(by Dr. Alomar-Jimenez)

Low Back Pain

Low back pain will affect 85% of the population at some time in their lives. The majority (90%) will improve over a 3-month period; however, recurrences are very common.

Risk Factors associated with low back pain include Age, Gender, Physical Work, Fitness, and psychological influences such as stress, anxiety, and depression.

Table Tennis sport requires frequent bending and twisting. This physical work may predispose players to a higher incidence of low back pain.

Table Tennis Players often perform excessive torsional stress which is known to damage the facet joints and the annulus fibrosus. The annulus fibrosus is vulnerable to axial rotation and forward flexion.

It is important to evaluate patients with low back pain for red flags symptoms such as bowel or bladder changes, weakness, fever, history of cancer, because any of those warning signs will require rapid medical work-up and management.

Common causes of low back pain are paraspinals muscle pain, gluteal myofascial pain, sacro-iliac joint injury or inflammation, intervertebral disc, and facet joint. Less common etiologies include nerve root compression and stress fractures such as spondylolysis.

Treatment of low back pain without red flags:

• Remain active as tolerated. Gentle Stretches, Range of Motion. Avoid complete bed rest.
• Superficial heat. Lidocaine patches.
• Transcutaneous electric stimulation (TENS). Kinesio-tape (KT Tape).
• Soft Tissue Massage Therapy of the quadratus lumborum, erector spinae, and gluteal muscles. Massage Gun Therapy.

Most patients with acute low back pain will improve over time regardless of treatment, therefore nonpharmacologic treatment is preferred.

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Motrin can be used. I recommend oral medications in cases of moderate to severe low back pain based on athlete clinical symptoms.

An important consideration during competition with NSAIDs use is to hydrate well to avoid any renal side effects. Muscle Relaxants act on the central nervous system, thus during competition they are not the medication of choice.

 Strategies for Prevention of Low Back Pain

Optimize spine stability with neuromuscular control.

Lumbar Multifidus exercise program (Ej. Birddog, T-Lateral Ball Roll).

Improve flexibility over hamstrings and quadriceps muscles.

Dynamic Stretching Before and After Practices/Matches.

Exercise and Physical Therapy might be needed to restore range of motion, strength, and stability.

https://primephysiocare.co.uk/physiotherapy-exercises-for-lower-back-pain/

Dr. Alomar-Jimenez at NCTTA tournament