Low Back Pain in Athletes: Science Applied In Hillsboro & Portland Sports Rehab

On a damp Oregon morning, the kind runners in Hillsboro know well, an athlete laces up shoes and heads out anyway. The body feels strong. Training has been steady. Then, somewhere between mile two and three, a dull ache creeps into the lower back. It is not sharp. It is not dramatic. It is just enough to make the rest of the run feel tense and guarded.

That quiet ache is how low back pain often enters an athlete’s life. Not with fireworks, but with whispers.

Low back pain is not rare or mysterious. It isn't a sign that your spine is broken or fragile (even though that's potentially in the back of your head). It is one of the most common problems in sport, across age groups, skill levels, and disciplines. What matters is how it develops, is understood, and managed.

I've written this article for athletes, parents of youth athletes, and active adults across Hillsboro, Portland, and the rest of Washington County. Using only elite sports medicine research, the science is translated so it works for real people, not just journals.

How Common Is Low Back Pain in Athletes?

If you have a back, chances are you will deal with low back pain at some point. Some sources estimate 90% of people will have low back pain.Athletes and active adults are no exception to experiencing it.

One large systematic review (basically looking at all the research out there related to a topic and filtering for only the very best research on the topic) published in the British Journal of Sports Medicine found that at any given moment, about 4 out of 10 athletes report low back pain, and over a lifetime, nearly 67% will experience it, according to the review led by Fiona Wilson that analyzed more than 30,000 athletes across 86 studies

That means low back pain is not an outlier problem. It is part of the athletic landscape.

What is striking is not just how common it is, but how variable it can be. The same review showed that prevalence estimates ranged widely depending on sport, training load, and how pain was defined. Some sports reported prevalence of low back pain as rare as 18 percent (e.g. baseball), others as common as 80 percent or more (e.g. Taekwando).

Translation: back pain is influenced by context. Training volume, sudden increases in load, and years spent in a sport matter more than a single bad movement.

What Happens at the Highest Levels of Sport?

Elite sport gives us a magnifying glass.

In Australian international level rowers followed over eight full seasons, the lumbar spine was the most frequently injured body region, accounting for 84 cases of injury and representing 1.7 percent of all athlete training days lost, according to a long term surveillance study published in the British Journal of Sports Medicine by Larissa Trease and colleagues.

Rowing is a sport built on repetition, long training hours, and sustained spinal loading. Most of the lumbar injuries recorded were not sudden accidents. They were overuse injuries, developing gradually over time.

One detail from that study matters deeply for everyday athletes. When the Australian rowing program switched from fixed rowing machines to dynamic ergometers that allowed more natural movement, the rate and burden of low back injuries went down.

That is a reminder that equipment, environment, and training design shape injury risk. Pain is not just about bodies. It is about systems.

Back Pain Does Not End When Sport Ends

One of the most sobering insights comes from retired Olympians.

In a global survey of more than 3,300 retired Olympic athletes from 131 countries, over 63 percent reported at least one significant injury during their Olympic career. The lumbar spine was the second most commonly injured region after the knee, accounting for more than 13 percent of reported injuries, according to research led by Debbie Palmer in the British Journal of Sports Medicine.

Years later, nearly one third of these former Olympians still reported ongoing pain and functional limitations that they attributed to injuries sustained during their athletic careers/

This does not mean sports are harmful, especially since former elite athletes still report better overall health than the general population. However, it does mean that how back pain is handled during an athletic career can echo long after competition ends.

The goal is not just getting back to sport quickly. The goal is staying healthy decades later!

Youth Athletes and the Developing Spine

Low back pain is not just an adult problem.

At the Lausanne 2020 Youth Olympic Winter Games, which followed nearly 1,800 adolescent athletes from 79 countries, musculoskeletal injuries were common, and although knee and head injuries dominated headlines, back pain remains a critical concern because injuries during youth can shape future participation and long term health, according to the prospective injury surveillance study led by Debbie Palmer.

Young athletes have spines that are still developing. Growth plates are open. Bone structures are not fully matured. As outlined in educational materials on lumbar spine injuries in athletes of all ages from a presentation in 2017 by Dr.Cindy Chang at UCSF Sports Medicine, adolescent spines have greater mobility and different stress tolerance compared to adults, which changes how repetitive loading affects them.

This is may be why conditions like spondylolysis, a stress fracture of part of the vertebra, are far more common in adolescent athletes than adults, especially in sports involving repeated extension and rotation, such as gymnastics, football, rowing, and weightlifting. However these injuries don't always inherently lead to problems or pain so please don't jump to conclusions that this is automatically a horrible injury when it might be an incidental finding on an imaging report.

Recreational Athletes Matter Too

Even though Nike is in Beaverton, not everyone in Washington County is an Olympian. Most athletes are recreational.

A comprehensive review on lumbar spine injuries in recreational athletes emphasized that this group often trains hard, values performance, but has fewer medical resources and less recovery time than professionals, according to the Journal of the American Academy of Orthopaedic Surgeons review by Hsu, Turk, and Spector.

In recreational athletes, common suggested causes of low back pain (based on what was reported in the review) include muscle strains, "disc irritation", and stress related conditions like spondylolysis. Importantly, the review highlighted that most of these conditions respond very well to non surgical management, with excellent outcomes and return to activity when care is appropriately structured.

That means surgery is rarely the starting point. Smart loading, progressive physical therapy, and patience usually win.

What Actually Causes Low Back Pain in Athletes?

Here is the uncomfortable truth. Most low back pain cannot be pinned to a single structure.

More than 90 percent of low back pain is classified as non specific, meaning imaging does not reveal a single clear cause, as emphasized in the systematic review on treating low back pain in athletes led by Jane Thornton.

Risk factors show up again and again across studies. A previous episode of low back pain is the strongest predictor of future pain. High training volume matters. Sudden spikes in workload matter. Years of exposure to a sport matter.

What does not consistently predict pain is posture, isolated muscle weakness, or structural abnormalities seen on imaging. Disc bulges and degeneration are common findings even in pain free athletes, as outlined in the review on management of lumbar conditions in elite athletes published in the Journal of the American Academy of Orthopaedic Surgeons.

Pain is not easily explained by a simple structural issue. It is a biological, psychological, and social experience shaped by stress, fatigue, recovery, expectations, and environment.

Treatment: What Does the Evidence Actually Support?

This is where clarity matters most.

A systematic review and meta analysis of randomized controlled trials on treating low back pain in athletes found that exercise based approaches consistently reduced pain and disability, according to Jane Thornton and colleagues.

The same review found no high quality evidence supporting surgery or injections as first line treatments for most athletic low back pain. Unfortunately manual therapy alone, such as massage or spinal manipulation/adjustments, lacked sufficient evidence to stand on its own without exercise.

Exercise does not mean random core work. It means progressive loading, sport specific movement, and restoring confidence in the spine’s ability to handle stress.

The review also pointed out a major gap in research. Many studies reduced pain, but did not track return to sport outcomes. Pain relief without restoring performance is an incomplete victory; it's also something we at Pain & Performance Coach stress to make sure our clients come back stronger and more capable than before.

When Structural Diagnoses Might Matter

Some conditions require closer attention.

Lumbar disc herniation, degenerative disc disease, and spondylolysis are the most common structural diagnoses linked to missed playing time in elite athletes, according to the review on management of lumbar conditions in elite athletes.

The good news is that even here, prognosis is often strong. In professional athletes diagnosed with lumbar disc herniation, more than 80 percent returned to play, most with non surgical care, as summarized in that same review.

Surgery is reserved for specific cases involving neurological issues (like an inability to use muscles in the leg or severe lingering weakness explained only by the injury) or failure of well structured conservative care. Surgery for low back pain is not the default, and it should not be rushed.

What This Means for Athletes in Hillsboro and Portland

Athletes in Washington County live real lives. They juggle work, school, family, and training. Back pain does not happen in a vacuum.

The research is clear on several points.

Low back pain is common and expected in athletes. It is rarely a sign of serious damage. It responds best to active, progressive care, not passive fixes. Training errors, not broken spines, are often the real culprit.

The most dangerous mistake is not having pain. It is avoiding movement out of fear, or rushing back to full training without addressing workload, recovery, and confidence.

The spine is versatile and adapts to load. Like any system, it needs the right stress, at the right time, in the right dose.

A Final Thought

Low back pain is not a personal failure or a clear sign of weakness. It's just feedback.

The athletes who thrive long term are not the ones who never feel pain. They are the ones who listen early, adjust intelligently, and respect the long game.

That is as true on a muddy trail on the Dogwood-Wild Cherry loop in Portland as it is on an Olympic start line.

And the science backs it up.