank Camissa, a spine surgeon at The Hospital for Special Surgery, "This is one of the more common conditions to cause lower back pain." Often we think of back pain as something that occurs in older patients, however, according to Camissa, "this condition results from a process that sometimes starts at a young age. The intervertebral disc can wear out losing its properties of elasticity and adaptation to normal activities such as during sitting, walking, standing or running. When the discs start to thin out, the bone beneath responds causing a cascading phenomenon which can be very painful and disabling." While the disk itself can be a source of pain, its herniated contents can sometimes irritate the nerve roots or the spinal cord resulting in secondary pain, numbness, or weakness. On the other hand, it is important to remember that disk "bulges" are remarkably common, and that not all bulging disks are problematic or a cause for undue concern. This is why it is so crucial for the doctor to put the findings of a back imaging study, such as an xrays or MRIs, in clinical perspective.
Treating disk injuries or degeneration is not a simple matter. Nonoperative management versus surgery is influenced by a myriad of factors, including age, symptoms, severity of disk disease, associated neurological symptoms, number of disk levels involved, and response to conservative measures. If surgery is performed, the plan must be individualized to the patient and can range from partial disk excision, disk replacement, or disk removal and fusion of the vertebral bodies. These decisions are often particularly difficult in the competitive athlete given their desire and expectation to return to play at the highest level. As Gallinari is finding out firsthand, the decisions that need to be made are not easy ones. Whatever the ultimate treatment plan is, hopefully he will be back next season exhibiting the talents he played with over the last few weeks.