Twist and Ouch

The New York Times—October 28, 2007

The New York Times
Sports Magazine

Not long after a typically underwhelming showing by the British contingent at the Wimbledon championships in July, the British Journal of Sports Medicine published the results of a study that suggested to beleaguered English tennis fans that things are only going to get worse. In the study, researchers from the Royal National Orthopaedic Hospital scanned the spines of 33 elite adolescent tennis players, male and female, who trained at the National Tennis Centre, the club of choice for Britain's most promising young prospects. None of the players had reported back pain. But their backs, it turned out, were a mess.

Twenty-eight of the teenagers — 85 percent — were found to have serious spinal abnormalities, ranging from cysts to fractures. Twenty-three had early-stage joint disease and 13 had herniated discs or desiccated, shriveled discs, common in septuagenarians but much less prevalent in teenagers. These kids, the cream of the next generation of British tennis, had backs 60 years older than they were.

"Tennis requires more frequent, repetitive and rapid rotation from the lumbar spine than other sports," the authors wrote. Playing it is particularly detrimental "during the growth spurt." High-level tennis, in other words, can be brutal on the young.

But as many of us know from debilitating firsthand experience, back problems don't afflict just teenage tennis players. According to various studies, at least a third of all competitive football players will hurt their lower backs during play, as will a third of gymnasts and 25 percent of serious rowers. About 40 percent of divers will develop a spinal stress fracture, and many cyclists will experience constant, grinding back pain while riding. In one study, six out of seven rhythmic gymnasts — those madly grinning ribbon twirlers — reported severe lower back problems. The harshest sport, however, seems to be golf. Ninety percent of injuries to professional golfers involve the lower back and the neck, and almost 80 percent of professionals will miss at least one tournament because of back pain.

If you're a runner, do a backbend of thanksgiving: runners statistically have a lower risk than most athletes of developing back problems. But for everyone else, the news is . . . painful. So what, if anything, can you do to preserve and protect your spine?

To build a better back, most experts agree, you need a solid core. "The core" is one of those areas of the body that coaches and athletes refer to constantly but few people can accurately locate. "It's not just the abdominal area, as many people think," says Vijay Vad, a sports medicine specialist at Hospital for Special Surgery in New York City and a back-care adviser to the PGA Tour and the professional men's tennis circuit. "To really include all of the elements that move and stabilize the spine, you have to go from your knees to your nipples. That's the core."

The muscles, ligaments and tendons that make up the elaborate core muscle system provide rigging for the spine. The rectus, transverse and oblique abdominals, for instance — the big muscles at the front and sides of the spine — are particularly important in stabilizing the back. So are the less familiar intertransversi, interspinalis and multifidus muscles, which link to the larger abdominal group but which rarely figure in magazine articles about washboard abs. Each of these muscles must be strong and supple if the spine is to remain stable.

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Don't forget flexibility, either. In 2004, Vad and other researchers led a study of 42 professional golfers and found that those with the smallest range of motion in their lead hip and lower back had the highest frequency of back pain. "If you have a loss of flexibility in the hips, the back will take up the slack and absorb more of the pressures of the swing than it should," Vad says. "Yoga, Pilates, dance — they're all good for core flexibility."

If your back aches for more than a few weeks, or if the pain is acute or radiating, visit a doctor. "Most back injuries will clear up on their own within six to eight weeks, if you rest adequately," Vad says. "Surgery is very rarely necessary, maybe in 3 to 5 percent of cases."

Read the full story and learn about exercises to strengthen your back at NYTimes.com