What do Steve Nash, Randy Johnson, Robin Lopez, and 80% of Americans have in common? They have all experienced back pain.

Nash's back has bothered him for years, yet he has been named NBA Most Valuable Player multiple times. Randy Johnson had to actually undergo back surgery, yet he still found a way to win 198 more games, four Cy Young awards, and a World Series. Robin Lopez continues to play for the Phoenix Suns.

It's obvious that sports are an important part of American society and culture. Millions watch football or basketball each week, many play golf or even move to places like Arizona to play golf. But while slam-dunking a basketball is a lot different from swinging a baseball bat or golf club, these sports cause the same amount of stress to the spine.

While most don't think about sports this way, sports are really nothing more than organized, competitive exercise programs. Very few people are lucky enough to make a living playing sports or to be paid to exercise every day. But, it does not matter whether you're a weekend warrior, a golf fanatic, or a marathon running tri-athlete. The key is that sports equal exercise. When performed safely and correctly, exercise is good for the heart, kind to the waist, and excellent for the back.

However, low back pain is still a common complaint among athletes, so proper rehabilitation is imperative. Most of us use sports as a form of exercise or recreation, yet surprisingly, professional athletes are similar to amateurs when it comes to back pain and activity. One study compared Olympic level athletes to non-athletes over a four year period and showed that while athletes had significantly more x-ray abnormalities, both groups had the same frequency of back pain.

Some believe these differences exist because of differences in core strength. The core muscles act in coordination like a hoop around the lower body. The deep layers of low back muscles attach directly to the bones of the lumbar spine. The lower back muscles have a thick, tough layer of tissue overlying them called the thoracolumbar fascia. The major abdominal muscles start in the front and wrap around connecting to this fascia. These connections create an integrated band of structures surrounding and supporting the lumbar spine, which actively links upper and lower extremity motions. Passively, these connections send feedback to the brain about the position of the trunk.

When it comes to the spine, core strength is more important than total muscle strength. During daily activity only about 10% of muscle control and strength is necessary. However as the discs of the spine degenerate and the ligaments become more lax, the core muscles are required to do more work to control and stabilize the spine. This is why it is so important these muscles stay strong – they help to unload the spine, which can help decrease pain. The spine must be conditioned enough to withstand the rigors of your form of exercise and sports; otherwise, one is at higher risk for injury during sports play.

Studies have shown that the core muscles function throughout the entire range of all sports-related motions. Weak muscles and altered neurological control of the core and other muscles may actually be the cause of most low back pain. Decreased strength and control cause abnormal spine motion, which becomes magnified when the body is performing exercise. Therefore, pain with exercise may be more related to the individual and less related to the sport. Although core strength decreases the recurrence rate of low back pain after an acute episode, it probably won't reduce the duration or intensity of the episode. The goal is to prevent the episode in the first place. Core strength can be the difference.

Inflexibility and strength deficits are usually the main focus of back rehabilitation. People with low back pain have decreased control of their muscles. Ideally, the core muscles should activate simultaneously before the larger muscles that actually move the arms or legs. People with low back pain show significantly delayed firing of these muscles. People with low back pain also demonstrate far less control of these muscles. Rehabilitation for those with low back pain associated with exercise usually begins with learning to gain better control of these muscles. Inflexibility and strength deficits are usually the main focus of back rehabilitation. I encourage every patient to return to full activity without restrictions when they achieve a pain free range of motion and regain their strength.

We should all exercise more. Our backs would really appreciate it. In general, exercise benefits the body and mind. No matter what the exercise, it's imperative to build a strong core in order to prevent pain or to recover after an injury. Exercise, done correctly, usually does not cause back pain, and the benefits to the entire body are enormous both short and long-term.