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Hendricks M, Verhagen E, van de Water ATM. Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review. Scand J Med Sci Sports 2024; 34:e14614. [PMID: 38610079 DOI: 10.1111/sms.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/13/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.
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Affiliation(s)
- Matthias Hendricks
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander T M van de Water
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne/Bundoora, Victoria, Australia
- AdPhysio: Research, Training & Consultancy, Apeldoorn, The Netherlands
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2
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Carraro A, Gilic B, Bertolo R, Albergoni A, Sarto F, Roklicer R, Sarto D. Lower back pain in young climbers: a retrospective cross-sectional study. Front Sports Act Living 2023; 5:1328811. [PMID: 38186399 PMCID: PMC10770867 DOI: 10.3389/fspor.2023.1328811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Objective The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers. Methods The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS). Results A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes. Conclusions This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.
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Affiliation(s)
- Attilio Carraro
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Barbara Gilic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Riccardo Bertolo
- Associazione Sportiva Dilettantistica Opera Verticale, Scorzè, Venezia, Italy
| | - Andrea Albergoni
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Roberto Roklicer
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Diego Sarto
- School of Human Movement Sciences, University of Padova, Padova, Italy
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3
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Azevedo VD, Ferreira Silva RM, de Carvalho Borges SC, Fernades MDSV, Miñana-Signes V, Monfort-Pañego M, Silva Noll PRE, Noll M. Instruments for assessing back pain in athletes: A systematic review. PLoS One 2023; 18:e0293333. [PMID: 37922315 PMCID: PMC10624266 DOI: 10.1371/journal.pone.0293333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023] Open
Abstract
Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.
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Affiliation(s)
| | | | | | | | | | | | | | - Matias Noll
- Federal University of Goiás, Goiânia, Brazil
- Goiano Federal Institute, Itumbiara, Brazil
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4
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de Carvalho Borges SC, Mendonça CR, Ferreira Silva RM, De Vitta A, Noll M. Prevalence and Risk Factors of Musculoskeletal Disorders in Basketball Players: Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11081190. [PMID: 37108024 PMCID: PMC10138073 DOI: 10.3390/healthcare11081190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Musculoskeletal disorders characteristically induce pain and limitations in mobility, ability, and overall functioning. In athletes, including basketball players, disorders such as back pain, postural changes, and spinal injuries are common. This systematic review aimed to evaluate the prevalence of back pain and musculoskeletal disorders in basketball players and ascertain the associated factors. Methods: The Embase, PubMed, and Scopus databases were searched for studies published in English without a time limit. Using STATA, meta-analyses were performed to estimate the prevalence of pain and musculoskeletal disorders of the back and spine. Results: Of the 4135 articles identified, 33 studies were included in this review, with 27 studies included in the meta-analysis. Of these, 21 were used for the meta-analysis of back pain, 6 articles were used for the meta-analysis of spinal injury, and 2 studies were used for the meta-analysis of postural changes. The overall prevalence of back pain was 43% [95% CI, -1% to 88%]; of these, the prevalence of neck pain was 36% [95% CI, 22-50%], the prevalence of back pain was 16% [95% CI, 4-28%], the prevalence of low back pain was 26% [95% CI, 16-37%], the prevalence of thoracic spine pain was 6% [95% CI, 3-9%]. The combined prevalence of spinal injury and spondylolysis was 10% [95% CI, 4-15%], with a prevalence of spondylolysis of 14% [95% CI, 0.1-27%]. The combined prevalence of hyperkyphosis and hyperlordosis was 30% [95% CI, 9-51%]. In conclusion, we found a high prevalence of neck pain, followed by low back pain and back pain, in basketball players. Thus, prevention programs are important to improve health and sports performance.
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Affiliation(s)
| | | | | | - Alberto De Vitta
- Departament of Physical Therapy, Centro Universitário das Faculdades Integradas de Ourinhos, Ourinhos 19909-100, Brazil
| | - Matias Noll
- Health Science, Universidade Federal de Goiás, Goiânia 74001-970, Brazil
- Departament of Education, Instituto Federal Goiano, Ceres 76300-000, Brazil
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5
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Purcell C, Duignan C, Fullen BM, Ryan S, Ward T, Caulfield B. Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review. Br J Sports Med 2023; 57:535-542. [PMID: 36759138 DOI: 10.1136/bjsports-2022-106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps. METHODS AND ANALYSIS Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers. INCLUSION CRITERIA Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception. RESULTS 470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies. DISCUSSION Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed. CONCLUSION This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.
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Affiliation(s)
- Ciarán Purcell
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland .,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Ciara Duignan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Shiofra Ryan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Tomas Ward
- Insight Centre for Data Analytics, School of Computing, Dublin City University, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Ansari S, Sharma S. Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study. PHYSICIAN SPORTSMED 2022:1-10. [PMID: 35914545 DOI: 10.1080/00913847.2022.2108351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This study aimed to establish the prevalence of chronic low back pain (CLBP) in university-level athletes and to examine the influence of age, sex, body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP. The secondary purpose was to check the association of certain variables in athletes having CLBP with the sports discipline and chronicity of LBP. METHODS A total of 340 players (100% response rate) from different sports, aged 18-30 years with at least 1 year of participation in sports at the university level were screened for the present study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their demographic variables, personal and pain-related factors. The study was registered on the clinical trials registry, India (CTRI/2021/09/036675). RESULTS The results revealed the sport-wise point prevalence as follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%), badminton (7.7%) and tennis (7.7%). A higher number of years at university-level participation (>4 years), smoking, anxiety and BMI (>25 kg/m2) are risk factors for CLBP. The type of LBP, the intensity of the pain (current and last week), variation of the pain intensity, disability, intake of oral medications, physiotherapy for CLBP, number of missed days of training and number of missed matches are not significantly related to the chronicity of LBP or the sports discipline. Only the number of missed days of training had a significant association with the chronicity of LBP. CONCLUSIONS CLBP is a common complaint in Indian university athletes, and our findings indicate the necessity for a specific prevention program.
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Affiliation(s)
- Sumbul Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
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Prevalence and factors associated with low back pain in retired Great Britain’s Olympians: A cross‐sectional study. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Harr MR, Mansfield CJ, Urbach B, Briggs M, Onate J, Boucher LC. Prevalence and Incidence of Injury during Olympic-style Shooting Events: A Systematic Review. Int J Sports Phys Ther 2021; 16:1235-1249. [PMID: 34631244 PMCID: PMC8486400 DOI: 10.26603/001c.28231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Shooting sports are included in collegiate and Olympic events. However, there is minimal evidence examining injury prevalence and incidence for these athletes. HYPOTHESIS/PURPOSE The purpose of this study was to systematically review the literature to examine the available evidence regarding the incidence, prevalence, and types of injuries that affect athletes in Olympic-style shooting events. STUDY DESIGN Systematic review. METHODS The electronic databases PubMed, Cochrane Library, Cinahl, MEDLINE, and SPORTDiscus were searched utilizing terms related to shooting and injuries. Studies were included if they reported prevalence or incidence of injury in collegiate or Olympic shooting events, and were excluded if inclusion criteria were not met, full text was unavailable, or not in English. Two reviewers independently screened articles in two phases: 1) screening of titles/abstracts 2) full text review. A third reviewer resolved conflicts. RESULTS Nineteen studies were ultimately included. The sports identified were biathlon, rifle, pistol, and shotgun. Shooting events in both winter and summer Olympics had low percentages of injuries compared to other sports. Winter shooting events had a higher percentage of injuries (6.9%) compared to summer (2.3%). In summer, females demonstrated a higher percentage of injuries (6.9%) compared to males (1.7%). In winter, males had a higher percentage of injuries (8.6%) versus females (5.1%). CONCLUSION Injury incidence and prevalence was low for athletes in shooting sports in the Olympics. Injury rate was higher in the winter Olympic shooting events likely from increased physiological demand. With injury surveillance focusing on acute injuries rather than chronic, the number of injuries may be underestimated. Females had higher injury rates than males in the summer Olympics while the opposite was observed in the winter Olympics, likely from sex differences and differences in physiological demand for each event. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | - Cody J Mansfield
- School of Health and Rehabilitation Sciences, The Ohio State University; Sports Medicine; The Ohio State University Wexner Medical Center
| | | | - Matt Briggs
- Sports Medicine Research Institute, The Ohio State university Wexner Medical Center; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center; Department of Orthopedics, The Ohio State University Wexner Medical Center
| | - James Onate
- School of Health and Rehabilitation Sciences, The Ohio State University; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center
| | - Laura C Boucher
- School of Health and Rehabilitation Sciences, The Ohio State University; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center
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Titze C, Fett D, Trompeter K, Platen P, Gajsar H, Hasenbring MI. Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic! Scand J Pain 2021; 21:59-69. [PMID: 32892188 DOI: 10.1515/sjpain-2020-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In non-athletes, fear-avoidance and endurance-related pain responses appear to influence the development and maintenance of low back pain (LBP). The avoidance-endurance model (AEM) postulates three dysfunctional pain response patterns that are associated with poorer pain outcomes. Whether comparable relationships are present in athletes is currently unclear. This cross-sectional case-control study explored frequencies and behavioral validity of the AEM-based patterns in athletes with and without LBP, as well as their outcome-based validity in athletes with LBP. METHODS Based on the Avoidance-Endurance Fast-Screen, 438 (57.1% female) young adult high-performance athletes with and 335 (45.4% female) without LBP were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR) or "adaptive" (AR) pattern. RESULTS Of the athletes with LBP, 9.8% were categorized as FAR, 20.1% as DER, 47.0% as EER, and 23.1% as AR; of the athletes without LBP, 10.4% were categorized as FAR, 14.3% as DER, 47.2% as EER, and 28.1% as AR. DER and EER reported more pronounced endurance- and less pronounced avoidance-related pain responses than FAR, and vice versa. DER further reported the highest training frequency. In athletes with LBP, all dysfunctional groups reported higher LBP intensity, with FAR and DER displaying higher disability scores than AR. CONCLUSIONS The results indicate that also in athletes, patterns of endurance- and fear-avoidance-related pain responses appear dysfunctional with respect to LBP. While EER occurred most often, DER seems most problematic. IMPLICATIONS Endurance-related pain responses that might be necessary during painful exercise should therefore be inspected carefully when shown in response to clinical pain.
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Affiliation(s)
- Christina Titze
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Daniela Fett
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
- Federal Institute of Sports Science (BISp), Bonn, Germany
| | - Katharina Trompeter
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany
| | - Hannah Gajsar
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
- Faculty of Health Science, University of Southern Denmark, J.B. Winsløws Vej 19, 3, DK-5000, Odense, Denmark
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Evaluation Instruments for Assessing Back Pain in Athletes: A Systematic Review Protocol. Healthcare (Basel) 2020; 8:healthcare8040574. [PMID: 33561044 PMCID: PMC7766916 DOI: 10.3390/healthcare8040574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022] Open
Abstract
Back pain is a public health problem that affects adolescents and adults worldwide. However, studies on back pain present inconsistent findings in part due to the use of different instruments, especially for athletes. Therefore, the objective of this systematic review protocol was to map the existing evidence on such tools. The systematic review will be conducted according to PRISMA guidelines. Five electronic databases, Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus will be searched. This review includes studies that investigated prevalence, incidence, and other variables. Titles and abstracts will be selected. Two independent reviewers will read the articles carefully and discrepancies, if any, will be dealt with by a third reviewer. All steps will be completed with Rayyan for systematic reviews and the methodological quality will be analyzed with a COSMIN checklist. Discussion: This systematic review will gather evidence on tools that assess back pain in athletes. The findings may indicate the most appropriate tools for assessing back pain. They will contribute to better reliability, safe measurements, and help to standardize a comparison tool between different studies. They will also assist in the development of specific tools for athletes. Registration: This review was submitted and registered under CRD42020201299 in PROSPERO.
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Wilson F, Ardern CL, Hartvigsen J, Dane K, Trompeter K, Trease L, Vinther A, Gissane C, McDonnell SJ, Caneiro JP, Newlands C, Wilkie K, Mockler D, Thornton JS. Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis. Br J Sports Med 2020; 55:bjsports-2020-102537. [PMID: 33077481 DOI: 10.1136/bjsports-2020-102537] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes. DESIGN Systematic review with meta-analysis. DATA SOURCES Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching. ELIGIBILITY CRITERIA Studies evaluating prevalence of LBP in adult athletes across all sports. RESULTS Eighty-six studies were included (30 732, range 20-5958, participants), of which 45 were of 'high' quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%-80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%-88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%-94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6-4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport. CONCLUSION LBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.
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Affiliation(s)
- Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - Clare L Ardern
- Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
- Sport & Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Kathryn Dane
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - Katharina Trompeter
- Department of Sports Medicine and Sports Nutrition, Ruhr University Bochum, Bochum, Germany
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Larissa Trease
- Healthcare in Remote and Extreme Environments program, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy and QD-Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Conor Gissane
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | | | - J P Caneiro
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | | | - Kellie Wilkie
- Bodysystem Physiotherapy, Hobart, Tasmania, Australia
| | - David Mockler
- John Stearne Library, Trinity College Dublin, Dublin, Ireland
| | - Jane S Thornton
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
- Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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12
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Examining the Presence of Back Pain in Competitive Athletes: A Focus on Stress and Recovery. J Sport Rehabil 2019; 28:188-195. [PMID: 29140183 DOI: 10.1123/jsr.2017-0235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Explanatory approaches for back pain (BP) in athletes focus on biomechanical factors while neglecting psychological perspectives. Psychological factors have gained importance in the prediction of injuries in athletes and BP in the general population, with stress and recovery emerging as central risk factors. However, scarce evidence exists regarding the role of these aspects for the prevalent burden of BP. OBJECTIVE To investigate the association between stress and recovery parameters and the presence of BP. DESIGN Cross-sectional design. SETTING The questionnaires were distributed after the training sessions. PARTICIPANTS A total of 345 competitive athletes (mean age = 18.31 y [SD = 5.40]) were investigated. The classification of the athletes' competitive status was based on performance level. INTERVENTIONS Data were collected using questionnaires for the assessment of stress, recovery, and BP. MAIN OUTCOME MEASURES The authors performed a multiple logistic regression to obtain odds ratios for stress and recovery parameters with regard to the outcome variable BP status. RESULTS For stress, the dimension "overall stress" (odds ratio = 1.83; 95% confidence interval, 1.30-2.59; P = .001) and the scale "physical complaints" (odds ratio = 1.68; 95% confidence interval, 1.25-2.25; P = .001) of the general version of the Recovery-Stress Questionnaire resulted to be significantly associated with BP. None of the recovery-related scales displayed a statistically significant relationship with BP. CONCLUSION The outcomes of this study imply a modest association between stress and the presence of BP in competitive athletes. Practitioners may take these findings into account regarding the conception of training and for monitoring purposes.
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Fett D, Trompeter K, Platen P. Prevalence of back pain in a group of elite athletes exposed to repetitive overhead activity. PLoS One 2019; 14:e0210429. [PMID: 30677044 PMCID: PMC6345455 DOI: 10.1371/journal.pone.0210429] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of back pain in athletes has been investigated in several studies, but there are still under- or uninvestigated sports discipline like sports exposed to repetitive overhead activity. Elite athletes spend much time in training and competition and, because of the nature of their disciplines, subject their bodies to a great deal of mechanical strain, which puts a high level of stress on their musculoskeletal systems. From this it is hypothesized that elite athletes who engage in repetitive overhead motions experience a higher strain on their spine and thus possibly a higher prevalence of back pain compared with an active control group. Objectives To examine the prevalence of back pain and the exact location of pain in a cohort of elite athletes with repetitive overhead activity and in a control group of physically active sport students. Additionally, to examine different characteristics of pain, and to evaluate the influence of confounders on back pain. Methods A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to German national and international elite athletes, and a control group of physically active but non-elite sports students. Results The final sample comprised 181 elite athletes of the sports disciplines badminton, beach volleyball, handball, tennis and volleyball and 166 physically active controls. In elite athletes, lifetime prevalence of back pain was 85%, 12-month prevalence was 75%, 3-month prevalence was 58% and point prevalence was 38%; for the physically active control group, these prevalences were 81%, 70%, 59% and 43%, respectively. There was no significant group difference in prevalence over all time periods. The lower back was the main location of back pain in elite athletes across all disciplines and in controls; additionally a distinct problem of upper back pain was found among volleyball players. Conclusion Despite the high mechanical load inherent in the sport disciplines included in this study, the elite athletes who engaged in repetitive overhead activities did not suffer more from back pain than the physically active controls. This suggests that other mechanisms may be influencing back pain prevalences in a positive way in these athletes. Furthermore, these disciplines may practice preventive factors for back pain that outweigh their detrimental factors. Therefore, we posit that extensive prevention work is already being implemented in these sports and that there are additional individual protection factors in play. More research is required to explore these suppositions, and should include investigations into which preventive training programs are being used. Nevertheless, in volleyball particularly, a focus on stabilization/preventive training should be applied to the upper back and neck.
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Affiliation(s)
- Daniela Fett
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
| | - Katharina Trompeter
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
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Wippert PM, Arampatzis A, Banzer W, Beck H, Hasenbring MI, Schiltenwolf M, Schneider C, Stengel D, Platen P, Mayer F. Psychosoziale Risikofaktoren in der Entstehung von chronisch unspezifischen Rückenschmerzen. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2019. [DOI: 10.1026/1612-5010/a000245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Zusammenfassung. Chronisch unspezifische Rückenschmerzen (CURS) gehören international zu den häufigsten Schmerzphänomenen und können für Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der jährlichen Trainingsausfallzeiten werden auf CURS zurückgeführt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles Ätiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbevölkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten darüber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks ( Medicine in Spine-Exercise-Network, Förderzeitraum 2011 – 2018) aufgegriffen. Entsprechend der Empfehlung einer frühzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz“, beschäftigt sich das Netzwerk u. a. mit der Überprüfung, Entwicklung und Evaluation diagnostischer Möglichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einschätzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.
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Affiliation(s)
| | - Adamantios Arampatzis
- Department für Trainings- und Bewegungswissenschaften, Humboldt-Universität zu Berlin
| | - Winfried Banzer
- Abteilung für Trainings- und Sportmedizin, Goethe-Universität Frankfurt am Main
| | - Heidrun Beck
- Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Christian Schneider
- Sportorthopädisches Institut der Schön Klinik München Harlaching
- Orthopädiezentrum Theresie, München
| | - Dirk Stengel
- Zentrum für Klinische Forschung, Unfallkrankenhaus Berlin
| | - Petra Platen
- Fakultät für Sportwissenschaft, Sportmedizin und Sporternährung, Ruhr-Universität Bochum
| | - Frank Mayer
- Zentrum für Sportmedizin, Universität Potsdam, Hochschulambulanz
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15
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Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-018-0450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
OBJECTIVE To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes. DESIGN Systematic literature review. DATA SOURCES Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded. MAIN RESULTS Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared. CONCLUSIONS Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.
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17
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Moreno Catalá M, Schroll A, Laube G, Arampatzis A. Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population. Front Neurosci 2018; 12:436. [PMID: 30018531 PMCID: PMC6037821 DOI: 10.3389/fnins.2018.00436] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of the study was to investigate the athletic-based specificity of muscle strength and neuromuscular control of spine stability in chronic non-specific low-back pain (LBP). Thirty elite athletes and 29 age-matched non-athletes with (15 athletes and 15 non-athletes) and without LBP (15 athletes and 14 non-athletes) participated in the study. Muscle strength was measured during maximal isometric trunk flexion and trunk extension contractions. The neuromuscular control of spine stability was analyzed by determining trunk stiffness, trunk damping, and onset times of the lumbar and thoracic erector spinae muscles after sudden perturbations (quick release experiments) as well as maximum Lyapunov exponents (local dynamic stability) using non-linear time series analysis of repetitive lifting movements. LBP was assessed using the visual analog scale. We found lower maximal trunk extension moments (p = 0.03), higher trunk damping (p = 0.018) and shorter onset times (p = 0.03) of the investigated trunk muscles in LBP patients in both athletes and non-athletes. Trunk stiffness and the local dynamic stability did not show any differences (p = 0.136 and p = 0.375, respectively) between LBP patients and healthy controls in both groups. It can be concluded that, despite the high-level of training in athletes, both athletes and non-athletes with LBP showed the same deconditioning of the lumbar extensor muscles and developed similar strategies to ensure spine stability after sudden perturbations to protect the spine from pain and damage. The findings highlight that specific training interventions for the trunk muscles are not only crucial for individuals of the general population, but also for well-trained athletes.
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Affiliation(s)
- María Moreno Catalá
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Gunnar Laube
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
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18
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[Psychosocial risk factors for chronic back pain in the general population and in competitive sports : From theory to clinical screening-a review from the MiSpEx network]. Schmerz 2018; 32:259-273. [PMID: 29946960 DOI: 10.1007/s00482-018-0307-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. METHODS The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months. RESULTS We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). CONCLUSION Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.
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19
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Sutherlin MA, Gage M, Mangum LC, Hertel J, Russell S, Saliba SA, Hart JM. Changes in Muscle Thickness Across Positions on Ultrasound Imaging in Participants With or Without a History of Low Back Pain. J Athl Train 2018; 53:553-559. [PMID: 29912568 DOI: 10.4085/1062-6050-491-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Injury-prediction models have identified trunk muscle function as an identifiable factor for future injury. A history of low back pain (HxLBP) may also place athletes at increased risk for future low back pain. Reduced muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) has been reported among populations with clinical low back pain via ultrasound imaging in multiple positions. However, the roles of the LM and TrA in a more functional cohort and for injury prediction are still unknown. OBJECTIVES To (1) assess the reliability of LM and TrA ultrasound measures, (2) compare changes in muscle thickness across positions between persons reporting or not reporting HxLBP, and (3) determine the ability to distinguish between groups. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants were 34 people who did not report HxLBP (age = 22 ± 7 years, body mass index = 23.7 ± 2.7) and 25 people who reported HxLBP (age = 25 ± 10 years, body mass index = 24.0 ± 3.2). MAIN OUTCOME MEASURE(S) Muscle thickness and changes in muscle thickness of the LM and TrA as shown on ultrasound imaging. RESULTS Intraclass correlation coefficients ranged from 0.641 to 0.943 for all thickness measures and from 0 to 0.693 for all averaged thickness modulations bilaterally. Participants who reported HxLBP had voluntarily reduced TrA thickness modulations compared with those not reporting HxLBP ( P = .03), and the testing position influenced TrA thickness modulations ( P < .01). No differences were observed for LM thickness modulations between groups or positions ( P > .05). A tabletop cutoff value of 1.32 had a sensitivity of 0.640 and a specificity of 0.706, whereas a seated cutoff value of 1.18 had a sensitivity of 0.600 and a specificity of 0.647. CONCLUSIONS In participants reporting HxLBP, TrA thickness modulations were lower and both tabletop and seated thickness modulations were able to distinguish reported HxLBP status. These findings suggest that TrA muscle function may be altered by HxLBP.
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Affiliation(s)
| | - Matthew Gage
- Department of Health Professions, Liberty University, Lynchburg, VA
| | - L Colby Mangum
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Shawn Russell
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville
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20
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Belz J, Heidari J, Levenig C, Hasenbring M, Kellmann M, Kleinert J. Stress and risk for depression in competitive athletes suffering from back pain - Do age and gender matter? Eur J Sport Sci 2018; 18:1029-1037. [PMID: 29741992 DOI: 10.1080/17461391.2018.1468482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Back pain (BP), a prominent problem for competitive athletes, is a primary reason for limitations in athletic performance and daily life restrictions. As studies on the relationship between psychological variables and BP in athletes are scarce, the aim of this study was to investigate stress and depression in competitive athletes with BP. In a cross-sectional design, data of 154 competitive athletes (51% female; Mage = 18.81 years, SDage = 5.05 years) were collected, assessing Performance stress, Socio-emotional stress, Risk for depression and Psychological well-being and the two BP parameters BP Intensity and Disability. Two multiple linear regressions were conducted to predict (1) BP Intensity and (2) Disability from Performance stress, Socio-emotional stress, Risk for depression and Psychological well-being. Multiple linear regressions demonstrated that Performance stress (β = .21, p = .01) was the only significant predictor of BP Intensity (F1,142 = 6.68, p = .01, R2 = .05), whilst Risk for depression (β = .24, p = .01) was the only significant predictor of Disability (F1,142 = 8.46, p = .01, R2 = .06). Neither gender nor age explained a significant amount of variance in the models. Study results showed that, as in the general population, the variables stress and depression are related to BP in competitive athletes. In particular, BP intensity was found to be associated with stress and BP-related disability was associated with depression, whereas age and gender showed no association with the BP parameters. A longitudinal investigation is warranted to determine the direction of the observed relationships.
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Affiliation(s)
- Johanna Belz
- a Department of Health & Social Psychology , German Sport University Cologne , Cologne , Germany
| | - Jahan Heidari
- b Unit of Sport Psychology, Faculty of Sport Science , Ruhr University Bochum , Bochum , Germany
| | - Claudia Levenig
- c Department of Medical Psychology and Medical Sociology , Ruhr University Bochum , Bochum , Germany
| | - Monika Hasenbring
- c Department of Medical Psychology and Medical Sociology , Ruhr University Bochum , Bochum , Germany
| | - Michael Kellmann
- b Unit of Sport Psychology, Faculty of Sport Science , Ruhr University Bochum , Bochum , Germany.,d School of Human Movement and Nutrition Sciences , The University of Queensland , St Lucia , Australia
| | - Jens Kleinert
- a Department of Health & Social Psychology , German Sport University Cologne , Cologne , Germany.,e German Research Centre of Elite Sport - Momentum , German Sport University Cologne , Cologne , Germany
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21
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Witwit WA, Kovac P, Sward A, Agnvall C, Todd C, Thoreson O, Hebelka H, Baranto A. Disc degeneration on MRI is more prevalent in young elite skiers compared to controls. Knee Surg Sports Traumatol Arthrosc 2018; 26:325-332. [PMID: 28409199 PMCID: PMC5754419 DOI: 10.1007/s00167-017-4545-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Evidence-based facts regarding spine abnormalities and back pain are needed in order to develop rehabilitation programs and prevent spine injuries in young skiers. The aim therefore is to identify MRI changes in the thoraco-lumbar spine and the lifetime prevalence of back pain, as well as the association between them, in young skiers compared to non-athletes. METHODS Seventy-five young elite alpine and mogul skiers, age range 16-20 years, were compared with 27 non-athletic controls. All subjects underwent spinal MRI and answered back pain questionnaires. RESULTS Fifty-six percent of skiers had at least one disc Pfirrmann grade ≥3 compared to 30% of controls (p = 0.027). Schmorl's nodes (46%) and disc height reduction (37%) were significantly more prevalent in skiers compared to controls (0%) (p < 0.001). When all parameters were combined together, skiers had significantly higher rate of radiological changes than controls, 82% compared to 54% (p = 0.007). The mean number of discs with Pfirrmann grade ≥3 was 1.1 per individual in skiers (median 1, range 0-6) versus 0.6 in controls (median 0, range 0-3). There was no significant difference in lifetime prevalence of back pain between skiers (50%) and controls (44%) (n.s.). MRI abnormalities in skiers did not correlate with lifetime prevalence of back pain. Skiers had a better health perception than controls (p = 0.026). CONCLUSION Alpine skiers have more degenerative disc changes compared to non-athletes, but these changes do not correlate with the lifetime prevalence of back pain. Lifetime prevalence of back pain is not significantly different between the groups; however, skiers report more severe pain on VAS score. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Wisam A. Witwit
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Peter Kovac
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Anna Sward
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Agnvall
- Sportsmedicine Åre and Åre Ski High School, Ostersund, Sweden
| | - Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Wippert PM, Puschmann AK, Arampatzis A, Schiltenwolf M, Mayer F. Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx). BMJ Open Sport Exerc Med 2017; 3:e000295. [PMID: 29259814 PMCID: PMC5731227 DOI: 10.1136/bmjsem-2017-000295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/17/2022] Open
Abstract
Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds. Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index - Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves. Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100%; RPI-S: 75%-100%) and specificity (RSI: 76%-93%; RPI-S: 71%-93%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95% CI 0.71 to 1.0)). Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians' decision making and allow stratified treatment and prevention.
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Affiliation(s)
- Pia-Maria Wippert
- Department of Sociology of Health and Physical Activity, Universität Potsdam, Potsdam, Germany
| | - Anne-Katrin Puschmann
- Department of Sociology of Health and Physical Activity, Universität Potsdam, Potsdam, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Marcus Schiltenwolf
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Mayer
- Centre of Sports Medicine, University Outpatient Clinic, Universität Potsdam, Potsdam, Germany
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23
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Fett D, Trompeter K, Platen P. Back pain in elite sports: A cross-sectional study on 1114 athletes. PLoS One 2017; 12:e0180130. [PMID: 28662110 PMCID: PMC5491135 DOI: 10.1371/journal.pone.0180130] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/10/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To establish the prevalence of back pain in German elite athletes; examine the influence of age, sex, sports discipline and training volume; and compare elite athletes with a physically active control group. METHODS A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to approximately 4,000 German national and international elite athletes, and a control group of 253 physically active but non-elite sports students. RESULTS We received responses from 1,114 elite athletes (46.5% male and 53.1% female, mean age 20.9 years ± 4.8 years, mean height 176.5 ± 11.5 cm, mean weight 71.0 ± 10.3 kg) and 166 physically active sports students (74.7% male and 24.1 female, mean age 21.2 ± 2.0 years, mean height 180.0 ± 8.0 cm, mean weight 74.0 ± 14.5 kg). In elite athletes, the lifetime prevalence of back pain was 88.5%, the 12-month prevalence was 81.1%, the 3-month prevalence was 68.3% and the point prevalence was 49.0%, compared with 80.7%, 69.9%, 59.0% and 42.8%, respectively in the control group. The lifetime, 12-month and 3-month prevalences in elite athletes were significantly higher than in the control group. Regarding the individual sports disciplines, the prevalence of back pain was significantly higher in elite rowers, dancers, fencers, gymnasts, track and field athletes, figure skaters and marksmen, and those who play underwater rugby, water polo, basketball, hockey and ice hockey compared with the control group. The prevalence of back pain was significantly lower in elite triathletes. CONCLUSIONS Back pain is a common complaint in German elite athletes. Low back pain seems to be a problem in both elite athletes and physically active controls. A high training volume in elite athletes and a low training volume in physically active individuals might increase prevalence rates. Our findings indicate the necessity for specific prevention programs, especially in high-risk sports. Further research should investigate the optimal dose-effect relationship of sporting activity for the general population to prevent back pain.
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Affiliation(s)
- Daniela Fett
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
- * E-mail: (DF); (KT)
| | - Katharina Trompeter
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
- * E-mail: (DF); (KT)
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
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24
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Noll M, Silveira EA, de Avelar IS. Evaluation of factors associated with severe and frequent back pain in high school athletes. PLoS One 2017; 12:e0171978. [PMID: 28222141 PMCID: PMC5319774 DOI: 10.1371/journal.pone.0171978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023] Open
Abstract
Several studies have shown that half of all young athletes experience back pain (BP). However, high intensity and frequency of BP may be harmful, and the factors associated with BP severity have not been investigated in detail. Here, we investigated the factors associated with a high intensity and high frequency of BP in high school athletes. We included 251 athletes (173 boys and 78 girls [14-20 years old]) in this cross-sectional study. The dependent variables were a high frequency and high intensity of BP, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, anthropometric, behavioural, and postural factors and the level of exercise. The effect measure is presented as prevalence ratio (PR) with 95% confidence interval (CI). Of 251 athletes, 104 reported BP; thus, only these athletes were included in the present analysis. Results of multivariable analysis showed an association between high BP intensity and time spent using a computer (PR: 1.15, CI: 1.01-1.33), posture while writing (PR: 1.41, CI: 1.27-1.58), and posture while using a computer (PR: 1.39, CI: 1.26-1.54). Multivariable analysis also revealed an association of high BP frequency with studying in bed (PR: 1.19, CI: 1.01-1.40) and the method of carrying a backpack (PR: 1.19, CI: 1.01-1.40). In conclusion, we found that behavioural and postural factors are associated with a high intensity and frequency of BP. To the best of our knowledge, this study is the first to compare different intensities and frequencies of BP, and our results may help physicians and coaches to better understand BP in high school athletes.
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Affiliation(s)
- Matias Noll
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
- Instituto Federal Goiano, Goiás, Brazil
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
| | - Ivan Silveira de Avelar
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
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Cauci S, Migliozzi F, Trombetta CS, Venuto I, Saccheri P, Travan L, Chiriacò G. Low back pain and FokI (rs2228570) polymorphism of vitamin D receptor in athletes. BMC Sports Sci Med Rehabil 2017; 9:4. [PMID: 28184307 PMCID: PMC5294822 DOI: 10.1186/s13102-017-0069-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
Abstract
Background Low back pain (LBP) is common in athletes. LBP can be detrimental to athletic performance and health. Factors predisposing to LBP in athletes remain elusive and require further studies. We investigated whether carriage of a specific genotype and/or allele of vitamin D receptor gene (VDR) FokI polymorphism (rs2228570) was a risk factor for LBP in athletes of different sports disciplines. Methods This genotype/phenotype association case-control study included 60 Italian athletes (25 females and 35 males; mean age 33.9 ± 13.3 years; body-mass-index 23.5 ± 3.5 kg/m2) of which 16.7% were swimmers, 11.7% soccer players, 11.7% volleyball players, 10.0% rugby players and other disciplines. VDR-FokI polymorphism was measured by PCR-RFLP in 24 athletes with LBP and 36 athletes without LBP episodes. Absence or presence of the FokI restriction site was denoted “F” and “f”, respectively. Other risk factors were evaluated by a questionnaire. Results The homozygous FF genotype was found in 58.3% (14/24) of athletes with LBP versus 27.8% (10/36) of athletes without LBP, adjusted OR = 5.78, 95% CI 1.41–23.8, P = 0.015. The F allele was a 2-fold risk factor to develop LBP, adjusted OR = 2.55, 95% CI 1.02–6.43, P = 0.046, while f allele was protective. Exposure to vehicle vibrations ≥2 h daily, and family history of lumbar spine pathology were significant risk factors for LBP with OR = 3.54, and OR = 9.21, respectively. Conclusions This is the first study in which an association between VDR-FokI polymorphism and LBP in athletes was found. Further research is needed to extend our results, and to clarify the biochemical pathways associated with how vitamin D modulates LBP in athletes. The VDR-FokI polymorphism should be considered when developing genetic focused studies of precision medicine on health in athletes. Electronic supplementary material The online version of this article (doi:10.1186/s13102-017-0069-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabina Cauci
- Department of Medical and Biological Sciences, School of Medicine, University of Udine, Udine, 33100 Italy.,Clinical Biochemistry and Molecular Biology, Department of Medical and Biological Sciences, Piazzale Kolbe 4, 33100 Udine, Italy
| | - Francesca Migliozzi
- Department of Medical and Biological Sciences, School of Medicine, University of Udine, Udine, 33100 Italy.,Department of Medicine, Surgery and Health Sciences, School of Medicine, University of Trieste, Trieste, 34100 Italy
| | - Carlo Simone Trombetta
- Department of Medical and Biological Sciences, School of Medicine, University of Udine, Udine, 33100 Italy
| | - Ilaria Venuto
- Department of Medical and Biological Sciences, School of Medicine, University of Udine, Udine, 33100 Italy
| | - Paola Saccheri
- Department of Experimental and Clinical Medical Sciences, School of Medicine, University of Udine, Udine, 33100 Italy
| | - Luciana Travan
- Department of Experimental and Clinical Medical Sciences, School of Medicine, University of Udine, Udine, 33100 Italy
| | - Giovanni Chiriacò
- Department of Medicine, Surgery and Health Sciences, School of Medicine, University of Trieste, Trieste, 34100 Italy
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Heidari J, Hasenbring M, Kleinert J, Kellmann M. Stress-related psychological factors for back pain among athletes: Important topic with scarce evidence. Eur J Sport Sci 2016; 17:351-359. [PMID: 27838957 DOI: 10.1080/17461391.2016.1252429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health issues represent a frequent problem for athletes, as this particular demographic is repeatedly confronted with physically and psychologically stressful situations. Back pain (BP) materialises as comparatively common health problem being regarded as functionally limiting and psychologically straining burden for athletes. According to research conducted on athletes with BP, biomechanical and physiological mechanisms emerge as influential, whereas stress-related psychological factors appear to be neglected. For athletic injuries, the essential impact of psychological processes on injury occurrence and return from injury has already been corroborated. Hence, the aim of this literature review is to: (1) introduce a conceptual differentiation between injuries and BP; (2) summarise the results obtained regarding stress-related psychological aspects for injuries; and (3) connect the injury research to the state-of-the-art evidence regarding stress-related factors for BP among athletes. A distinction between injuries and BP could be established based on previous definitions, despite the fact that a considerable overlap between both concepts prevails. Injuries can be attributed to a physical origin, whereas BP frequently lacks this physical criterion. For BP, our enquiry yielded four studies including psychological measures of stress - with two studies specifically examining the association between BP and psychological stress among athletes longitudinally. Abundant findings from the general population support the importance of considering psychological and specifically stress-related factors in BP prevention and rehabilitation, but evidence related to the athletic field remains elusive. Further scientific investigations with a wider methodological approach are needed to deepen the knowledge about the crucial relationship between psychological stress, BP, and athletes.
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Affiliation(s)
- Jahan Heidari
- a Unit of Sport Psychology, Faculty of Sport Science , Ruhr University Bochum , Germany
| | - Monika Hasenbring
- b Department of Medical Psychology and Medical Sociology , Ruhr University Bochum , Germany
| | - Jens Kleinert
- c Department of Health and Social Psychology , German Sport University , Cologne , Germany
| | - Michael Kellmann
- a Unit of Sport Psychology, Faculty of Sport Science , Ruhr University Bochum , Germany.,d School of Human Movement and Nutrition Sciences , The University of Queensland , St Lucia , Australia
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Niederer D, Vogt L, Wippert PM, Puschmann AK, Pfeifer AC, Schiltenwolf M, Banzer W, Mayer F. Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: study protocol for a multicentre, single-blind randomized controlled trial. Trials 2016; 17:507. [PMID: 27765058 PMCID: PMC5072341 DOI: 10.1186/s13063-016-1645-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/07/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Arising from the relevance of sensorimotor training in the therapy of nonspecific low back pain patients and from the value of individualized therapy, the present trial aims to test the feasibility and efficacy of individualized sensorimotor training interventions in patients suffering from nonspecific low back pain. METHODS AND STUDY DESIGN A multicentre, single-blind two-armed randomized controlled trial to evaluate the effects of a 12-week (3 weeks supervised centre-based and 9 weeks home-based) individualized sensorimotor exercise program is performed. The control group stays inactive during this period. Outcomes are pain, and pain-associated function as well as motor function in adults with nonspecific low back pain. Each participant is scheduled to five measurement dates: baseline (M1), following centre-based training (M2), following home-based training (M3) and at two follow-up time points 6 months (M4) and 12 months (M5) after M1. All investigations and the assessment of the primary and secondary outcomes are performed in a standardized order: questionnaires - clinical examination - biomechanics (motor function). Subsequent statistical procedures are executed after the examination of underlying assumptions for parametric or rather non-parametric testing. DISCUSSION The results and practical relevance of the study will be of clinical and practical relevance not only for researchers and policy makers but also for the general population suffering from nonspecific low back pain. TRIAL REGISTRATION Identification number DRKS00010129. German Clinical Trial registered on 3 March 2016.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487 Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487 Frankfurt am Main, Germany
| | - Pia-Maria Wippert
- Department of Sociology of Physical Activity and Health, Cluster of Excellence in Cognitive Sciences, University of Potsdam, Potsdam, Germany
| | - Anne-Katrin Puschmann
- Department of Sociology of Physical Activity and Health, Cluster of Excellence in Cognitive Sciences, University of Potsdam, Potsdam, Germany
| | - Ann-Christin Pfeifer
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487 Frankfurt am Main, Germany
| | - Frank Mayer
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, Potsdam, Germany
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