Biopsychosocial Approach to Managing Back Pain in Combat Athletes – Part 2 – Direct, Tissue-Specific Load

In the first post we discussed how different types of load can contribute to an athlete’s back pain. In this post we will discuss the first of these, direct, tissue-specific load. 

Tissue-specific load essentially refers to the actual tissue that has been identified or hypothesised as the origin of the pain. In some areas of the body, the specific tissue can be easily identified. If we land an odd punch and feel sharp pain in a specific area of the hand and imaging reveals a fracture in that area, we know specifically which tissue is causing the pain. With the lower back, however, things are often more complicated. In some instances fractures can present in the spine, however these are rare. More commonly found on scans are things such as disc pathology (bulges, herniations, protrusions etc.) and stenosis (narrowing of the exit space around a nerve). Unfortunately these findings are also extremely common in people without back pain, and often aren’t well correlated with symptoms. Therefore in most instances we don’t rely on imaging for back pain diagnosis. What we are looking for, both in the athlete’s history, and on physical examination, are provocative movements. 

If an MMA athlete has decided to focus on their jiu jitsu and has doubled their grappling practice, spending a lot of time in a flexed (rounded) position of the back, and then they present with pain upon forward-bending movements, then this fits the pattern, and acute management will include temporary avoidance of the aggravating movement (this may be aided with modalities such as taping), to allow the area to settle. Adjuncts such as manual therapy, needling etc. may be useful in helping the area to settle quicker.

Following this, we need to gradually reintroduce the painful movement as tolerated, and build up the capacity of the tissue to tolerate specific load. This may take the form of strength training exercises, such as a deadlift, but it is important to understand that the goal is not to work on hip strength (and the load will likely be insufficient to achieve this) but to actually train the load capacity of the affected tissue.

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