Prevalence of Low Back Pain in Adolescent Athletes – an Epidemiological Investigation

Prevalence of Lower Back Pain and Risk Factors in Equestrians: A Systematic Review

This systematic review aimed to determine the prevalence of lower back pain (LBP) in equestrian athletes (EAs) and identify associated risk factors. Following the PRISMA guidelines, observational studies published between 2004 and 2024 in English, Portuguese, Spanish, and German were included. The review identified relevant studies through the Web of Science, EBSCO, MEDLINE, and SCOPUS (last search performed on 30 October 2024), yielding 14 studies with a total of 4527 participants. The question format for the included studies specified the population as equestrian athletes, the exposure as equestrian sports, and the outcome as lower back pain. The risk of bias was evaluated using the Observation Study Quality Evaluation tool, and six studies were deemed high-quality. LBP prevalence in EAs was higher than in the general and athlete population, with point prevalence ranging from 27.9% to 87.9%. Sport-specific factors, including workload and stable duties, were significant risk factors. Methodological inconsistencies, such as varying definitions of LBP and a lack of standardized exposure assessment, and the overall low quality of studies limited the comparability of findings. This review underscores the need for more high-quality research and tailored interventions addressing both riding and off-horse activities in EAs.

Obesity and overweight as risk factors for low back pain in children and adolescents: a meta-analysis

BACKGROUND

Childhood obesity and overweight are associated with musculoskeletal pain, but the association between low back pain (LBP) and overweight/obesity in this population needs clarification. The objective of this meta-analysis is to ascertain the relationship between LBP and obesity/overweight in children and adolescents.

METHODS

Various databases and specialized journals were queried from inception to October 2022. Encompassed were all studies examining the association between overweight or obesity and LBP among participants aged 6 to 18 years. The ROBINS-E tool was employed to assess bias. Random-effects models were used to pool results across studies, with location-scale models used to search for moderator variables where evidence of heterogeneity was found.

RESULTS

In total, 34 studies were incorporated. Four studies had a low risk of bias, while the remaining studies had some concerns. Nine studies evinced an association between overweight and LBP, in contrast to normal weight, yielding an OR of 1.13 (95% CI 1.10-1.16) and no heterogeneity. Eight studies demonstrated a similar association between obesity and LBP compared to normal weight, with an OR of 1.27 (95% CI 1.20-1.34) and no heterogeneity. Ten studies established an association between overweight/obesity and LBP compared to normal weight, yielding an OR of 1.18 (95% CI 1.14-1.23) and no heterogeneity. Finally, nineteen studies showcased an association between body mass index (BMI) and LBP, with an OR of 1.19 (95% CI 1.03-1.39) with evidence of heterogeneity. For this last analysis, we compared the mean BMI in groups and transformed results to log OR, and then retransformed to OR.

CONCLUSION

Overweight and obesity may be risk factors for LBP in children and adolescents. The association between LBP and obesity appears to be stronger than with overweight. However, the analysis revealed considerable heterogeneity and risk of bias across studies.

Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review

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.

The effect of gender, age and sports specialisation on isometric trunk strength in Greek high level young athletes

Aim of the study was to compare the isometric strength of flexors and extensors trunk muscles between male and female elite adolescent athletes of different age and training experience. Absolute and relative trunk muscle isometric peak extension (PTE) and flexion (PTF) torque, as well as flexion/extension (F/E) ratio were evaluated in 388 elite adolescent athletes 188 males (Age: 15.4±1.8 years, Body height: 175.5±11.2 cm, Body mass: 68.8±14.5 kg, BMI: 22.1±0.3 kg/m2) and 207 females (Age: 15.1±1.6 years, Body height: 166.8±7.8 cm, Body mass: 60.8±8.4 kg and BMI: 21.8±0.4 kg/m2). Participants were assigned into seven different groups according to their sport specialisation (oars-paddle, swimming, contact-combat, team, racket, winter and mixed other sports). Significant effect of age (η2: 0.077-0.112, p < 0.05), gender (η2: 0.020-0.077; p < 0.05) and sport category factors (η2: 0.057-0.154. p < 0.005) for absolute/relative PTE, PTF and F/E ratio was found. The highest values were observed in contact-combat and the lowest in mixed other sports groups. F/E ratio significantly differs between the age groups, especially in female athletes. The present data suggest that TMSs and F/E ratio are highly affected by age, gender and sports specialisation in high level trained adolescents.

Injury Prevalence among Young Elite Baseball Players

This study aimed to describe the injury profiles of young Korean baseball players according to position and age as the proportion and distribution of injuries based on playing position and age remains unclear. A total of 271 elite youth baseball players aged 8 to 16 years were divided into two groups: elementary school (ES) (n = 135) and middle school (MS) (n = 136). The participants' basic, baseball practice, and injury information were collected. Injuries in the MS group were not limited to the elbow and shoulder, and injury prevalence varied by age group and baseball position. The most injured body region in the ES group was the elbow joint, regardless of the position. In contrast, the most injured body region in the MS group was the lower back, except for infielders whose elbows were the most injured. Additionally, the MS group was more likely to experience injuries to the lower back (OR = 4.27, 95% CI = 2.47-7.40), shoulder (OR = 1.93, 95% CI = 1.08-3.43; p = 0.024), and knee (OR = 2.15, 95% CI = 1.17-3.94; p = 0.012). Our findings indicate that excessive practice and a lack of rest during MS (growth spurt period) can significantly increase the risk of lower back problems in young baseball players.

Prevalence of Glenohumeral Internal Rotation Deficit and Sex Differences in Range of Motion of Adolescent Volleyball Players: A Case-Control Study

Shoulder range of motion (ROM) adaptation is common observed among volleyball players, but studies on the shoulder joint function of adolescent athletes are lacking. This study aimed to clarify the prevalence of glenohumeral internal rotation deficit (GIRD) among adolescent players and differences in ROM based on sex. A questionnaire survey and ROM measurements of the shoulder joint and trunk using a plastic goniometer were conducted on 123 volleyball players (63 males and 60 females; mean age, 15.8 years). The prevalence of GIRD was investigated for internal rotation differences of >10° and total rotation motion of <5°. Questionnaire items and ROM were compared between GIRD and non-GIRD patients, and sex differences in ROM were also presented. Of the participants, 38.2% (n = 47/123) had GIRD. The GIRD group showed a decrease in external rotation on the dominant side (p = 0.003, 1 − beta = 0.84), but this was not associated with a history of shoulder injury. Sex differences in shoulder ROM showed hypomobility in males and hypermobility in females. However, there was no association between shoulder injury and GIRD among adolescent players. There are sex differences in ROM, which should be considered in future studies.

Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis

OBJECTIVE

To investigate the incidence, prevalence, risk factors and morphological presentations of low back pain (LBP) in adolescent athletes.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Medline, Embase, CINAHL via EBSCO, Web of Science, Scopus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies evaluating the incidence and/or prevalence of LBP in adolescent athletes across all sports.

RESULTS

There were 80 studies included. The pooled incidence estimate of LBP in adolescent athletes was 11% (95% CI 8% to 13%, I²=0%) for 2 years, 36.0% (95% CI 4% to 68%, I²=99.3%) for 12 months and 14% (95% CI 7% to 22%, I²=76%) for 6 months incidence estimates. The pooled prevalence estimate of LBP in adolescent athletes was 42% (95% CI 29% to 55%, I²=96.6%) for last 12 months, 46% (95% CI 41.0% to 52%, I²=56%) for last 3 months and 16% (95% CI 9% to 23%, I²=98.3%) for point prevalence. Potential risk factors were sport participation, sport volume/intensity, concurrent lower extremity pain, overweight/high body mass index, older adolescent age, female sex and family history of LBP. The most common morphology reported was spondylolysis. Methodological quality was deemed high in 73% of cross-sectional studies and in 30% of cohort studies. Common reasons for downgrading at quality assessment were use of non-validated survey instruments and imprecision or absence of LBP definition.

SUMMARY/CONCLUSION

LBP is common among adolescent athletes, although incidence and prevalence vary considerably due to differences in study methodology, definitions of LBP and data collection.

PROSPERO REGISTRATION NUMBER

CRD42020157206.

Efficacy of semi-customized exercises in preventing low back pain in high school volleyball players: A randomized controlled trial

BACKGROUND

Low back pain (LBP) is a common injury in high school volleyball players. We hypothesized that a prevention program could decrease the incidence of LBP in high school volleyball players. This study was an in-season cluster-randomized controlled trial.

METHODS

We block-randomized 8 high school volleyball teams comprising 70 players aged 15 to 17 years into the intervention (4 teams, 34 players) and control (4 teams, 36 players) groups. The intervention program consisted of 9 physical function tests as well as 1 or 2 self-selected preventive exercises, including dynamic thoracic mobility, trunk stabilization exercises, and static stretching, performed during warm-up. Both groups were followed up for 4 weeks, during which the incidence of LBP was recorded. Physical function tests (back endurance; spinal and back flexibility; active or passive shoulder and trunk range of motion; ankle joint mobility; and iliopsoas, quadriceps, and hamstrings flexibility) were conducted before and after the intervention.

RESULTS

The intervention group had a significantly lower incidence of LBP (8.8%) than the control group (33.3%) (relative risk, 3.78; 95% confidence interval, 1.17-12.23; P = .017, 1 - β = 0.99). Lumbar extension accounted for nearly 70% of LBP incidences. Most players in the intervention group demonstrated improved physical function associated with the exercises.

CONCLUSION

The semi-customized prevention program decreased the incidence of LBP and enhanced the physical function parameter in high school volleyball players.

Relationship between the number of steps taken during lockdown caused by the COVID-19 pandemic and low back pain

Introduction: In 2020, the whole world was overwhelmed by the SARS-CoV-2 coronavirus threat. In order to prevent the spread of the virus, national governments introduced restrictions of movement in public space, closing schools, universities, many companies switched to remote working. In addition to the obvious benefits of the above changes, numerous side effects can be observed. One of them is pain in the locomotive organs caused by the sedentary lifestyle. Objective: The main objective of the study was to assess the relationship between physical activity during quarantine, caused by the COVID-19 pandemic, and the occurrence of spinal pain. Material and methods: The study was attended by 55 people (29 women and 26 men) who attended physiotherapeutic consultations due to low back pain. For comparison purposes, they were divided into two groups: Group 1 (n=24) includes active persons, Group 2 (n=31) includes inactive persons. The survey was conducted in June 2020. The study used the reading of pedometers from mobile phones and the Rolland-Morris Questionnaire, Laitinen’s Pain Scale and author’s own questionnaire. The respondents were asked to share the pedometer results from given weeks before, during and after restriction causes by the COVID-19. Results: Physically active persons (those performing health training) performed more steps before introducing restrictions (p<0.001). After the introduction of restrictions, all-day activity decreased significantly in both groups. The evaluation of pain characteristics revealed significant differences (between groups) in two categories – pain intensity and physical activity limitation. Group 2 individuals also reported greater functional limitations. Conclusion: In physically inactive people, the intensity of low back pain was much higher. This proves the relationship between activity levels and pain.

Performance on a Motor Control Test in an Asymptomatic Adolescent Population

BACKGROUND

Low back pain is a condition present during both adulthood and adolescence. Adolescents with low back pain may benefit from treatment focused on improving abdominal muscle performance and motor control. The supine double leg lowering test (SDLLT) may be a reliable measure to assess core stability in adults, but adolescent performance on the SDLLT has not yet been established in the literature.

PURPOSE

To examine performance on the SDLLT in healthy adolescents ages 13 to 18 years and describe influences of gender, age, body mass index, and participation in sport.

STUDY DESIGN

Cross-Sectional Study.

METHODS

Four licensed physical therapists administered the SDLLT with a Stabilizer pressure biofeedback cuff and inclinometer in 90 adolescents without low back pain (females = 41, males = 49) from three schools in a mid-western metropolitan area. Descriptive statistics, independent sample t-tests, two-way analysis of variance, and Pearson correlation coefficients were utilized to analyze the data.

RESULTS

Average SDLLT score was 72.36 +/- 12.54 degrees. A significant difference between SDLLT score was present between genders with males performing better than females. No interactions between performance and involvement in sport were demonstrated.

CONCLUSIONS

Female and male adolescents appear to perform differently on the SDLLT with a stabilizer and appear to perform worse than scores recorded for adults. The SDLLT may be used to measure motor control in adolescents, but clinicians should utilize age-appropriate data for clinical decision making.

LEVELS OF EVIDENCE

Level 2c.

A Comparison between Different Types and Frequency of Physiotherapy Treatment for Children and Adolescents with Postural Problems and Low Back Pain

AIM

To examine the effect of a once-a-week group physiotherapy session in addition to a once-a-month individual physiotherapy treatment, in comparison to a monthly individual physiotherapy treatment.

METHODS

Fifty children and adolescents aged 10-18 years with poor back posture, some of whom had LBP, met individually with a physiotherapist once a month. The intervention group received an additional once-a-week group physiotherapy session for 12 weeks. Thorax curve angle, postural behavior, and low back pain (LBP) were measured before and after intervention.

RESULTS

The thorax curve angle decreased from 39.2 ± 9.3 to 28.2 ± 6.8 (p < 0.001) in the group + individual therapy group and from 38.9 ± 9.3 to 27.9 ± 7.8 in the individual therapy only group (p < 0.001). LBP decreased from 5.6 ± 2.2 to 1.6 ± 1.9 (p < 0.001) and from 5.5 ± 2.1 to 2.8 ± 2.0 (p < 0.001). A significantly greater improvement in postural behavior was found in the group + individual therapy group (p = 0.04). Moreover, attrition rates were lower in the experimental group.

CONCLUSION

A lower-frequency individual physiotherapy treatment for 12 weeks proved as beneficial as the same program with an additional higher-frequency group physiotherapy in improving thorax curve angle and LBP. However, the higher-frequency group physiotherapy in addition to the lower-frequency individual treatment was significantly more effective in improving postural behavior and adherence to treatment.

Changes in Children's Body Composition and Posture during Puberty Growth

The main goal of our study was to determine how the age of children, puberty and anthropometric parameters affect the formation of body composition and faulty body posture development in children. The secondary goal was to determine in which body segments abnormalities most often occur and how gender differentiates the occurrence of adverse changes in children's body posture and body composition during puberty. The study group consisted of 464 schoolchildren aged from 6-16. Body posture was assessed with the Zebris system. The composition of the body mass was tested with Tanita MC 780 MA body mass analyzer and the body height was measured using a portable stadiometer PORTSTAND 210. The participants were further divided due to the age of puberty. Tanner division was adopted. The cut-off age for girls is ≥10 years and for boys it is ≥12 years. The analyses applied descriptive statistics, the Pearson correlation, stepwise regression analysis and the t-test. The accepted level of significance was p < 0.05. The pelvic obliquity was lower in older children (beta = -0.15). We also see that age played a significant role in the difference in the height of the right pelvis (beta = -0.28), and the difference in the height of the right shoulder (beta = 0.23). Regression analysis showed that the content of adipose tissue (FAT%) increased with body mass index (BMI) and decreased with increasing weight, age, and height. Moreover, the FAT% was lower in boys than in girls (beta negative equal to -0.39). It turned out that older children (puberty), had greater asymmetry in the right shoulder blade (p < 0.001) and right shoulder (p = 0.003). On the other hand, younger children (who were still before puberty) had greater anomalies in the left trunk inclination (p = 0.048) as well as in the pelvic obliquity (p = 0.008). Girls in puberty were characterized by greater asymmetry on the right side, including the shoulders (p = 0.001), the scapula (p = 0.001) and the pelvis (p < 0.001). In boys, the problem related only to the asymmetry of the shoulder blades (p < 0.001). Girls were characterized by a greater increase in adipose tissue and boys by muscle tissue. Significant differences also appeared in the body posture of the examined children. Greater asymmetry within scapulas and shoulders were seen in children during puberty. Therefore, a growing child should be closely monitored to protect them from the adverse consequences of poor posture or excessive accumulation of adipose tissue in the body.

Low back pain among Italian runners: A cross-sectional survey

BACKGROUND

Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear.

OBJECTIVES

To determine the prevalence of LBP in a wide sample of Italian runners.

DESIGN

A cross-sectional online survey.

SETTING

A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019.

PARTICIPANTS

2539 Italian runners.

METHODS

A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self-reported and included 38 questions.

MAIN OUTCOME MEASURES

Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer's V. Only correlation values higher >0.60 were deemed of interest.

RESULTS

2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer's V < 0.60) were found between LBP and demographics, training characteristics or lifestyle habits.

CONCLUSION

The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle.

Rehabilitation of a child with a complicated aneurysmal bone cyst

An aneurysmal bone cyst (ABC) is a benign lesion often found in long bones. Almost one third of ABCs are secondary to primary tumors. When found in the spine, ABCs can cause insidious back pain and, in rare cases, neurological deficits. This case will discuss an adolescent female who acquired a non-traumatic spinal cord injury (NTSCI) as a result of complications from an aneurysmal bone cyst. Treatment consisted of surgical removal of the cyst, laminectomy, corpectomy, and fusion of the thoracic spine. Following surgical intervention, the child spent several weeks in an acute inpatient pediatric rehabilitation facility. Goal oriented outpatient services facilitated further recovery and led to near complete resolution of symptoms associated with non-traumatic spinal cord injury. Contemporary and clinically oriented child and family interventions are essential in successful rehabilitation of children with NTSCI as a result of ABCs.

Morphological changes of the lateral abdominal muscles in adolescent soccer players with low back pain: A prospective cohort study

BACKGROUND

Most papers examining the lateral abdominal muscles (LAMs) and low back pain (LBP) are cross-sectional, with groups of participants being divided into a control and an LBP group. We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence. The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players.

METHODS

Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study. The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position. Nine cases of LBP occurred during the follow-up 6-month observation.

RESULTS

An obliquus internus (OI) asymmetry was related to increasing LBP risk (odds ratio = 19.99; 95%CI: 2.4-167.9). Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP (R = 0.75, p = 0.02). An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players.

CONCLUSION

The morphological changes of the OI may be related to LBP's incidence in adolescent soccer players. The presence of OI asymmetry increases the odds of LBP by at least 2.4 times. Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.

Physical function characteristics in Japanese high school volleyball players with low back pain: A case-controlled study

Low back pain (LBP) is a typical symptom in volleyball players, yet associated physical function factors have not been identified. This study purpose is to determine the relationship between LBP and physical function factors in order to identify potential factors for the management of LBP.Participants were 123 male and female volleyball players of 15- to 17-year-olds who, completed a questionnaire regarding demographic details, presence of LBP, and years of volleyball experience. Participants were divided into 2 groups based on the presence of current LBP and evaluated on physical function tests. The results of the questionnaire response and physical function test were compared between the 2 groups. Data were analyzed using a multivariate logistic regression analysis with presence and absence of current LBP as the explanatory variable.11.4% of all participants reported current LBP. Physical function factors associated with current LBP were a positive modified Thomas test, years of volleyball experience and reduced range of motion of shoulder horizontal abduction on the dominant hand side.The associations between physical function factors and LBP found in this survey suggest that attention should be given to more experienced players with decreased flexibility of hip and shoulder flexors on the dominant side in order to manage LBP in high school volleyball players.

Prevalence and incidence of low back pain among runners: a systematic review

Background

Running is one of the most popular sports worldwide. Despite low back pain (LBP) represents the most common musculoskeletal disorder in population and in sports, there is currently sparse evidence about prevalence, incidence and risk factors for LBP among runners. The aims of this systematic review were to investigate among runners: prevalence and incidence of LBP and specific risk factors for the onset of LBP.

Methods

A systematic review has been conducted according to the guidelines of the PRISMA statement. The research was conducted in the following databases from their inception to 31st of July 2019: PubMed; CINAHL; Google Scholar; Ovid; PsycINFO; PSYNDEX; Embase; SPORTDiscus; Scientific Electronic Library Online; Cochrane Library and Web of Science. The checklists of The Joanna Briggs Institute Critical Appraisal tools were used to investigate the risk of bias of the included studies.

Results

Nineteen studies were included and the interrater agreement for full-text selection was good (K = 0.78; 0.61–0.80 IC 95%). Overall, low values of prevalence (0.7–20.2%) and incidence (0.3–22%) of LBP among runners were reported. Most reported risk factors were: running for more than 6 years; body mass index > 24; higher physical height; not performing traditional aerobics activity weekly; restricted range of motion of hip flexion; difference between leg-length; poor hamstrings and back flexibility.

Conclusions: Prevalence and incidence of LBP among runners are low compared to the others running related injuries and to general, or specific population of athletes. View the low level of incidence and prevalence of LBP, running could be interpreted as a protective factor against the onset of LBP.

Systematic review registration

PROSPERO CRD42018102001.

Relationship between exercise time and musculoskeletal problems in children

Objectives: The purpose of this study was to evaluate the relationship between exercise time and musculoskeletal problems and to determine the appropriate amount of exercise for children in both lower- and higher-grade levels of elementary and junior high schools.

Materials and Methods: Mark-sheet-type questionnaires were distributed to and collected from all elementary and junior high schools in two cities. We collected 22,494 questionnaires in total. The relationship between exercise time and musculoskeletal problems was analyzed. The χ² test and multivariate logistic regression analysis were used for statistical analyses.

Results: The mean exercise time in school, in addition to physical education time, was 3.1 hours per week. In 56% of the children, the exercise time was less than 2 hours per week, and in 13% of the children, the exercise time was more than 10 hours per week. Although the rate of sports injury increased with an increase in exercise time, the duration of one-leg stand (a test of balance and muscle strength) also increased with an increase in exercise time. The cut-off values for sports injuries in boys/girls were 2.9/2.9 hours, 4.0/2.9 hours, and 7.5/4.2 hours in lower grade elementary school, higher grade elementary school, and junior high school, respectively.

Conclusions: Although an appropriate amount of exercise improves one’s physical health and ability, excessive exercise leads to musculoskeletal problems. Approximately 7 hours/week of exercise is recommended for junior high school students. In elementary school, the exercise time should be carefully decided as the musculoskeletal system of the students is still immature.

The Effectiveness of the Mézières Method in Elite Rhythmic Gymnastics Athletes With Low Back Pain: A Randomized Controlled Trial

CONTEXT

One of the main reasons why athletes with a high physical condition suffer from low back pain disease is because they often participate in sports that involve disc compression movements during flexion, lifting loads, or torsion movement.

OBJECTIVES

This study aims to examine the effectiveness of the postural treatment of the Mézières method on elite rhythmic gymnastics athletes with low back pain.

DESIGN

Double-blind, randomized, controlled trial.

SETTING

The sports hall of "Puente Tocinos," Murcia, Spain.

PARTICIPANTS

Ninety gymnastics athletes were randomized into 2 parallel groups (intervention: n = 39; control: n = 51), of whom 98.9% were women (women = 89; man = 1).

INTERVENTION

The Mézières method postural therapy was implemented. It lasted about 60 minutes in repeated sessions of 2 to 3 meetings per week by counting in overall 60 sessions during a 24-week period.

MAIN OUTCOME MEASURES

Visual analog scale of pain, sit and reach flexibility test, Runtastic (pedometer performance android application), Roland-Morris Questionnaire for the physical disability, and the Health Status Questionnaire were used.

RESULTS

The univariate analysis of variance and independent sample t test revealed a significant improvement in the intervention group concerning the visual analog scale pain assessment scale (P < .05, ηp2=.625), and, also, the between-groups effect size was high during the 24 sessions of treatment (d > 0.8) compared with the control one. The same situation persists even for Roland-Morris Questionnaire (P < .05, ηp2=.802), physical score (P < .05, ηp2=.613), mental score (P < .05, ηp2=.736), sit and reach flexibility test (P < .05, ηp2=.666), and Runtastic performance (P < .05, ηp2=.790), where the between-groups effect size was high during the 24 sessions of treatment (d > 0.8).

CONCLUSION

The Mézières method treatment performed on athletes with low back pain has caused positive effects on all the outcomes analyzed compared with the ones of control group.

Factors associated with low back pain in elite high school volleyball players

[Purpose] To determine the relationship between low back pain and a range of demographic, environmental, and injury history factors to identify potential factors for the management of low back pain. [Participants and Methods] The participants were 123 elite high school male and female volleyball players. They answered an extensive questionnaire regarding demographic details, low back pain in the previous year, volleyball-specific movements, previous regional injuries, and years of volleyball experience. Questionnaire responses were analyzed. Data were analyzed using a multivariate logistic regression analysis using the presence and absence of low back pain within 1 year as the explanatory variable. [Results] Of the 123 volleyball players, 48.0% reported low back pain. The volleyball-specific movements that induced pain were diverse (e.g., spike, serve, and pass) with no common factor. The factors associated with low back pain were an ankle injury within the previous year and years of volleyball experience. [Conclusion] The associations found in this survey indicate that particular attention should be given to more experienced players with a history of ankle injury to manage low back pain in high school volleyball players.

Trunk muscle strength and lumbo-pelvic kinematics in adolescent athletes: Effects of age and sex

Considering their potential relevance for low-back pain, we investigated trunk muscle strength, sagittal lumbo-pelvic alignment while standing and lumbo-pelvic ratio during trunk flexion in adolescent athletes with regard to the effects of age and sex. Twenty-two early adolescent (EA: 13-15 years, 10 females) and 28 late adolescent (LA: 16-19 years, 14 females) high-level athletes (training duration more than 12 hours per week) participated in the study. We measured trunk extension and trunk flexion moments during maximum voluntary isometric contractions using a dynamometer. Further, we examined lumbo-pelvic kinematics in the upright standing position and during forward trunk bending using two 3-dimensional accelerometers. Using a lineal regression model in which the flexion moment from each participant was used as predictor for the corresponding extension moment, we found higher residuals (P < 0.001) in the EA compared to LA, indicating greater imbalances in the trunk muscle strength in EA. We found a higher lordosis in the upright position, greater pelvic rotation, and greater lordotic posture during the forward bending in females (P < 0.01). These age-related imbalances and sex-related characteristics in lumbo-pelvic kinematics might affect the neuromuscular control of trunk stability and the magnitude of spine loading. We recommend the implementation of specific coordination and stabilization programs for muscle groups that contribute to lumbo-pelvic kinematics and training routines that support a balanced strength development within the trunk muscles in adolescent athletes.

Psychological pain responses in athletes and non-athletes with low back pain: Avoidance and endurance matter

BACKGROUND

Dysfunctional psychological pain responses, namely fear-avoidance (FAR), including catastrophizing and helplessness, as well as endurance-related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non-athletes regarding psychological responses to pain.

OBJECTIVES

This study set out to compare FAR and ER between athletes and non-athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability.

METHODS

The 173 athletes and 93 non-athletes cross-sectionally reported how frequently they employ FAR and ER on the Avoidance-Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non-athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability.

RESULTS

Athletes reported lower frequencies of behavioural avoidance than non-athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non-athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non-athletes.

CONCLUSIONS

The results of the present study suggest that athletes and non-athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non-athletes and contribute to disability in both groups.

SIGNIFICANCE

Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non-athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non-athletes alike. However, both types of responses seem relevant to clinical pain management in athletes as well as non-athletes.

Low back pain and associated disability in Swedish adolescents

INTRODUCTION

Low back pain (LBP) defined as ache or pain in the lowest part of the back is a common experience among people all over the world. The lifetime prevalence is reported to be as high as 84%, and the prevalence of LBP seems to be almost the same among adolescents as among adults. The risk for having LBP later in life if you experienced LBP in adolescence is high.

MATERIAL AND METHODS

In this cross-sectional study of 2550 students aged 16-20 years, we used the Standardized Nordic Questionnaire for the analysis of musculo-skeletal symptoms. We studied gender difference, prevalence, and disability of Low back pain. We also studied differences in LBP in adolescent athletes depending on hours spent on sports or physical activity.

RESULTS

Significantly, more girls than boys had had problems sometimes during their life. Those who participated in sports reported LBP to a significantly higher extent than those who were physically inactive in their spare time. Gender and spare time sports were important risk factors for getting LBP some time in life. There was a higher risk for girls to have low back pain problems more than 30 days or daily the last year if they had had low back pain some time earlier in life.

CONCLUSION

This study shows that low back pain (LBP) is common among Swedish adolescents, more common among girls than boys. High sport activity was associated with the risk of having LBP, length of time with LBP, and disability due to LBP.

Prevalence of low back pain among athletes: A systematic review

BACKGROUND

The prevalence of low back pain (LBP) in athletes across a variety of time frames and sports is not known.

OBJECTIVES

To systematically collate and appraise studies on the prevalence of LBP in athletes and stratify by point, one year and life-time prevalence.

METHODS

A comprehensive search was conducted in February 2016. The following sources were individually searched: PubMed (1950 to present), Ovid SP Medline (1950 to present), ISI (1982 to present) and Google Scholar; Surveys were included if they aimed to report the prevalence of LBP amongst the athletes. Two reviewers independently evaluated the methodological quality of the studies.

RESULTS

The literature search generated 4379 records. Title and/or abstracts were reviewed by two investigators and full-texts of 201 relevant articles were selected for further evaluation. Studies were included if they reported the prevalence of LBP in an athletic population (any level of participation in sports and any age range) and were written in English. Furthermore, to adequately assess the prevalence rate, studies had to report the number of athletes with LBP as a percentage of the total number of athletes. Studies that did not contain necessary data to calculate prevalence rate including case reports and non-original studies were excluded and 41 studies entered the bias assessment step. A bias assessment was applied to the methodology of 41 studies, and 36 with low to moderate risk for bias were included in this review. LBP in athletes was shown to have a point prevalence ranging from 10% to 67%, a one-year prevalence ranging from 17% to 94%, and a life-time prevalence ranging from 33% to 84%. The highest prevalence of LBP was found among skiers, floorball players and rowers and the lowest were found in shooters, golfers and triathletes.

CONCLUSION

Like general population, LBP is quite prevalent among athletes. There is a lack of sound data on the prevalence and mechanism of LBP in some popular sports such as volleyball, swimming and track and field. The lack of standardization of research methods and outcome measurement tools are significant problems in literature. Researchers need to use standard and internationally acceptable definitions for LBP and related functional disability. Investigators are encouraged to conduct epidemiologic studies, along with search for possible mechanism of LBP, by recruitment of large sample population of the athletes who are selected through randomization of the national population and adopt recent recommendations for a standard definition of LBP.

Prevalence of Neck Pain among Athletes: A Systematic Review

Many studies have investigated the prevalence of neck pain (NP) and its risk factors in the general population. However, the prevalence of NP among athletes has not yet been systematically investigated. We aimed to systematically review the prevalence of NP in athletes. A comprehensive search was conducted in September 2015 using PubMed, Ovid SP Medline, ISI, and Google Scholar. We included studies in English that reported the prevalence of NP in an athletic population during a defined period of time. We assessed the risk of bias in studies due to various definitions of NP, response rates, and reliability of the study instruments. Two reviewers independently assessed the studies’ quality and performed data extraction. Of 1,675 titles identified, eight articles were assessed for risk of bias, and six with low or moderate risk were included. NP was shown to be prevalent in athletes, with a 1-week prevalence ranging from 8% to 45%, a 1-year prevalence ranging from 38% to 73%, and a lifetime prevalence of about 48%. The prevalence of NP in athletes is high. More studies regarding the prevalence and risk factors of NP may be useful for planning educational programs and developing appropriate rehabilitation protocols and preventive guidelines. Researchers are encouraged to perform epidemiologic studies in athletes with a low risk of bias.

Reproducibility of Static and Dynamic Postural Control Measurement in Adolescent Athletes with Back Pain

Static (one-legged stance) and dynamic (star excursion balance) postural control tests were performed by 14 adolescent athletes with and 17 without back pain to determine reproducibility. The total displacement, mediolateral and anterior-posterior displacements of the centre of pressure in mm for the static, and the normalized and composite reach distances for the dynamic tests were analysed. Intraclass correlation coefficients, 95% confidence intervals, and a Bland-Altman analysis were calculated for reproducibility. Intraclass correlation coefficients for subjects with (0.54 to 0.65), (0.61 to 0.69) and without (0.45 to 0.49), (0.52 to 0.60) back pain were obtained on the static test for right and left legs, respectively. Likewise, (0.79 to 0.88), (0.75 to 0.93) for subjects with and (0.61 to 0.82), (0.60 to 0.85) for those without back pain were obtained on the dynamic test for the right and left legs, respectively. Systematic bias was not observed between test and retest of subjects on both static and dynamic tests. The one-legged stance and star excursion balance tests have fair to excellent reliabilities on measures of postural control in adolescent athletes with and without back pain. They can be used as measures of postural control in adolescent athletes with and without back pain.

Changes in Muscle Thickness Across Positions on Ultrasound Imaging in Participants With or Without a History of Low Back Pain

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.

Effect of Capacitive and Resistive electric transfer on changes in muscle flexibility and lumbopelvic alignment after fatiguing exercise

[Purpose] This study aimed to clarify the effects of Capacitive and Resistive electric transfer (CRet) on changes in muscle flexibility and lumbopelvic alignment after fatiguing exercise. [Subjects and Methods] Twenty-two healthy males were assigned into either the CRet (n=11) or control (n=11) group. Fatiguing exercise and CRet intervention were applied at the quadriceps muscle of the participants' dominant legs. The Ely test, pelvic tilt, lumbar lordosis, and superficial temperature were measured before and after exercise and for 30 minutes after intervention. Statistical analysis was performed using one-way analysis of variance, with Tukey's post-hoc multiple comparison test to clarify within-group changes and Student's t-test to clarify between-group differences. [Results] The Ely test and pelvic tilt were significantly different in both groups after exercise, but there was no difference in the CRet group after intervention. Superficial temperature significantly increased in the CRet group for 30 minutes after intervention, in contrast to after the exercise and intervention in the control group. There was no significant between-group difference at any timepoint, except in superficial temperature. [Conclusion] CRet could effectively improve muscle flexibility and lumbopelvic alignment after fatiguing exercise.

Reliability and Validity of Athletes Disability Index Questionnaire

OBJECTIVE

The purpose of this study was to evaluate validity and reliability of a new proposed questionnaire for assessment of functional disability in athletes with low back pain (LBP).

DESIGN

Validity and reliability study.

SETTING

Elite athletes participating in different fields of sports.

PARTICIPANTS

Participants were 165 male and female athletes (between 12 and 50 years old) with LBP.

INTERVENTIONS

Athlete Disability Index (ADI) Questionnaire which is developed by the authors for assessing LBP-related disability in athletes, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ).

MAIN OUTCOME MEASURES

Self-reported responses were collected regarding LBP-related disability through ADI, ODI, and RDQ.

RESULTS

The test-retest reliability was strong, and intraclass correlation value ranged between 0.74 and 0.94. The Cronbach alpha coefficient value of 0.91 (P < 0.001) demonstrated excellent internal consistency of the questionnaire. The correlation coefficient between ADI and ODI was r = 0.918 (P < 0.0001), between ADI and RDQ was r = 0.669 (P < 0.0001), and between ADI and visual analog scale was r = 0.626 (P < 0.001). According to ODI and RDQ, disability levels were mild in the large majority of subjects (91.5% and 86.0%, respectively). Alternatively, disability assessments by the ADI did not cluster at the mild level and ranged more broadly from mild to very high.

CONCLUSION

The ADI is a reliable and valid instrument for assessing disability in athletes with LBP. Compared with the available LBP disability questionnaires used in the general population, ADI can more precisely stratify the disability levels of athletes due to LBP.

Body Mass Normalization for Lateral Abdominal Muscle Thickness Measurements in Adolescent Athletes

OBJECTIVES

To determine the value of allometric parameters for ultrasound measurements of the oblique external (OE), oblique internal (OI), and transversus abdominis (TrA) muscles in adolescent athletes. The allometric parameter is the slope of the linear regression line between the log-transformed body mass and log-transformed muscle size measurement.

METHODS

The study included 114 male adolescent football players between the ages of 10 and 19 years. All individuals with no surgical procedures performed on the trunk area and who had played a sport for at least 2 years were included. A real-time B-mode ultrasound scanner with a linear array transducer was used to obtain images of the lateral abdominal muscles from both sides of the body. A stabilometric platform was used to assess the body mass value.

RESULTS

The correlations between body mass and the OE, OI, and TrA muscle thicknesses were r = 0.73, r = 0.79, and r = 0.64, respectively (in all cases, P < .0001). The allometric parameters were 0.77 for the OE, 0.67 for the OI, and 0.61 for the TrA. Using these parameters, no significant correlations were found between body mass and the allometric-scaled thickness of the lateral abdominal muscles.

CONCLUSIONS

Significant positive correlations exist between body mass and lateral abdominal muscle thickness in adolescent athletes. Therefore, it is reasonable to advise that the values of the allometric parameters for the OE, OI, and TrA muscles obtained in this study should be used, and the allometric-scaled thicknesses of those muscles should be analyzed in future research on adolescent athletes.

Trunk Strength Characteristics of Elite Alpine Skiers - a Comparison with Physically Active Controls

Core muscle imbalances and weak trunk strength are relevant for injury prevention and performance. Information regarding core strength requirements and ideal flexion/extension ratios in alpine skiing is limited. We aimed to compare trunk strength capacities in elite alpine skiers with those of a matched control group. The concentric maximal trunk flexion and extension of 109 elite skiers and 47 active controls were measured at 150°/s in a ballistic mode using the CON-TREX® TP 1000 test system. The relative flexion peak torque was higher in male ski racers (p = 0.003; 2.44 ± 0.30 Nm/kg) than in the controls (2.32 ± 0.42 Nm/kg). The relative peak torque for extension was 4.53 ± 0.65 Nm/kg in ski racers and 4.11 ± 0.52 Nm/kg in the controls (p = 0.001). Female athletes were significantly stronger in both, relative flexion force (p = 0.006; skiers 2.05 ± 0.22 Nm/kg; controls 1.74 ± 0.28 Nm/kg) and relative extension force (p = 0.001; skiers 3.55 ± 0.53 Nm/kg; controls 3.14 ± 0.48 Nm/kg). No significant differences were found in the ratios of flexion to extension forces in females and males. Ski racers are engaged in extensive strength training for both leg and trunk muscles, which explains the higher peak values. Both groups indicated a low ratio from 0.54-0.59, which represents high trunk extensor muscles strength relative to flexor muscles.

Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain

In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 ± 1.3 y; 176 ± 11 cm; 68 ± 11 kg; 12.4 ± 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 ± 1.3 y; 174 ± 7 cm; 67 ± 8 kg; 14.9 ± 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized to MIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3–1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.

Evaluation of factors associated with severe and frequent back pain in high school athletes

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.

Back Pain in Adolescent Athletes: Results of a Biomechanical Screening

The aim was to use a short biomechanical test battery to screen adolescent athletes with and without back pain to reveal relevant and possibly preventable deficits. 1 559 adolescent athletes (m/f 945/614; 13.2±1.6y) were included. Back pain was assessed (1–5: 1=no pain; 5=maximum pain) for dichotomous categorization into back pain (BP: pain>2, n=113), healthy (NBP _All : pain=1, n=1 213) and matched healthy (NBP _matched : pain=1, n=113) athletes. Athletes performed stability, performance (jumps) and trunk strength testing. The center of pressure displacement [mm], jump height [cm], peak force [N], contact time [ms] and peak torque of the trunk [Nm] were analyzed. Analysis showed a statistically significant influence of trunk strength on back pain (BP/NBP _ALL ). Nevertheless, after including co-variables (anthropometrics, gender and training volume), there were no significant variables detectable any longer. ANOVA identified no group differences (BP/NBP _matched ) in the outcome measurement for the biomechanical tests (p>0.05). This short biomechanical screening shows no sufficient differentiation in adolescent athletes for back pain. Therefore, age, training load and gender has greater relevance than strength deficits or postural control. This is challenging for further understanding of the complex conditions in young athletes with back pain.

Prevalence and proposed mechanisms of chronic low back pain in baseball: part i

The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.

Incidence of back pain in adolescent athletes: a prospective study

Background

Recently, the incidence rate of back pain (BP) in adolescents has been reported at 21%. However, the development of BP in adolescent athletes is unclear. Hence, the purpose of this study was to examine the incidence of BP in young elite athletes in relation to gender and type of sport practiced.

Methods

Subjective BP was assessed in 321 elite adolescent athletes (m/f 57%/43%; 13.2 ± 1.4 years; 163.4 ± 11.4 cm; 52.6 ± 12.6 kg; 5.0 ± 2.6 training yrs; 7.6 ± 5.3 training h/week). Initially, all athletes were free of pain. The main outcome criterion was the incidence of back pain [%] analyzed in terms of pain development from the first measurement day (M1) to the second measurement day (M2) after 2.0 ± 1.0 year. Participants were classified into athletes who developed back pain (BPD) and athletes who did not develop back pain (nBPD). BP (acute or within the last 7 days) was assessed with a 5-step face scale (face 1–2 = no pain; face 3–5 = pain). BPD included all athletes who reported faces 1 and 2 at M1 and faces 3 to 5 at M2. nBPD were all athletes who reported face 1 or 2 at both M1 and M2. Data was analyzed descriptively. Additionally, a Chi² test was used to analyze gender- and sport-specific differences (p = 0.05).

Results

Thirty-two athletes were categorized as BPD (10%). The gender difference was 5% (m/f: 12%/7%) but did not show statistical significance (p = 0.15). The incidence of BP ranged between 6 and 15% for the different sport categories. Game sports (15%) showed the highest, and explosive strength sports (6%) the lowest incidence. Anthropometrics or training characteristics did not significantly influence BPD (p = 0.14 gender to p = 0.90 sports; r² = 0.0825).

Conclusions

BP incidence was lower in adolescent athletes compared to young non-athletes and even to the general adult population. Consequently, it can be concluded that high-performance sports do not lead to an additional increase in back pain incidence during early adolescence. Nevertheless, back pain prevention programs should be implemented into daily training routines for sport categories identified as showing high incidence rates.

Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: study protocol for a multicentre, single-blind randomized controlled trial

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.

Comparison of Lateral Abdominal Muscle Thickness and Cross Sectional Area of Multifidus in Adolescent Soccer Players with and without Low Back Pain: A Case Control Study

BACKGROUND

Low back pain (LBP) is a common complaint amongst adolescent athletes. While different studies have shown association between LBP and trunk muscle thickness in the general population, few articles have studied it in adolescent athletes.

OBJECTIVES

The aim of this study is to compare lateral abdominal muscle thickness and function, and cross sectional area (CSA) of lumbar multifidus (LM) in adolescent soccer players with and without LBP.

METHODS

In total, 28 adolescent soccer players with and without LBP, from the premier league participated in this study. The thickness of external oblique, internal oblique and transversus abdominis and the CSA of the LM muscles at L4 level on both sides were measured at rest and contraction via ultrasound imaging (USI). In addition, leg length discrepancy, hamstring flexibility, active lumbar forward flexion, and isometric muscle endurance of trunk extensors were measured in both groups. (study design/setting: case control study).

RESULTS

The mean (SD) age in LBP group and non-LBP group were 14.0 (1.1) and 14.1 (0.9) years, respectively. There was no significant difference in baseline characteristics of participants between groups. Findings showed no significant difference between LBP and non-LBP groups comparing all measured variables.

CONCLUSIONS

The data obtained support that there is not a correlation between abdominal muscle thickness and CSA of the lumbar multifidi and LBP in adolescent soccer players. These findings suggest that other factors rather than the thickness of deep trunk muscles may play a more significant role in the etiology of LBP in adolescent soccer players.

Star Excursion Balance Test in Young Athletes with Back Pain

The Star Excursion Balance Test (SEBT) is effective in measuring dynamic postural control (DPC). This research aimed to determine whether DPC measured by the SEBT in young athletes (YA) with back pain (BP) is different from those without BP (NBP). 53 BP YA and 53 NBP YA matched for age, height, weight, training years, training sessions/week and training minutes/session were studied. Participants performed 4 practice trials after which 3 measurements in the anterior, posteromedial and posterolateral SEBT reach directions were recorded. Normalized reach distance was analyzed using the mean of all 3 measurements. There was no statistical significant difference (p > 0.05) between the reach distance of BP (87.2 ± 5.3, 82.4 ± 8.2, 78.7 ± 8.1) and NBP (87.8 ± 5.6, 82.4 ± 8.0, 80.0 ± 8.8) in the anterior, posteromedial and posterolateral directions respectively. DPC in YA with BP, as assessed by the SEBT, was not different from NBP YA.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study

BACKGROUND

The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs.

METHODS

This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors.

RESULTS

The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls.

CONCLUSIONS

In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Age-dependency of posture parameters in children and adolescents

[Purpose] Poor posture in children and adolescents is a well-known problem. Therefore, early detection of incorrect posture is important. Photometric posture analysis is a cost-efficient and easy method, but needs reliable reference values. As children’s posture changes as they grow, the assessment needs to be age-specific. This study aimed to investigate the development of both one-dimensional posture parameter (body inclination angle) and complex parameter (posture index) in different age groups (childhood to adolescence). [Subjects and Methods] The participants were 372 symptom-free children and adolescents (140 girls and 232 boys aged 6–17). Images of their habitual posture were obtained in the sagittal plane. High-contrast marker points and marker spheres were placed on anatomical landmarks. Based on the marker points, the body inclination angle (INC) and posture index (PI) were calculated using the Corpus concepts software. [Results] The INC angle significantly increased with age. The PI did not change significantly among the age groups. No significant differences between the corresponding age groups were found for PI and INC for both sexes. [Conclusion] When evaluating posture using the body inclination angle, the age of the subject needs to be considered. Posture assessment with an age-independent parameter may be more suitable.

Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review

BACKGROUND

In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing, prevention of progression and return to sport.

OBJECTIVE

To evaluate the diagnostic utility of patient history and physical examination data to identify spondylolysis and/or spondylolisthesis in athletes.

DESIGN

Systematic review was undertaken according to published guidelines, and reported in line with PRISMA.

METHOD

Key databases were searched up to 13/11/15.

INCLUSION CRITERIA

athletic population with LBP, patient history and/or physical examination accuracy data for spondylolysis and/or spondylolisthesis, any study design including raw data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. A data extraction sheet was pre-designed. Pooling of data and investigation for heterogeneity enabled a qualitative synthesis of data across studies.

RESULTS

Of the eight included studies, two were assessed as low ROB, one of which also had no concerns regarding applicability. Age (<20 years) demonstrated 81% sensitivity and 44% specificity and gender (male) 73% sensitivity and 57% specificity for spondylolysis. Difficulty falling asleep, waking up because of pain, pain worse with sitting and walking all have sensitivity >75% for spondylolisthesis. Step-deformity palpation demonstrated 60-88% sensitivity and 87-100% specificity for spondylolisthesis. The one-legged hyperextension test was not supported for spondylolysis (sensitivity 50-73%, specificity 0-87%).

CONCLUSION

No recommendations can be made utilising patient history data. Based on one low ROB study, step deformity palpation may be useful in diagnosing spondylolisthesis. No physical tests demonstrated diagnostic utility for spondylolysis. Further research is required.

Parameters of low back pain chronicity among athletes: Associations with physical and mental stress

OBJECTIVE

In the general population, physical and mental stress factors are linked to chronic low back pain (LBP). The aim of the present study was to examine this association among athletes.

DESIGN

Longitudinal study with a six-month interval between measurements.

SETTING

Questionnaires were filled out at home, either in paper-pencil version or online.

PARTICIPANTS

Eighty-two male and 57 female athletes (N = 139, MAge = 32.24) who exercise on a competitive (n = 102) or recreational level (n = 37), with a weekly training volume of at least 3 h.

MAIN OUTCOME MEASURES

At T0, stress parameters were assessed via the Recovery-Stress Questionnaire (RESTQ-Basic-48) and the Screening Scale of the Trier Inventory for the Assessment of Chronic Stress (TICS-SSCS). At T0 and T1, different chronification indicators were measured. Based on these assessments, the sample was split into a chronification and no-chronification group.

RESULTS

ANCOVAs were used to conduct group comparisons with regard to stress levels. The chronification groups showed higher stress values for all chronification indicators. For the variables Physical Complaints and Overall Stress-TICS, the group differences became significant (p < .05).

CONCLUSION

A relationship between stress parameters and LBP chronification was demonstrated among athletes for the first time.