Back pain comes with plenty of explanations. A weak core. Tight hamstrings. A spine supposedly sitting in the wrong place. Usually before anyone has asked much about the person attached to it.
Consider a teenage gymnast whose back hurts when she arches into a bridge. A university rower who feels fine for the first twenty minutes on the ergometer, then struggles as the session goes on. A sprinter returning to fast running after injury. An AFL player trying to fit kicking, running, contact and gym work into the same week.
They all have back pain. Giving them all the same exercises would be convenient, but it would miss much of what matters.
“Low back pain” tells us where something hurts. Understanding the problem takes a little more work.
When back pain needs attention
Back pain after significant trauma, or with fever, feeling unwell, unexplained weight loss or a history of cancer, also needs prompt medical review. Pain travelling down a leg, numbness or ongoing loss of function deserves assessment. [1]
Younger athletes with persistent pain in one spot deserve particular attention, especially if arching, twisting or impact repeatedly brings it on. Lumbar bone stress is one possibility. Pain during an extension test does not diagnose it. Repeatedly stretching through the pain is a poor substitute for finding out. [3]
For an episode without concerning features, some adjustment to training and continued movement you tolerate are reasonable starting points. Get assessed if pain persists, worsens or keeps interfering with daily life or sport.
What changed before the pain started?
The moment pain first appeared often gets all the attention. The preceding month deserves some.
Did the gymnast go from regular training into a camp? Did the rower add an extra ergometer session? Has the sprinter returned to full-speed running after weeks without it? Did the footballer have two matches in five days?
Also ask about school sport, gym work, sleep, illness and growth. An athlete does not have a separate body for each coach’s programme. School, club and representative training all end up in the same week.
A training diary need not be elaborate. What did you do, how long did it take, how hard was it, and when did symptoms appear? Add what happened later and the next morning. Those details often tell us more than a weekly total.
A change in training does not prove it caused the injury. Pain has more than one influence. Stress, nutrition, previous episodes and confidence in movement also deserve a place in the assessment. Nor is there a percentage increase which makes every athlete’s week safe.
What does your sport ask of your back?
Bending, arching and rotating are normal movements. Their presence in a sport is not, on its own, a problem. The amount, speed and repetition of those movements help explain what the athlete needs to tolerate.
Gymnastics: having the range is only the beginning
For most adults, repeatedly arching into a bridge sounds like an ambitious way to spend a Tuesday. For gymnasts, it is Tuesday.
Large ranges are part of the sport. The question is how the gymnast is coping with the number of skills, the repetitions of extension and rotation, and the landings across training.
Someone might have enough flexibility to perform a skill once, yet struggle after dozens of attempts. Fatigue changes the task. More stretching is not an obvious answer for an athlete who already has plenty of range.
Persistent focal pain in a growing gymnast deserves assessment for bone stress. Once the problem is understood, strength, control, recovery and skill volume help shape the plan. [3]
Sprinting: gym fitness does not replace fast running
A sprinter returning from a hamstring injury might have kept lifting and maintained aerobic fitness. They might also have spent weeks without running at full speed.
It is easy to look fit in the gym and still be underprepared for a sprint session. Acceleration, maximal-speed running, plyometrics and lifting each add something different to the week.
If back pain starts when fast running returns, look at all of those activities. Rehabilitation depends on the diagnosis, then gradually brings back the speed and repeated efforts the sprinter needs. Pain-free jogging is a start. It leaves the fastest part of the job untested.
Rowing: the fiftieth minute matters
A rower who is comfortable for twenty minutes but sore after fifty has told us something useful. The movement is familiar. The duration is becoming a problem.
Ask about stroke volume, intensity, fatigue and what changes as the session continues. A clinic exercise lasting ten seconds is unlikely to reproduce everything happening late in a long row.
Adjusting ergometer duration or intensity while retaining other suitable training is often part of the discussion. The 2021 rowing consensus supports reducing aggravating activity, maintaining fitness and working back towards full training. It combines research with expert agreement and was written for adult rowers. [2]
Eventually, the rower needs to tolerate sustained rowing. Completing a comfortable set of exercises is encouraging, but it is a different task.
AFL: look beyond the running total
AFL players sprint, kick, jump, land, tackle, absorb contact and lift weights. Often with limited space between one demanding session and the next.
Take a midfielder returning after a short interruption. Running distance looks normal. High-speed running is still low, kicking volume has risen, and the gym session has moved closer to match day.
The total distance figure has missed several details. Those details matter when choosing what to change and what needs rebuilding.
A defender returning to marking contests and contact has different preparation needs from a midfielder returning to repeated running efforts. The diagnosis matters, but the playing role still deserves attention.
Soccer: everyone’s reasonable session adds up
A young player trains with school, club and a representative squad. Each coach sees a reasonable amount of football. The player experiences all three.
Kicking, acceleration, deceleration and changes of direction add to the picture. Ask when pain appears: after repeated kicks, during sprinting, late in a match or following gym work?
Blaming an uneven kicking action or a weak core is easy. Establishing the reason for pain takes a history and examination. For return to play, the player needs preparation for football training and competition, including the activities which originally bothered them.
One problem worth recognising: lumbar bone stress
Not every athlete with back pain has a bone injury. In younger athletes with persistent focal symptoms, it is important to consider.
The pars interarticularis is part of the bony arch behind a vertebra. Bone stress in this area ranges from an early stress response to a fracture, often called spondylolysis. Symptoms alone do not tell us where an athlete sits along this range. [3]
Early stress changes are not reliably visible on plain X-rays. MRI is used when the assessment raises suspicion and the result would help guide care. Training history and bone health also belong in the discussion. [3]
If bone stress is suspected, get assessed before continuing to push through the painful activity. Once diagnosed, the treating team should explain which sport loads need to stop or change, and which rehabilitation activities are appropriate.
For fast bowlers and their parents, I have written a plain guide to back stress fractures in fast bowlers on The Cricket Physio.
Do you have to wait before starting rehabilitation?
A 2026 trial gives us a better answer for adolescents with active lumbar spondylolysis. It compared starting supervised physiotherapy promptly with waiting for symptoms to resolve before starting.
The 64 participants were aged 10–19. Those starting earlier had better early pain and function outcomes, returned to sport sooner and reported fewer back pain recurrences over twelve months. [4]
Read the figure as text
Early physiotherapy began within seven days and progressed by pain and function. The delayed group started after symptoms settled and progressed by time. The chart measures back pain recurrence.
Starting rehabilitation is different from continuing painful sport. These findings concern adolescents with diagnosed spondylolysis. They do not tell us how to treat every person with a sore back.
A follow-up MRI analysis of 53 participants found no worse healing outcome with early physiotherapy. It came from the same trial, so it is additional information about these athletes rather than a second independent trial. [5]
Do you need a scan?
Not automatically. The Australian clinical care standard advises against routine imaging for uncomplicated low back pain. Concern about a serious underlying problem changes the decision. [1]
Suspected bone stress, significant trauma or neurological findings sometimes make imaging important. An assessment helps decide whether the result would change treatment.
A scan also needs interpretation. A finding on an image is one part of the picture, alongside symptoms, examination and the athlete’s history.
Feeling better is one part of returning
An athlete might feel fine walking, sitting and doing a gym session. Good news. It does not tell us how they will cope with an hour on the ergometer, a gymnastics routine, maximal sprinting or an AFL match.
Some injuries need protection from particular activities. Others are managed through adjustments to training and progressive exercise. Either way, the plan should explain what you are working towards and how you will get there.
A gymnast eventually needs repeated skills and landings. A rower needs longer periods of rowing. A sprinter needs high-speed running. Footballers need kicking, running and, where relevant, contact.
Those activities belong in rehabilitation before they arrive in competition. Watch the response afterwards, too. Tolerating one session and recovering well enough for the next are both useful information.
If pain keeps building, function deteriorates or progress stalls, get reassessed. If preparation has been interrupted, a reduced role early on is often more sensible than trying to fit several missed weeks into a few days.
Back pain does not mean your spine is fragile. It does deserve a clearer explanation than “your core is weak”. Start with your symptoms and training history, get the problem assessed, and expect the rehabilitation to prepare you for your sport.
Read more about lower back pain assessment in Richmond and cricket physiotherapy at Bridge Road.
Back pain getting in the way of sport?
Book an assessment at Bridge Road Physiotherapy, inside Uplift Gym at 507 Bridge Road, Richmond. We’ll review the problem, your current activity and the next steps for your rehabilitation.
References and further reading
- Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. 2022. Read the source.
- Wilson F, et al. 2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers. BJSM. 2021;55:893–899. Read the source.
- Selhorst M, et al. Rehabilitation considerations for spondylolysis in the youth athlete. International Journal of Sports Physical Therapy. 2020;15:287–300. Clinical commentary. Read the source.
- Selhorst M, et al. Immediate physical therapy is beneficial for adolescent athletes with active lumbar spondylolysis: a multicentre randomised trial. BJSM. 2026;60:125–132. Read the source.
- Sweeney EA, et al. Rest before physical therapy is not necessary to achieve bony healing of lumbar spondylolysis in adolescent athletes. Orthopaedic Journal of Sports Medicine. 2026;14. Read the source.
General education. An individual assessment is needed to diagnose your symptoms and choose appropriate care.