By Peter H. Edwards, Jr., M.D.

Back pain can be a common, reoccurring injury experienced by soccer players and other athletes. Learn more about the structure of the back and how players can prevent injuries to stay healthy and active on the field.

Anatomy of the back

The spine is composed of three regions from an athlete’s neck to the lower back. The cervical

region corresponds to the neck, the thoracic region is the mid-back, or back of the chest, and

the lumbar area is the lower back. The lumbar area provides the most motion and works the

hardest in supporting soccer players’ weight, and enables them to bend, twist and lift.

Each area of the spine is composed of stacked bony vertebral bodies with interposed cushioning

pads called discs. The vertebral bodies provide protection for the spinal cord and nerve roots

that exit the spinal cord. Between each vertebral body, the disc serves as a shock absorber,

giving soccer players the flexibility to move. Each disc consists of a jelly-like fluid filled center

or nucleus surrounded by a stiff ligament-like outer ring, called the annulus. This hydraulic

type of system enables athletes to perform heavy lifting and twisting tasks by moving fluid in

and out of the discs. However, this hydraulic ability of the disc diminishes with time and can

lead to injury.

Structures of the back that can cause pain

Low back pain can come from all the spinal structures. The bony elements of the spine can

develop stress fractures, or in the older soccer player, arthritic changes, which may pinch the

nerve roots. The annulus has a large number of pain fibers, and any injury to this structure, such

as a sprain, bulging disc and disc herniation, will result in pain. Finally, the surrounding

muscles and ligaments also may suffer an injury, leading to pain.

Causes of lower back injuries

Lower back injuries can result from improper conditioning and warm-up, repetitive loading

patterns, excessive sudden loads and twisting activities. Proper body mechanics and flexibility

are essential for all activities. To prevent injury, soccer players must use proper technique.

Improper mechanics lead to increased loads on the lower spine, making it more susceptible to


Tests to diagnose causes of back pain

A good history and physical exam by a physician will provide the most information leading to

an accurate diagnosis of lower back pain. Several different diagnostic tests also are helpful to

aid in this assessment. X-rays reveal any abnormalities of the vertebral bodies, such as arthritis,

fractures and slippage. MRI’s best identify degeneration, bulging and herniation of the discs. A

stress fracture is best seen with a bone scan.

Common lower back injuries

Mechanical low back pain results from an injury to the surrounding muscles of the lower back.

Lower back pain most likely is the result of poor conditioning and body mechanics, as well as

from inadequate warm-ups.

A small tear or sprain of the annulus is usually caused by a sudden movement or lifting an

excessive load. Since this structure contains a large number of pain fibers, such injuries are

quite painful. In addition to the back pain, athletes also may experience pain along the sciatic

nerve into the buttocks.

A bulging disc occurs as the disc degenerates and begins to wear out and the annulus weakens

as the jelly-like fluid begins to push out, causing pain. The pain is similar to a torn annulus, but

the degeneration and bulging will appear on a MRI.

With a disc herniation, the nucleus is squeezed through the annulus into the spinal canal. It may

press against the nerves, causing pain, numbness, tingling and weakness. While an excessive

load may cause this complete herniation, it is usually the result of multiple lesser injuries that

lead to the disc degeneration and final rupture.

Ask your orthopedic sports medicine specialist or trainer about proper technique and

strengthening exercises to prevent lower back injuries from occurring on the soccer field.