ArticlePDF AvailableLiterature Review

Prevalence of Back Pain in Sports: A Systematic Review of the Literature

June 2017
Sports Medicine 47(6)

DOI:10.1007/s40279-016-0645-3

License
CC BY 4.0

Authors:

Katharina Trompeter

Hochschule für Gesundheit

Daniela Fett

Ruhr-Universität Bochum

Petra Platen

Ruhr-Universität Bochum

Background Back pain is a frequent health problem in the general population. The epidemiology of back pain in the general population is well researched, but detailed data on the prevalence and risk factors of back pain in athletes are rare. Objective The primary objective was to review articles about back pain in athletes to provide an overview of its prevalence in different sports and compare its prevalence among various types of sports and the general population. Data SourcesA comprehensive search of articles published through May 2015 was conducted. Two independent reviewers searched six databases from inception (PubMed®, Embase, MEDLINE®, Cochrane Library, PsycINFO and PSYNDEX), using specifically developed search strategies, for relevant epidemiological research on back pain in 14- to 40-year-old athletes of Olympic disciplines. The reviewers independently evaluated the methodological quality of reviewed articles meeting the inclusion criteria to identify potential sources of bias. Relevant data were extracted from each study. ResultsForty-three articles were judged to meet the inclusion criteria and were included in the assessment of methodological quality. Of these, 25 were assessed to be of high quality. Lifetime prevalence and point prevalence were the most commonly researched episodes and the lower back was the most common localization of pain. In the high-quality studies, lifetime prevalence of low back pain in athletes was 1–94%, (highest prevalence in rowing and cross-country skiing), and point prevalence of low back pain was 18–65% (lowest prevalence in basketball and highest prevalence in rowing). Conclusion The methodological heterogeneity of the included studies showed a wide range of prevalence rates and did not enable a detailed comparison of data among different sports, within one discipline, or versus the general population. Based on the results of this review, however, it seems obvious that back pain requires further study in some sports.

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SYSTEMATIC REVIEW

Prevalence of Back Pain in Sports: A Systematic Review

of the Literature

Katharina Trompeter

•Daniela Fett

•Petra Platen

Published online: 29 December 2016

ÓThe Author(s) 2016. This article is published with open access at Springerlink.com

Abstract

Background Back pain is a frequent health problem in the

general population. The epidemiology of back pain in the

general population is well researched, but detailed data on

the prevalence and risk factors of back pain in athletes are

rare.

Objective The primary objective was to review articles

about back pain in athletes to provide an overview of its

prevalence in different sports and compare its prevalence

among various types of sports and the general population.

Data Sources A comprehensive search of articles pub-

lished through May 2015 was conducted. Two independent

reviewers searched six databases from inception

(PubMed

, Embase, MEDLINE

, Cochrane Library,

PsycINFO and PSYNDEX), using speciﬁcally developed

search strategies, for relevant epidemiological research on

back pain in 14- to 40-year-old athletes of Olympic disci-

plines. The reviewers independently evaluated the

methodological quality of reviewed articles meeting the

inclusion criteria to identify potential sources of bias.

Relevant data were extracted from each study.

Results Forty-three articles were judged to meet the

inclusion criteria and were included in the assessment of

methodological quality. Of these, 25 were assessed to be of

high quality. Lifetime prevalence and point prevalence

were the most commonly researched episodes and the

lower back was the most common localization of pain. In

the high-quality studies, lifetime prevalence of low back

pain in athletes was 1–94%, (highest prevalence in rowing

and cross-country skiing), and point prevalence of low

back pain was 18–65% (lowest prevalence in basketball

and highest prevalence in rowing).

Conclusion The methodological heterogeneity of the

included studies showed a wide range of prevalence rates

and did not enable a detailed comparison of data among

different sports, within one discipline, or versus the general

population. Based on the results of this review, however, it

seems obvious that back pain requires further study in

some sports.

Key Points

Back pain is a frequent health problem in athletes.

The prevalence rates of back pain in athletes vary

enormously.

Validated instruments and consideration of

seasonality are needed in further studies to determine

prevalence rates of back pain in sports.

K. Trompeter and D. Fett contributed equally to this paper.

Electronic supplementary material The online version of this

article (doi:10.1007/s40279-016-0645-3) contains supplementary

material, which is available to authorized users.

&Katharina Trompeter

katharina.trompeter@rub.de

Daniela Fett

daniela.fett@rub.de

Petra Platen

petra.platen@rub.de

Department of Sports Medicine and Sports Nutrition, Ruhr-

University Bochum, Gesundheitscampus Nord Haus 10,

44801 Bochum, Germany

123

Sports Med (2017) 47:1183–1207

DOI 10.1007/s40279-016-0645-3

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

1 Introduction

Back pain, especially low back pain is a frequent health

problem in the general population. It can cause disability,

reduce the quality of life, and impair ability to work, which

constitutes a great socioeconomic burden on patients and

society [1]. It is also the leading cause of limitation of

activity and absence from work throughout most parts of

the world [2–6], and results in enormous costs for the

healthcare system.

In the general population, the epidemiology of back pain

and low back pain is well researched, but due to the

methodological heterogeneity among studies, a wide range

of prevalence has been reported for different groups over

time. Lifetime prevalence for the general population has

been reported to be as high as 85% [7,8]. One-year

prevalence of low back pain ranges from 1 to 83% and

point prevalence from 1 to 58% [3,9]. Nevertheless, an

accurate estimate of prevalence is necessary to assess the

impact of back pain in the population and is an important

basis for etiologic studies and healthcare evaluations [3].

The relationship between low back pain and physical

activity has also been well researched [10,11]. The

importance of physical activity in the treatment of low

back pain is generally accepted. However, an increase in

physical activity has been suggested to be both a preventive

factor and a possible risk factor for low back pain. There is

evidence for an association between high physical work-

loads and back injury. For example, occupational exposure,

strenuous workloads, frequent lifting, bending and twist-

ing, and extreme sports activities are well-recognized risk

factors for low back pain [10–13]. At the same time, it is

suggested that an inactive or sedentary lifestyle is associ-

ated with low back pain complaints. Studies focusing on

physical activity and low back pain indicate that the rela-

tionship between activity level and low back pain follows a

U-shaped curve [11,14,15]. Many studies have shown that

both too little and too much activity is harmful to spinal

health [10,11,16–20], but the relationship between sports

and spinal health has not been adequately clariﬁed. Elite

athletes have a higher grade of physical activity and thus

might have a higher risk of developing back pain. They

spend much time in training and competition, which sub-

jects their bodies to a great deal of mechanical strain and,

thus, a high level of stress on the musculoskeletal system.

Depending on the sports discipline, this stress is exceed-

ingly high especially in the years from adolescence

(14 years of age), in which elite competitive sports begin,

until peak competitive performance at ages of up to

40 years [21]. The amount of strain on the back depends on

the duration, intensity, and frequency of training, the type

of sport, the level of competition, and the training periods

during the year. However, the exact inﬂuence of this daily

strain on back pain is not known. It is well known that

sports participation generally inﬂuences health in a positive

way [11], but there is a lack of knowledge about the

optimal dose-effect relation. As in the general population,

back pain in athletes can lead to high costs of treatment,

dropping out of training and competition, decreased quality

of life, and limitations to performance [22]. In this context,

back pain is a relevant topic for sports medicine profes-

sionals as well as for athletes, coaches, and physiothera-

pists. Of particular concern is whether sports, and what

types of sports, are associated with a higher or lower

prevalence of back pain compared with other sports; how

the training and competition level affect the prevalence of

back pain; and the general population. This information

would facilitate identiﬁcation of possible risk factors and

the development of prevention strategies in special-risk

sport groups. At present, the prevalence of back pain,

especially low back pain, with respect to sport-speciﬁc

loads and types of sports remains unclear.

The purpose of this study was to review articles on back

pain in athletes ranging from adolescence (14 years of age)

to the maximal age of peak competitive performance

(40 years of age) to more precisely determine the preva-

lence rates of back pain in different sports, compare the

prevalence of back pain in different types of sports, and

compare these with the general ‘‘non-sporting’’ population.

2 Methods

Details of the search strategy method, inclusion criteria,

analysis method, and data extraction form were speciﬁed

beforehand and documented in a protocol. This protocol

was not modiﬁed during the study to restrict the likelihood

of biased post-hoc decisions, such as selective outcome

reporting.

2.1 Search Strategy

A systematic review of the literature was performed in

accordance with the Preferred Reporting Items for Sys-

tematic Review and Meta Analyses (PRISMA) statement

using the PRISMA checklist [23]. From 1 January 2015 to

31 May 2015, two independent researchers (KT and DF)

undertook a comprehensive computerized search regarding

the prevalence of back pain in sports. Athletes were deﬁned

as 14- to 40-year-old individuals participating in competi-

tions of an Olympic discipline at any competition level. Six

databases (PubMed

, Embase, MEDLINE

, Cochrane

Library, PsycINFO, and PSYNDEX) were searched elec-

tronically from inception using the terms ‘back pain’, ‘neck

1184 K. Trompeter et al.

123

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pain,’ and ‘spine’ occurring in combination with the terms

‘sports’ AND ‘prevalence.’ Additionally, these terms were

combined with terms of different Olympic sports (‘alpine

skiing’ OR ‘aquatics’ OR ‘archery’ OR ‘badminton’ OR

‘basketball’ OR ‘boxing’ OR ‘biathlon’ OR ‘bobsleighing’

OR ‘canoe’ OR ‘cross-country skiing’ OR ‘curling’ OR

‘cycling’ OR ‘equestrian’ OR ‘fencing’ OR ‘ﬁgure skating’

OR ‘football’ OR ‘freestyle skiing’ OR ‘golf’ OR ‘gym-

nastics’ OR ‘handball’ OR ‘hockey’ OR ‘horse riding’ OR

‘ice hockey’ OR ‘judo’ OR ‘luge’ OR ‘Nordic combined’

OR ‘pentathlon’ OR ‘rugby’ OR ‘running’ OR ‘sailing’ OR

‘shooting’ OR ‘short track’ OR ‘ski jumping’ OR ‘snow-

boarding’ OR ‘soccer’ OR ‘speed skating’ OR ‘swimming’

OR ‘table tennis’ OR ‘taekwondo’ OR ‘tennis’ OR ‘track

and ﬁeld’ OR ‘trampoline’ OR ‘triathlon’ OR ‘volleyball’

OR ‘water polo’ OR ‘wrestling’ OR ‘weightlifting’). Each

database automatically uses its own term mapping. The

exact search strategy used in the present study is shown in

Electronic Supplementary Material Table S1. The results

were screened to identify relevant studies, ﬁrst by title, next

by abstract, and ﬁnally by full text. Non-relevant titles and

abstracts were omitted. Full texts were screened regarding

the inclusion criteria and were included in the review only

if they met all criteria. Differences in search outcomes

were veriﬁed and consensus for inclusion was reached. All

English- or German-language articles investigating the

occurrence of back pain in sports and published before 31

May 2015 were identiﬁed for this review, and all reference

lists of selected articles were checked for other relevant

articles.

2.2 Inclusion and Exclusion Criteria

Studies investigating the occurrence of back or neck pain in

sports were identiﬁed. There was no limitation on how this

was measured or with regard to study design. Other

inclusion criteria were:

1. Full report published in a scientiﬁc journal;

2. Study written in English or German;

3. Sample represented athletes participating in an Olym-

pic sport;

4. Study examined sport-speciﬁc prevalence rates;

5. Age of sample between 14 and 40 years;

6. Outcome included the association between sports and

the presence of cervical, thoracic, or lumbosacral pain

using one of the following terms: ‘back pain’, ‘cervical

pain’, ‘neck pain’, ‘thoracic pain’, ‘upper back pain’,

‘lumbar pain’, ‘lumbosacral pain’, ‘lower back pain’,

or ‘low back pain’.

Letters and abstracts, studies investigating the general

population and medical patients, and studies investigating

pain from a speciﬁc cause (i.e., traumatic injury) were

excluded.

2.3 Assessment of Methodological Quality

To explore the heterogeneity of the study results, we

hypothesized before conducting the analysis that preva-

lence rates of back pain may differ according to the

methodological quality of the studies. Thus, we decided

Table 1 Study methodological quality critical appraisal tool

A: Is the ﬁnal sample representative of the target population?

1. At least one of the following must apply to the study: an entire target population, randomly selected sample, or sample stated to represent

the target population

2. At least one of the following: reasons for nonresponse described, nonresponders described, comparison of responders and nonresponders, or

comparison of sample and target population

3. Response rate and, if applicable, drop-out rate reported

B: Quality of the data?

4. Were the data primary data of back pain or were they taken from a survey not speciﬁcally designed for that purpose?

5. Were the data collected from each adult directly or were they collected from a proxy?

6. Was the same mode of data collection used for all subjects?

7. At least one of the following in the case of a questionnaire: a validated questionnaire or at least tested for reproducibility

8. At least one of the following in the case of an interview: interview validated, tested for reproducibility, or adequately described and

standardized

9. At least one of the following in the case of an examination: examination validated, tested for reproducibility, or adequately described and

standardized

C: Deﬁnition of back pain

10. Was there a precise anatomic delineation of the back area or reference to an easily obtainable article that contains such speciﬁcation?

11. Was there further useful speciﬁcation of the deﬁnition of back pain, or question(s) put to study subjects quoted such as the frequency,

duration, or intensity, and character of the pain. Or was there reference to an easily obtainable article that contains such speciﬁcation?

12. Were recall periods clearly stated: e.g., 1 week, 1 month, or lifetime?

Prevalence of Back Pain in Sports 1185

123

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that a minimum requirement for meaningful data collection

and interpretation had to be reached to reduce the risk of

bias [2]. Selected articles that met the inclusion criteria

were evaluated for methodological quality by applying a

critical-appraisal tool (Table 1), which was devised by

Leboeuf-Yde and Lauritsen [2]. The original tool consisted

of 11 criteria. Walker [3] subsequently modiﬁed this tool

by adding one additional criterion. It was used in previous

reviews examining the prevalence of back pain and uses

three methodological tests containing 12 criteria for

prevalence studies [2–4]. The criteria are related to the

representativeness of the study sample, quality of data, and

deﬁnition of back pain. The criteria were veriﬁed for their

presence (criterion fulﬁlled) or absence (criterion not ful-

ﬁlled) in the studies. To assess methodological quality,

each study was given a methodological score, expressed as

the proportion of fulﬁlled criteria out of the total number of

criteria. The mean methodological score of the studies was

69% [standard deviation (SD) 17%; range 30–100%] and

was used to estimate a cutoff-point to gain insight into the

risk of bias within the results [4]. According to other epi-

demiological reviews that used the same critical appraisal

tool [3,4], this point was arbitrarily set marginally lower

than that mean, thus, the authors considered a score of 65%

and above to indicate a high-quality study. Studies with a

score \65% were considered to be of low quality. Only

high-quality studies were included in this review. Two

reviewers (KT and DF) independently assessed the quality

of each study. Disagreement between the reviewers on

individual items was discussed until consensus was

reached. Overall between-reviewer agreement per item of

the critical appraisal tool was calculated by unweighted

kappa statistic (j), with values between 0.61 and 0.80

considered substantial agreement and values between 0.81

and 1.00 considered almost perfect agreement [24].

2.4 Data Extraction and Analysis

A data extraction sheet was pilot-tested independently from

both reviewers on ten included studies and reﬁned

accordingly. In the preparation of the systematic review,

one reviewer independently extracted deﬁned data from the

Records identified through

database searching

(

n = 10455

)

Screening

Included Eligibility Identification

Records excluded on the

basis of non-relevant titles

(

n = 8698

)

Abstracts screened

(n = 1774)

Abstracts excluded

(n = 1346)

Full-text articles assessed for

eligibility (n = 428)

Full-text articles excluded

with reasons (n = 385)

- Age <14 or >40 years (n = 40)

- Former athletes (n = 21)

- Traumatic injuries (n = 37)

- Degenerative changes (n = 46)

- Biomechanics of athletes with back

pain (n = 139)

- Physical activity treatment (n = 31)

- Non-Olympic discipline (n = 20)

- Reviews and summaries (n = 44)

-Case re

ort

(

n = 7

)

Studies included in

qualitative synthesis

(

n = 43

)

Studies included in data

pooling (n = 6)

Additional records identified

through other sources

(

n =17

)

Fig. 1 PRISMA ﬂow diagram

1186 K. Trompeter et al.

123

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Table 2 Quality assessment of trials meeting the inclusion criteria

Representative Quality of data Deﬁnition of back pain Total score (%)

123456789101112

Aggrawal et al. [25] CNF CNF CNF CF CF CF NA NA CNF CNF CF CNF 40

Alricsson and Werner [50] CF CNF CF CF CF CF CF NA NA CF CF CF 90

Bahr [32] CNF CNF CF CF CF CF CF NA NA CF CF CF 80

Bahr et al. [29] CFCFCFCFCFCFCFNANACF CF CF 100

Baranto et al. [49] CFCFCFCFCFCFCFNANACF CF CF 100

Bergstrøm et al. [71] CF CNF CF CF CF CF NA NA CF CNF CF CNF 70

Brynhildsen et al. [34] CF CNF CF CF CF CF CNF NA NA CF CF CF 80

Brynhildsen et al. [72] CF CNF CNF CF CF CF CNF NA NA CF CNF CF 60

Cali et al. [52] CF CF CNF CF CF CF NA NA CF CF CF CF 90

Cabri et al. [30] CNF CNF CF CF CF CF CF NA NA CF CF CF 80

Clarsen et al. [44] CNF CNF CF CF CF CF NA CF NA CF CF CF 80

Dubravcic-Simunjak et al. [55] CF CNF CF CNF CF CF CNF NA NA CF CF CF 70

Eriksson et al. [43] CF CNF CF CF CF CF CNF NA NA CF CF CF 80

Greene et al. [73] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Hangai et al. [40] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Haydt et al. [47] CNF CNF CNF CF CF CF CF NA NA CF CF CF 70

Howell [57] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Hutchinson [33] CNF CNF CNF CF CF CF NA NA NA CF CF CF 67

Iwamoto et al. [39] CF CNF NA CF CF CF NA NA CNF CF CF CF 78

Kaneoka et al. [38] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Kernahan et al. [74] CNF CNF CNF CF CF CF CNF NA NA CNF CF CF 50

Koyama et al. [36] CNF CNF CNF CF CF CF CF NA NA CF CNF CF 60

Lindgren and Twomey [75] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Lively [42] CNF CNF NA CF CF CF NA NA CF CF CF CF 78

Maselli et al. [28] CF CNF CF CF CF CF CF NA NA CF CF CF 90

Martins et al. [41] CNF CNF CNF CNF CF CF CNF NA NA CNF CNF CF 30

Mulhearn and Georg [76] CNF CNF CNF CF CF CF CNF NA NA CF CF CF 60

Murtaugh [35] CNF CNF CF CF CF CF CNF NA NA CNF CNF CF 50

Newlands et al. [27] CF CNF CF CF CF CF CNF NA NA CF CF CF 80

Ng et al. [45] CF CNF CF CF CF CF CNF NA NA CF CF CF 80

Okada et al. [37] CNF CNF CNF CF CF CF CF NA NA CF CF CNF 60

Perich et al. [53] CNF CNF CF CF CF CF CF NA NA CF CF CF 80

Reilly and Seaton [77] CNF CNF CF CF CF CF CNF NA NA CNF CNF CF 50

Roy et al. [51] CNF CNF CNF CF CF CF CF NA NA CF CF CF 70

Selanne et al. [54] CNF CNF CF CF CF CF CF NA NA CF CF CF 80

Swa

¨rd et al. [46] CF CNF CNF CF CF CF CNF NA NA CF CF CF 70

Swa

¨rd et al. [48] CF CF CNF CF CF CF NA CF NA CF CF CF 90

Szot et al. [78] CNF CNF CNF CF CF CF NA NA CNF CNF CNF CNF 30

Tunas et al. [31] CNF CF CF CF CF CF CF NA NA CF CF CF 90

van Hilst et al. [26] CNF CNF CF CF CF CF CF NA NA CF CF CF 90

Vad et al. [79] CNF CNF NA CF CF CF NA NA CNF CF CF CNF 56

Vad et al. [80] CNF CNF CNF CF CF CF NA CNF NA CF CF CF 60

Willscheid et al. [81] CNF CNF CF CNF CF CF CNF NA NA CNF CNF CF 40

CF criterion fulﬁlled, CNF criterion not fulﬁlled, NA not applicable

See Table 1for deﬁnitions of 1 to 12

Prevalence of Back Pain in Sports 1187

123

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included studies, and the other checked the data of each

study. Disagreements were resolved by discussion between

the two reviewers. If no agreement could be reached, it was

planned that a third author would decide. The ﬁrst author,

country, explored sports discipline, ﬁnal sample size, age

and sex distributions, sports level, response rate, collection

mode, deﬁnition of pain, pain localization, recall periods,

prevalence data, and calculated risk factors were extracted

from each study. This was separately conducted for the

high- and low-quality studies. The original authors were

not contacted for further details.

All extracted data were rounded to the nearest integer.

The analysis of prevalence data refers only to high-quality

studies. Additionally, the studies were evaluated with

respect to the confounders’ age and sex.

2.5 Data Pooling

Studies that used exactly the same instrument for data

collection were summarized and the results were pooled if

studies reported the same time periods and the same

localization of pain. The overall prevalence rate of back

pain for all athletes within these pooled data was calculated

considering the sample sizes. To achieve this, the total

number of athletes reporting back pain was calculated for

each study. This was done using information on sample

size and prevalence rate in percentages. The total number

of athletes as well as the total number of athletes with back

pain were then calculated. The overall prevalence rate was

calculated using this information.

3 Results

3.1 Search Strategy

The comprehensive computerized search for published

epidemiological research with regard to prevalence of

back pain in sports (Fig. 1) achieved 10,455 hits. In

addition, 17 relevant articles were identiﬁed by checking

the reference lists of selected articles. First, all titles were

screened and 8698 non-relevant titles were omitted. In the

next step 1774 abstracts were screened according to their

relevance. Of these, 1346 were excluded, mainly because

of failure to examine an athletic population. For example,

many studies examined physical activity treatments in

back pain patients after rehabilitation. After exclusion of

these 1346 abstracts, 428 studies were considered eligible

for full-text screening. Full-text screening led to the

exclusion of 385 studies on the basis of disagreement with

the inclusion criteria. Reasons for exclusion are shown in

Fig. 1. Ultimately, 43 studies were included in the qual-

itative synthesis.

3.2 Methodological Assessment

Forty-three articles were judged to have met the inclusion

criteria and were included in the methodological-quality

assessment (Table 2). Agreement per item between the two

independent reviewers was 92% (472/516 items), which

resulted in almost perfect agreement (j=0.855; standard

error: 0.021).

Twenty-ﬁve articles had a score of 65% or more and

were thus assessed as high-quality studies. The most

common methodological deﬁcits were related to represen-

tativeness of the sample (65%), information about nonre-

sponders (88%), response and drop-out rates (50%), and no

valid or adequately described and standardized method in

case of a questionnaire (56%) or examination (57%). In

19% of the studies there was no mention of any anatomic

delineation of the back area.

3.3 General Description of High- and Low-Quality

Studies

Descriptive data extracted from the 25 high-quality studies

are represented as an overview summary in Tables 3and 4.

The 18 low-quality studies can be seen in Electronic

Supplementary Material Table S2. All high- and low-

quality studies were published between 1979 [25] and 2015

[26–28] and employed various modes of data collection,

including questionnaires, interviews, examinations, and

medical reports. Questionnaires were the most common

method for data collection (32 studies); 14 of the 32 used

validated questionnaires and six used the Nordic Ques-

tionnaire [26,28–32]. The ﬁnal sample size of Olympic

disciplines ranged from seven [33] to 361 [34]. Nineteen

studies reported a response rate varying between 32% [28]

and 100% [26,29,35], mean response rate was 81%.

Recall periods varied from present to lifetime and descri-

bed a full array of prevalence data, and most (22 studies)

reported lifetime prevalence. Point prevalence was deﬁned

as pain at the time of examination or during the last 7 days.

Five studies were from Japan [36–40], one was from

Brazil [41], and one was from India [25], the remainder

were from Western countries.

Prevalence data for 26 different Olympic disciplines

were extracted. The most frequently investigated disci-

plines were soccer, gymnastics, rowing, and ﬁeld hockey,

with nine, eight, seven, and six publications, respectively.

3.4 Deﬁnition of Back Pain

For all high- and low-quality studies, there was no consensus

regarding the deﬁnition of back pain, low back pain, thoracic

pain, and neck/cervical pain. The pain differed with respect

to localization, intensity, frequency, and duration. In some

1188 K. Trompeter et al.

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Table 3 Characteristics of high-quality studies included in the review (Summer Olympic disciplines)

References Country Final sample

size

Age [years]

mean ±SD

(range)

Level Response

rate [%]

Collection

mode

Deﬁnition of pain Localization Recall

periods

Prevalence [%]

Basketball

Brynhildsen

et al. [34]

Sweden 150 (F) Med: 21

(16–31)

Swedish ﬁrst league

clubs

85 Q Subjective feeling of back

pain; if she had suffered

from low back pain ever

(previous) or during the

last wk (current)

LB LT, 7-d LT: 53,

7-d: 21

Cabri et al.

[30]

Germany 100 20.4 (15–35) Regional/national

squat/selection

50 Q Pain, ache, or discomfort

in the lower back with

or without radiation to

one or both legs

B, LB, TH,

LT, 1-yr,

7-d

LT: B: 76, LB:

46, TH: 17,

C: 22;

1-yr: LB: 35,

TH: 20, C:

21;

7-d: LB: 18,

TH: 6, C: 4

Cycling

Clarsen

et al. [44]

Norway 109 26 ±4 UCI World Tour/

Tour de France

level, UCI Europe

Tour level

94 In Pain, ache, or soreness in

the low-back with or

without radiating pain to

the gluteal area or lower

extremities

LB LT, 1-yr LT: 65,

1-yr: 58

Dancing

Lively [42] USA 31 19 (17–22) Student-athletes – E Pre-existing recurrent low

back pain was deﬁned as

lumbar pain on at least

two previous occasions

that required the athlete

to suspend participation

in sports for at least one

day

LB LT 3

Field hockey

Haydt et al.

[47]

USA 90 (F) 19 ±1

(18–22)

NCAA Division III

intercollegiate

– Q low back pain lasting

more than 24 h, not

associated with

menstruation

LB I 56

Prevalence of Back Pain in Sports 1189

123

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Table 3 continued

References Country Final sample

size

Age [years]

mean ±SD

(range)

Level Response

rate [%]

Collection

mode

Deﬁnition of pain Localization Recall

periods

Prevalence [%]

van Hilst

et al. [26]

The Netherlands T: 61 Elite, highest level

in their age

Category

Junior (RG)

Cadet NS

Youngsters NS

Master NS

Senior NS

Newlands

et al. [27]

Rowing Multivariate logistic regression model

Pearson correlations

Relationship between

potential RF and low

back pain

Age S (OR =1.08; p=0.02; 95% CI

1.01–1.15)

Sex NS

BMI NS

Rowing discipline NS

History of previous

low back pain

S (OR =2.06; p=0.01; 95% CI

1.22–3.48)

MCS score NS

Relationship between

training load and low

back pain

Total TH/mo S (r=0.83, p\0.01)

Number of ergometer

TH/mo

S(r=0.80, p\0.01)

Average TH/mo S (r=0.73, p\0.01)

Average number of km

rowed per mo

S(r=0.71, p=0.01)

Ng et al.

[45]

Rowing Chi-square statistics Sex S (p\0.001)

Swa

¨rd et al.

[48]

Gymnastics Correlation by Pitman’s test, which

coincides with Fisher’s exact test

MRI ﬁndings NS

1202 K. Trompeter et al.

123

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

when considering degenerative changes of the spine that

might result from sport-speciﬁc loads. In the treatment and

exercise management of back pain, the focus is often on the

muscle system. However, as Belavy

´et al. [61] summarized

in a narrative review regarding whether exercise can pos-

itively inﬂuence the intervertebral discs, the discs are also

Table 5 continued

References Sport

discipline

Method Risk factor Results

Swa

¨rd et al.

[46]

Wrestling

Soccer

Gymnastics

Tennis

Correlation by Pitman’s test, which

coincides with Fisher’s exact test

Age S (p\0.05)

Radiological changes

Spondylolysis NS

Disc height reduction S (p\0.05)

Schmorl’s nodes S (p\0.05)

Change of conﬁguration

of vertebral body

S(p\0.05)

Tunas et al.

[31]

Soccer

Handball

Binary logistic regression TV NS

Seasons (years) NS

Soccer

Striker (RG)

Defender NS

Midﬁelder S (p=0.03; OR =2.5; 95% CI 1.1–5.7)

Forward NS

Goalkeeper S (p=0.05; OR =3.0; 95% CI 1.0–9.3)

Handball

Line player (RG)

Back NS

Wing NS

Goalkeeper NS

van Hilst

et al. [26]

Field

hockey

Soccer

Speed

skaters

Chi-square statistics

Bivariate logistic regression analysis

Sex S in ﬁeld hockey: p=0.01

Age S in speed skating: OR =1.4; p\0.05;

95% CI 1.1–1.9

BMI NS

Satisﬁed with

performance

S in ﬁeld hockey: OR =0.5; p\0.05;

95% CI 0.3–0.9

Satisﬁed with coaching

staff

S in ﬁeld hockey: OR =0.5; p\0.05;

95% CI 0.4–0.8

Number of training

hours

S in speed skating: OR =1.1; p\0.05;

95% CI 1.03–1.2

Stretching NS

Core stability training NS

Strength training

machine

Strength training weights NS

Performing Pilates S in speed skating: OR =4.1; p\0.05;

95% CI 1.1–15.7

Years of experience NS

Duration of warming up S in speed skating: OR =1.1; p\0.05;

95% CI 1.02–1.1

Having a job NS

ANOVA analysis of variance, BMI body mass index, CI conﬁdence interval, km kilometers, LB low back, MRI magnetic resonance imaging, MCS

Movement Competency Screen, mo month, NS not signiﬁcant, OR odds ratio, RF risk factor, RG reference group, Ssigniﬁcant, TH training

hours, TV training volume, vs. versus

Except where otherwise indicated

Prevalence of Back Pain in Sports 1203

123

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well-recognized sources of pain. A number of studies

summarized by Belavy

´et al. [61] examined intervertebral

disc degeneration and/or spinal abnormalities in speciﬁc

athletic populations, and thoracic and lumbar intervertebral

disc or spinal damage is more common in several different

types of sports. As Belavy

´et al. [61] reported, this is seen

in sports in which traumatic spinal injury is more frequent

(e.g., gymnastics, wrestling), in sports involving repetitive

loading of the spine during motion or load extremes (e.g.,

gymnastics, cricket, weightlifting, rowing), and in sports in

which the spine is subject to high-impact loads with

sometimes unpredictable landing forces (e.g., horseback

riding, volleyball). Due to the nature of these sports, it is

not surprising that the incidence of intervertebral disc or

spine abnormalities is higher. There is also some evidence

that upright activities such as running may have a protec-

tive effect on the intervertebral discs or, at an elite level,

are at least less detrimental to the intervertebral discs than

are other sports at an elite level. Some studies in the present

review investigated the relationship between radiographic

abnormalities and back pain [39,46,48,49]. Although

degenerative changes in the spine are not always accom-

panied by pain, the prevalence of back pain is increasingly

affected, even if just a few athletes with sports-related

spinal changes experience back pain.

4.4.2 Sex and Age

Sex and age are frequently discussed confounders regarding

back pain. Most studies in the literature have reported higher

prevalences for female than male athletes [17,62–67]. This

is often justiﬁed by the earlier maturity of girls or the dif-

ferences in their hormonal changes during puberty compared

with boys [64]. Additionally, the anatomic characteristics of

the female body can reinforce the development of back pain

and therefore lead to higher prevalence rates in females than

in males [64]. In this context, several studies have discussed

the lower muscle mass and bone densities of females that

might result in destabilization of the body and thus insufﬁ-

cient compensation for high loads, menstrual low back pain,

and pregnancy-related back pain [64,68,69]. However, the

result of the present review did not conﬁrm this hypothesis.

Most of the studies in this review that differentiated between

the two sexes found a higher prevalence of back pain in

male athletes. Only Ng et al. [45] found that male rowers

performed signiﬁcantly more hours of training than females

and that a higher training volume was linked to low back

pain or injuries in rowers. Swa

¨rd et al. [46] also found higher

prevalence of back pain in male athletes; however, it must

be considered that the male athletes were older than the

female athletes (median age of 19 vs. 16 years, respec-

tively), and this could be an age-related effect instead of a

sex-related effect.

Differences in the prevalence of musculoskeletal pain

between the sexes might also be inﬂuenced by different

factors. In some disciplines, male athletes might tolerate

higher loads because of their higher training volume,

higher loads during strength training, or differences in

basic rules (e.g., the number of sets in tennis). Addition-

ally, differences in spinal kinematics have been reported

for some disciplines, and spinal kinematics are suggested to

be associated with back pain.

Another frequently discussed confounder for back pain is

age. In the general population, the prevalence of back pain in

children and adolescents is reportedly lower than that in

adults, but is rising [18,70]. Although calculation of age-

related effects on back pain was not possible for all studies in

the present review, some of the investigated studies calculated

the effects of age on its own. Cali et al. [52], Maselli et al. [28],

and Ng et al. [45] did not ﬁnd age to be a risk factor for back

pain, while other researchers did [26,27,29,43]. Some studies

discussed the high vulnerability of the spine in growing

individuals as a risk factor for back pain in young athletes and

were therefore interested in the prevalence of back pain in

adolescent athletes. However, these studies did not compare

their results with an older population.

4.4.3 Anthropometrics

Various anthropometric parameters were examined as risk

factors for back pain, including height, weight, and body

mass index, and the results varied among the studies. At a

high competition level, anthropometrics usually differ

among different disciplines. For example, basketball

players or rowers usually are taller than gymnasts. On the

one hand, athletes with a stature that is typical in their

discipline (e.g., tall volleyball players) better meet the

requirements to become successful (compared to small

volleyball players). On the other hand, participation in

different sports generally leads to adaption by differently

stressed body structures. For example, the bodies of weight

lifters greatly differ from those of gymnasts. Accordingly,

it is difﬁcult to interpret anthropometric parameters as risk

factors in some disciplines. We are therefore unable to

determine whether an anthropometric parameter or a sport-

speciﬁc load is responsible for a back pain problem.

4.5 Study Limitations

This review did not cover all studies concerning back pain

prevalence in sports, it was limited to articles written in English

or German and published in scientiﬁc journals. Other sources of

information such as abstracts and reports were not considered. It

was also not a blinded review because the different studies were

easily recognizable. However, the reviewers had no personal or

professional ties to any of the authors of the articles reviewed.

1204 K. Trompeter et al.

123

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

The two reviewers gave independent assessments of the articles

and disagreements were discussed until consensus was reached.

Each article was judged solely on the basis of the full text; the

original authors were not contacted for further details. The

methodological measurement instrument was taken from a

prevalence study by Lebouef-Yde and Lauritsen [2], who

devised this instrument and arbitrarily set the threshold for

acceptability at 75%. Based on different instruments, preva-

lence reviews were assessed and demonstrated varying

thresholds for acceptability. Some studies set the threshold for

acceptability absolutely arbitrarily, others set no cutoff-point,

and several studies used the mean score for all studies in the

review as threshold for acceptability. Louw et al. [4]usedthe

same tool as that used in the present review. As in their review,

we used a cutoff-point based on a mean methodological quality

assessment score, which might have inﬂuenced the results.

There were some differences between the results of high- and

low-quality studies. For example, the overall lifetime preva-

lence of low back pain was higher in low-quality than in high-

quality studies. Fewer low-quality studies demonstrated low

prevalence rates, so that the range was 53–92%. Quality

assessment of studies that are included in systematic reviews is

important but is also considered a source of scientiﬁc contro-

versy. Quality scores can be misleading because there is no

objective way to assess quality, and different methods lead to

different analytic results. It is also difﬁcult to determine how to

weight each item in an overall quality score. However, it has

been suggested that sum scores in a systematic review can help

to distinguish between studies with low versus high risk of bias

[11]. Nevertheless, the tool we used in this review must be

applied critically. Although it focuses exactly on the topic of our

interest, it addresses the epidemiology of back pain, which

involves the general population and not a special population

like athletes. In particular, the items focusing on the represen-

tativeness of the sample scored conspicuously poorly. Further

research should develop a tool that is more precise for athletes.

For example, it should assess the deﬁnition of athletes and

differentiate more precisely the details of training and

competition.

The data pooling in this review must also be interpreted

with caution. A comparison between representative samples

that considers the exact distribution of disciplines among

athletes is needed to formulate a general statement of back

pain in athletes and in the general population. However, this

review gives a ﬁrst indication that there is in an increased risk

of back pain in athletes of some disciplines.

5 Conclusion

In the current review, we examined the literature on

prevalence and risk factors for back pain in Olympic sports.

The methodological heterogeneity of the included studies

showed a wide range of prevalence rates and did not enable

a detailed comparison of data among different sports,

within one discipline, or versus the general population.

Based on the results of this review, however, it seems

obvious that back pain requires further study in some

sports. Back pain seems to be a problem in some sports that

have been thoroughly investigated, while other sports have

been less frequently investigated or even not investigated at

all. These sports might have a preventive effect on the

development of back pain, which also requires clariﬁcation

in further research. This would offer the opportunity for

high-risk sports to positively inﬂuence back pain or even

prevent it. Our comparison with the general population

provides the ﬁrst data indicating that some sports seem to

have a higher risk for back pain. However, as many studies

in the literature suggest, a sedentary lifestyle also leads to

higher prevalence rates. The optimal dose-effect relation-

ship in sports remains unclear and needs to be examined in

further research. Also the inﬂuence of uninvestigated fac-

tors, such as psychosocial factors, needs further examina-

tion. This review is the basis for future development of

sport-speciﬁc back pain prevention strategies. For this

purpose, it is additionally important to understand exactly

what type of strain in which sports involves the spine and

whether this strain is detrimental or beneﬁcial for the spine.

In general, when comparing the prevalence of back pain in

different sports, it is also of importance to consider sport-

speciﬁc characteristics that might inﬂuence prevalence

rates. These characteristics are due to differences in the

contents of training and competition, body anthropomet-

rics, and the age of peak competitive performance. Further

research should more precisely focus on the differences in

sports disciplines and their speciﬁc risk factors using

identical tools for data collection. This would provide the

opportunity to develop special prevention strategies for

back pain. Additionally, athletes, coaches, physicians, and

physiotherapists should be sensitized to the back pain

problem in athletes and seek to integrate prevention pro-

grams in daily training.

Acknowledgements This review was conducted within the MiSpEx

(National Research Network for Medicine in Spine Exercise) research

consortium.

Compliance with Ethical Standards

Funding No sources of funding were used to assist in the preparation

of this article.

Conﬂict of interest Katharina Trompeter, Daniela Fett, and Petra

Platen declare that they have no conﬂicts of interest relevant to the

content of this review.

Open Access This article is distributed under the terms of the

Creative Commons Attribution 4.0 International License (http://

creativecommons.org/licenses/by/4.0/), which permits unrestricted

Prevalence of Back Pain in Sports 1205

123

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use, distribution, and reproduction in any medium, provided you give

appropriate credit to the original author(s) and the source, provide a

link to the Creative Commons license, and indicate if changes were

made.

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Supplementary Material 2

Data

January 2017

Katharina Trompeter · Daniela Fett · Petra Platen

Supplementary Material 1

Data

January 2017

Katharina Trompeter · Daniela Fett · Petra Platen

Supplementary Material 3

Data

January 2017

Katharina Trompeter · Daniela Fett · Petra Platen

The prevalence and risk factors of lower back pain among the general population in Al-Baha region, Saudi Arabia

Article

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Dec 2022

Cross-sectional study of characteristics and prevalence of musculoskeletal complaints in 1170 male golfers

Article

Full-text available

Mar 2023

Objectives The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises. Methods A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ ² test. Results The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints. Conclusion The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study

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Mar 2023
BMC MUSCULOSKEL DIS

Background Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status. Methods A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires. Results Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10—0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08—0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14–8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40–11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1–8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21–0.75, P = 0.03). Conclusion MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

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Jan 2022

The correlation between low back pain and strength training in elite athletes: a literature review

Article

Full-text available

Mar 2023

This systemic review aims to analyze the correlation between LBP and elite athletes who practice sports where strength training intervenes via weightlifting. To analyse the correlation between low back pain and athletes who practice sports where strength training programs, a narrative review was conducted by two independent author through MEDLINE database search. Inclued study’s methodology quality has been evaluated using NIH quality assessment tool for Observational Cohort and Cross-Sectional Studies. Out of 830 retrieved articles, after titles, abstracts and full text assessment, four studies met the inclusion criteria and were included in the present narrative review. The NIH total score ranged from 10 to 12 points. Demographic and sport-specific factors can influence the prevalence of LBP. Our findings highlight the importance of developing future research to provide prevention programs to reduce the incidence of LBP, taking into account the demographics of athletes and the unique nature of their sport activity. Keywords: Low back pain, weight lifting, strength sport, strength training, rehabilitation, muscle injuries, correlation.

Association Between Domain-Specific Physical Activity and Chronic Low Back Pain in Community-Dwelling Older Adults: A Cross-Sectional Study

Article

Jan 2023

To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the “more active” participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as “more active” in the household, sports, leisure-time, and total PA domains, respectively. “More active” participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP.

Multimedia Instructions for Motor Control Exercises in Patients With Chronic Nonspecific Low Back Pain

Article

Jan 2023

Background: Low back pain (LBP) is one of the top 3 diseases that may lead to disability. Current treatment guidelines define exercise as a first-line treatment for nonspecific LBP (NSLBP). There are various evidence-based exercise approaches for treating NSLBP, and many of them include motor control principles. Motor control exercises (MCEs) are better than general exercises that do not include motor control principles. Many patients find learning these exercises complex and challenging, in that MCE exercises have no standard teaching method. The researchers of this study developed multimedia instructions for an MCE program to make teaching MCE easier; thus, more effective. Methods: The participants were randomized into multimedia or standard (face-to-face) instruction groups. We applied the same treatments to both groups at the same dosage. The only differences between groups were the exercise instruction methods. The multimedia group learned MCE from multimedia videos; the control group learned MCE from a physiotherapist with face-to-face instructions. Treatment lasted 8 weeks. We evaluated patients' exercise adherence with Exercise Adherence Rating Scale (EARS), pain with the Visual Analog Scale, and disability with Oswestry Disability Index. Evaluations were made before and after treatment. Follow-up evaluations were carried out 4 weeks after the end of treatment. Results: There was no statistically significant interaction between the group and time on pain, F2,56 = 0.068, P = .935, partial η2 = .002 and Oswestry Disability Index scores, F2,56 = 0.951, P = .393, partial η2 = .033. Also, there was no statistically significant interaction between the group and time on Exercise Adherence Rating Scale total scores F1,20 = 2.343, P = .142, partial η2 = .105. Conclusions: This study showed that multimedia instructions for MCE have similar effects to standard (face-to-face) instructions on pain, disability, and exercise adherence in patients with NSLBP. To our knowledge, with these results, the developed multimedia instructions became the first free, evidence-based instructions that have objective progression criteria and a Creative Commons license.

Examining the Peer-Reviewed Published Literature Regarding Low Back Pain in Rowing: A Scoping Review

Article

Full-text available

Feb 2023
Int J Sports Phys Ther

Background Low back pain (LBP) is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods. Purpose The purpose of this scoping review was to explore the breadth and depth of the LBP literature in rowing and to identify areas for future research. Study Design Scoping review Methods PubMed, Ebsco and ScienceDirect were searched from inception to November 1, 2020. Only published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing were included for this study. Arksey and O’Malley’s framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool. Results Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use. Conclusion A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and barriers to injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.

Chronic Nonspecific Back Pain

Article

Jan 2023

Back Pain Prevalence and Its Associated Factors in Brazilian Athletes from Public High Schools: A Cross-Sectional Study

Article

Full-text available

Mar 2016
PLOS ONE

Most studies on the prevalence of back pain have evaluated it in developed countries (Human Development Index—HDI > 0.808), and their conclusions may not hold for developing countries. The aim of this study was to identify the prevalence of back pain in representative Brazilian athletes from public high schools. This cross-sectional study was performed during the state phase of the 2015 Jogos dos Institutos Federais (JIF), or Federal Institutes Games, in Brazil (HDI = 0.744), and it enrolled 251 athletes, 173 males and 78 females (14–20 years old). The dependent variable was back pain, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, exercise-level, anthropometric, strength, behavioral, and postural factors. The prevalence ratio (PR) was calculated using multivariable analysis according to the Poisson regression model (α = 0.05). The prevalence of back pain in the three months prior to the study was 43.7% (n = 104), and 26% of the athletes reported feeling back pain only once. Multivariable analysis showed that back pain was associated with demographic (sex), psychosocial (loneliness and loss of sleep in the previous year), hereditary (ethnicity, parental back pain), strength (lumbar and hand forces), anthropometric (body mass index), behavioral (sleeping time per night, reading and studying in bed, smoking habits in the previous month), and postural (sitting posture while writing, while on a bench, and while using a computer) variables. Participants who recorded higher levels of lumbar and manual forces reported a lower prevalence of back pain (PR < 0.79), whereas feeling lonely in the previous year, obesity, and ethnicity exhibited the highest prevalence ratio (PR > 1.30). In conclusion, there is no association between exercise levels and back pain but there is an association between back pain and non-exercise related variables.

Can Exercise Positively Influence the Intervertebral Disc?

Article

Full-text available

Apr 2016
SPORTS MED

To better understand what kinds of sports and exercise could be beneficial for the intervertebral disc (IVD), we performed a review to synthesise the literature on IVD adaptation with loading and exercise. The state of the literature did not permit a systematic review; therefore, we performed a narrative review. The majority of the available data come from cell or whole-disc loading models and animal exercise models. However, some studies have examined the impact of specific sports on IVD degeneration in humans and acute exercise on disc size. Based on the data available in the literature, loading types that are likely beneficial to the IVD are dynamic, axial, at slow to moderate movement speeds, and of a magnitude experienced in walking and jogging. Static loading, torsional loading, flexion with compression, rapid loading, high-impact loading and explosive tasks are likely detrimental for the IVD. Reduced physical activity and disuse appear to be detrimental for the IVD. We also consider the impact of genetics and the likelihood of a 'critical period' for the effect of exercise in IVD development. The current review summarises the literature to increase awareness amongst exercise, rehabilitation and ergonomic professionals regarding IVD health and provides recommendations on future directions in research.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Article

Full-text available

Jan 2014

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

Musculoskeletal symptoms in an adolescent athlete population: A comparative study

Article

Full-text available

Dec 2015
BMC MUSCULOSKEL DIS

Musculoskeletal pain, symptoms or injuries are prevalent in the adolescent athlete population as well as in the general adolescent population, and often have significant consequences on their future musculoskeletal health. However, differences between these two populations in regards to their musculoskeletal health are not known and have not yet been explored. Therefore, the main objectives of this study are to 1) compare the 6-month prevalence of musculoskeletal symptoms and their impact on school attendance and reduction in sport or leisure activity between a group of adolescent athletes and a group of control adolescents, and 2) determine if gender has different effects on the prevalence of musculoskeletal symptoms in these two populations. Among adolescents who participated in the 2012 Québec summer games, 1,865 agreed to participate and constituted the adolescent athletes group (mean age:14.12 ± 1.22). An additional cohort of 707 adolescents from two schools was also recruited to form the comparison control group (mean age: 14.69 ± 1.38). Anthropometric data were collected, and the musculoskeletal 6-month prevalence of symptoms and their related impacts were assessed using the Teen Nordic Musculoskeletal Screening Questionnaire (TNMQ-S). Participants' characteristics as well as symptoms prevalence for the nine anatomical regions as well as their impact on school/work absence and reduction in physical/leisure activities were compared between athletes and control adolescents. When compared to athlete adolescents, significantly more controls had a positive 6-month prevalence of symptoms affecting the neck (48.8 % vs 26.3 %), upper back (41.3 % vs 18.1 %) and low back (45.4 % vs 35.8 %) when compared to athlete. Symptoms affecting the spine led to significantly more school absence and reduction in physical activity in the control group. Controls also showed higher prevalence of shoulder (37.1 % vs 28.3 %) and wrist/hand (23.8 % vs 17.4 %) symptoms, while athletes had a higher prevalence of elbow symptoms (8.7 % vs 11.4 %). Despite their higher risk of injuries related to high levels of competition or sport participation, adolescent athletes have fewer symptoms affecting the spine than "typical adolescents", and similar prevalence of symptoms affecting the body's extremities. Further investigations are necessary to understand the differences between athletes and non-athletes in regard to disability and long-term complications associated to musculoskeletal pain or symptoms.

Low back pain prevalence in Brazil: A systematic review

Article

Full-text available

Jun 2015

The article describes the methodological quality of published studies on prevalence of low back pain in Brazil. Eighteen studies were considered eligible after searches in the following electronic databases: LILACS, PubMed, Embase, CINAHL, SPORTDiscus and SciELO. A high source of bias was observed in the criteria for external validity related to sampling, in addition to non-response bias. Considering the criteria for internal validity, the main sources of bias were the lack of an acceptable definition of low back pain and the use of instruments that lacked proven reliability and validity. No representative study was found that provides a generalizable prevalence of low back pain in Brazil. The published studies included in this review showed a high risk of bias that affects the prevalence data. Future studies with appropriate methodological design are necessary to verify the real impact of low back pain in Brazil and allow comparisons.

Aktiv gegen den Rückenschmerz

Article

Jan 2002

Aktiv gegen den Rückenschmerz ist keine herkömmliche Rückenschule: Dieser Ratgeber entstand im täglichen Miteinander von Patienten, Ärzten und Therapeuten und gibt Tipps, die sich im Alltag tatsächlich umsetzen lassen. Der rückenschmerzgeplagte Patient und Leser kann sich aus dem bebilderten, sehr umfangreichen Übungsteil sein individuelles Trainingsprogramm mühelos zusammenstellen.

Methods of systematic reviews and meta-analysis preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Article

Jan 2009
J CLIN EPIDEMIOL

Women's experience of low back and/ or pelvic pain (LBPP) during pregnancy

Article

Apr 2016
MIDWIFERY

DISK DEGENERATION AND ASSOCIATED ABNORMALITIES OF THE SPINE IN ELITE GYMNASTS - A MAGNETIC-RESONANCE-IMAGING STUDY

Article

Apr 1991

The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19-29 years) and in 16 male nonathletes (age range, 23-36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts and the nonathletes were pooled. Male elite gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.

Wirbelsäule im Sport

Article

Mar 2004
Sport Orthop Sport Traumatol

Rückenschmerzen betreffen im Laufe eines Lebens einen Großteil der Menschen. Im Beitrag werden die anatomisch-funktionellen Grundlagen dargestellt. Besondere Berücksichtigung finden neuere Aspekte zur Innervation der Bandscheibe und der Bezug zu sportlichen Belastungen.