1
|
Zemková E, Amiri B, Horníková H, Zapletalová L. Potential neurophysiological and biomechanical risk factors for sport-related back problems: A scoping review. Sports Med Health Sci 2024; 6:123-138. [PMID: 38708324 PMCID: PMC11067771 DOI: 10.1016/j.smhs.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 05/07/2024] Open
Abstract
This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).
Collapse
Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Slovakia
| | - Banafsheh Amiri
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
| | - Henrieta Horníková
- Department of Track and Field and Sport Conditioning, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
| | - Ludmila Zapletalová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Slovakia
| |
Collapse
|
2
|
Czaplewski LG, Rimmer O, McHale D, Laslett M. Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability. J Orthop Surg Res 2023; 18:351. [PMID: 37170132 PMCID: PMC10176889 DOI: 10.1186/s13018-023-03839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Estimating the contribution of endplate oedema known as Modic changes to lower back pain (LBP) has been the subject of multiple observational studies and reviews, some of which conclude that the evidence for an association of Modic change with LBP is uncertain while others demonstrate a clear link. The clinical trials demonstrating the benefit of basivertebral nerve ablation, a therapeutic intervention, in a tightly defined homogenous patient group with chronic LBP and Modic changes type 1 or type 2, provides further evidence for the contribution of Modic changes to LBP and shows that in these subjects, nerve ablation substantially reduces pain and disability. These interventional studies provide direct evidence that Modic changes can be associated with lower back pain and disability. This review set out to explore why the literature to date has been conflicting. METHODS A narrative, forensic, non-systematic literature review of selected articles to investigate why the published literature investigating the association between Modic imaging changes and chronic low back pain is inconsistent. RESULTS This review found that previous systematic reviews and meta-analyses included both heterogeneous study designs and diverse patient syndromes resulting in an inconsistent association between Modic changes and nonspecific chronic lower back pain. Re-analysis of literature data focussing on more homogenous patient populations provides clearer evidence that Modic changes are associated with nonspecific chronic lower back pain and that type 1 Modic changes are more painful than type 2. CONCLUSIONS Studies using tightly defined homogenous patient groups may provide the best test for association between MRI-findings and pain and disability. Clinical benefit of basivertebral nerve ablation observed in randomised controlled trials further supports the association between type 1 and type 2 Modic changes with pain and disability.
Collapse
Affiliation(s)
- Lloyd G Czaplewski
- Persica Pharmaceuticals Ltd, 7 Denne Hill Business Centre, Womenswold, Canterbury, Kent, CT4 6HD, UK.
| | - Otis Rimmer
- Veramed Ltd, 5th Floor Regal House, 70 London Road, Twickenham, TW1 3QS, UK
| | | | - Mark Laslett
- Mark Laslett, Physiotherapy Specialist, The Sports Clinic, 156 Bealey Ave., Christchurch, 8014, New Zealand
| |
Collapse
|
3
|
Fawcett L, James S, Botchu R, Martin J, Heneghan NR, Rushton A. The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts. Eur Spine J 2022; 31:225-32. [PMID: 34613494 DOI: 10.1007/s00586-021-06997-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/18/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics. METHODS A prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Forty (18 males) gymnasts aged 13-24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral. CONCLUSION Findings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.
Collapse
|
4
|
Yokoe T, Tajima T, Sugimura H, Kubo S, Nozaki S, Yamaguchi N, Morita Y, Chosa E. Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain. Orthop J Sports Med 2021; 9:2325967121995466. [PMID: 33889645 PMCID: PMC8040580 DOI: 10.1177/2325967121995466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis. Purpose: To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI. Study Design: Cohort study, Level of evidence, 3. Methods: The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans. Results: Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; P < .001), had a greater LL angle (22.8° ± 8.1° vs 19.3° ± 8.5°; P = .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; P = .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; P < .001) and an L1:L5 ratio of >65% (OR, 3.48; P = .003) were independent predictors of positive findings of spondylolysis on MRI scans. Conclusion: The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings.
Collapse
Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
- Takuji Yokoe, MD, Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan ()
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Hiroshi Sugimura
- Department of Radiology, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shinichirou Kubo
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shotarou Nozaki
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
Cejudo A, Ginés-Díaz A, Rodríguez-Ferrán O, Santonja-Medina F, Sainz de Baranda P. Trunk Lateral Flexor Endurance and Body Fat: Predictive Risk Factors for Low Back Pain in Child Equestrian Athletes. Children (Basel) 2020; 7:children7100172. [PMID: 33050134 PMCID: PMC7600765 DOI: 10.3390/children7100172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022]
Abstract
Low back pain (LBP) is the most common overuse musculoskeletal injury suffered by child equestrian athletes (CEA). Despite this, little is known about the risk factors related to LBP in these athletes, and very limited research has been conducted on this topic. This study was designed to investigate predictive risk factors for LBP in CEA. The purposes of this research were to determine whether anthropometric, range of motion (ROM), core endurance and sagittal spinal morphotype measures are risk factors for LBP and to establish a diagnostic cutoff value for those factors associated with LBP. Nineteen CEA between the ages of 12 and 17 years were voluntarily recruited. Potential risk factors evaluated included corporal composition, lower limb ROM, core endurance and sagittal spinal measures. Associations and predictions were calculated between these risk factors and the LBP during the last 12 months. Almost half of the CEA have suffered at least one episode of LBP. Two risk factors and cutoff values were identified as predictors of LBP in CEA: having a high body fat higher than 23% (p = 0.01) and trunk lateral flexor endurance lower to 65 s (p = 0.021), body fat being the strongest predictor.
Collapse
Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 Murcia, Spain; (A.C.); (P.S.d.B.)
- Sports and Musculoskeletal System Research Group (RAQUIS), Campus de San Javier, University of Murcia, 30720 Murcia, Spain;
| | - Angélica Ginés-Díaz
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 Murcia, Spain; (A.C.); (P.S.d.B.)
- Sports and Musculoskeletal System Research Group (RAQUIS), Campus de San Javier, University of Murcia, 30720 Murcia, Spain;
- Correspondence: (A.G.-D.); (O.R.-F.); Tel.: +34-868-88-8824; Fax: +34-868-88-8672
| | - Olga Rodríguez-Ferrán
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 Murcia, Spain; (A.C.); (P.S.d.B.)
- Sports and Musculoskeletal System Research Group (RAQUIS), Campus de San Javier, University of Murcia, 30720 Murcia, Spain;
- Correspondence: (A.G.-D.); (O.R.-F.); Tel.: +34-868-88-8824; Fax: +34-868-88-8672
| | - Fernando Santonja-Medina
- Sports and Musculoskeletal System Research Group (RAQUIS), Campus de San Javier, University of Murcia, 30720 Murcia, Spain;
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30720 Murcia, Spain; (A.C.); (P.S.d.B.)
- Sports and Musculoskeletal System Research Group (RAQUIS), Campus de San Javier, University of Murcia, 30720 Murcia, Spain;
| |
Collapse
|
7
|
Zemková E, Kováčiková Z, Zapletalová L. Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes? Front Physiol 2020; 11:894. [PMID: 32792989 PMCID: PMC7394240 DOI: 10.3389/fphys.2020.00894] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.
Collapse
Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia.,Sports Technology Institute, Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, Bratislava, Slovakia.,Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Zuzana Kováčiková
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Ludmila Zapletalová
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| |
Collapse
|
8
|
Dragsbæk L, Kjaer P, Hancock M, Jensen TS. An exploratory study of different definitions and thresholds for lumbar disc degeneration assessed by MRI and their associations with low back pain using data from a cohort study of a general population. BMC Musculoskelet Disord 2020; 21:253. [PMID: 32303267 PMCID: PMC7165403 DOI: 10.1186/s12891-020-03268-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lumbar disc degeneration seen on magnetic resonance imaging (MRI) is defined as loss of signal intensity and/or disc height, alone or in combination with other MRI findings. The MRI findings and thresholds used to define disc degeneration vary in the literature, and their associations with low back pain (LBP) remain uncertain. OBJECTIVE To explore how various thresholds of lumbar disc degeneration alter the association between disc degeneration and self-reported LBP. METHODS An exploratory, cross-sectional cohort study of a general population. Participants in the cohort 'Backs-on-Funen' had MRI scans and completed questionnaires about LBP at ages 41, 45 and 49 years. The MRI variables, signal intensity (Grades 0-3) and disc height (Grades 0-3), were dichotomised at different thresholds. Logistic regression analyses were used to determine associations. Arbitrarily, a difference in odds ratio (OR) of > 0.5 between thresholds was considered clinically relevant. Receiver Operating Characteristic curves were used to investigate differences between diagnostic values at each threshold. RESULTS At age 41, the difference in ORs between signal loss and LBP exceeded 0.5 between the thresholds of ≥2 (OR = 2.02) and = 3 (OR = 2.57). Difference in area under the curves (AUC) was statistically significant (p = 0.02). At ages 45 and 49, the difference in ORs exceeded 0.5 between the thresholds of ≥2 and = 3, but the differences between AUC were not statistically significant. At age 41, the difference in ORs between disc height loss and LBP at the thresholds of ≥1 (OR = 1.44) and ≥ 2 (OR = 2.53) exceeded 0.5. Differences in AUC were statistically significant (p = 0.004). At age 49, differences in ORs exceeded 0.5 (OR = 2.49 at the ≥1 threshold, 1.84 at ≥2 and 0.89 at =3). Differences between AUC were not statistically significant. CONCLUSION The results suggest that the thresholds used to define the presence of lumbar disc degeneration influence how strongly it is associated with LBP. Thresholds at more severe grades of disc signal and disc height loss were more strongly associated with LBP at age 41, but thresholds at moderate grades of disc degeneration were most strongly associated with LBP at ages 45 and 49.
Collapse
Affiliation(s)
- Line Dragsbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark. .,Health Sciences Research Centre, UCL University College, Odense, Denmark.
| | - Mark Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Tue Secher Jensen
- Department of Diagnostic Imaging, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| |
Collapse
|
9
|
Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma 2020; 11:761-769. [PMID: 32879563 PMCID: PMC7452231 DOI: 10.1016/j.jcot.2020.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Lumbar degenerative spinal ailments are the most important causes for chronic low back pain. Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD). Despite being widely studied, majority of issues concerning MC are still controversial. The current narrative, evidence-based review comprehensively discusses the various aspects related to MC. LITERATURE SEARCH An elaborate search was made using keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes", on pubmed and google (scholar.google.com) databases on the 3rd of March 2020. We identified crucial questions regarding Modic changes and included relevant articles pertaining to these topics for this narrative review. RESULTS The initial search using the keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" on pubmed yielded a total of 568, 412, 394 and 216 articles on "pubmed" database, respectively. A similar search using the aforementioned keywords yielded a total of 3650, 3548, 3726 and 21570 articles on "google scholar" database. The initial screening involved exclusion of duplicate articles, articles unrelated to MC, animal or other non-clinical studies, and articles in non-English literature based on abstracts or the titles of articles. This initial screening resulted in the identification of 405 articles. Full manuscripts were obtained for all these selected articles and thoroughly scrutinised at the second stage of article selection. All articles not concerning Modic changes, not pertaining to concerned questions, articles concerning other degenerative phenomena, articles discussing cervical or thoracic MC, case reports or animal studies, articles in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 69 articles were included in this review. CONCLUSION Modic change (MC) is a dynamic phenomenon and its true etiology is still not definitely known. Disc/end plate injury, occult discitis and autoimmune reactions seem to trigger an inflammatory cascade, which leads to their development. Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities, higher occupational loads and DDD are known risk factors. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.
Collapse
Affiliation(s)
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India,Corresponding author.
| | - S. Rajasekaran
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India,Department of Orthopedics, Ganga Medical Center and Hospitals, Coimbatore, India
| |
Collapse
|
10
|
Herlin C, Kjaer P, Espeland A, Skouen JS, Leboeuf-Yde C, Karppinen J, Niinimäki J, Sørensen JS, Storheim K, Jensen TS. Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS One 2018; 13:e0200677. [PMID: 30067777 DOI: 10.1371/journal.pone.0200677] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary studies, there is a need for a comprehensive systematic review. Our objectives were to investigate if MCs are associated with non-specific LBP and/or activity limitation and if such associations are modified by other factors. METHODS A protocol for this review was registered at PROSPERO prior to commencing the work (PROSPERO record: CRD42015017350). The MEDLINE, CINAHL and EMBASE databases were searched for relevant studies from first record to June 15th 2016. Prospective or retrospective cross-sectional cohort studies and case-control studies including people of all ages from general, working and clinical study populations were eligible for inclusion. Risk of bias assessment and data extraction for associations and potential modifiers were completed independently by pairs of reviewers. Meta-analysis was performed for homogeneous studies and presented as odds ratios (OR) with 95% CI. RESULTS In all, 5210 citations were identified and 31 studies were included. One study had low risk of bias. Fifteen studies (48%) reported statistically significant positive associations between MCs and LBP and one study found a statistically significant negative association. Meta-analysis performed for studies using concordant pain with provocative discography as the clinical outcome resulted in an OR of 4.01 (1.52-10.61). One of seven studies reported a statistically significant positive association between MCs and activity limitation. Lumbar disc level and disc degeneration were found to modify the association between MCs and LBP. CONCLUSIONS The results from this comprehensive systematic review indicate that the associations between MCs and LBP-related outcomes are inconsistent. The high risk of bias and the heterogeneity in terms of study samples, clinical outcomes and prevalence estimates of MCs and LBP may explain these findings. It is likely that new studies with low risk of bias will affect the direction and strength of these associations.
Collapse
|
11
|
Abstract
Background Back pain is a frequent health problem in the general population. The epidemiology of back pain in the general population is well researched, but detailed data on the prevalence and risk factors of back pain in athletes are rare. Objective The primary objective was to review articles about back pain in athletes to provide an overview of its prevalence in different sports and compare its prevalence among various types of sports and the general population. Data Sources A comprehensive search of articles published through May 2015 was conducted. Two independent reviewers searched six databases from inception (PubMed®, Embase, MEDLINE®, Cochrane Library, PsycINFO and PSYNDEX), using specifically developed search strategies, for relevant epidemiological research on back pain in 14- to 40-year-old athletes of Olympic disciplines. The reviewers independently evaluated the methodological quality of reviewed articles meeting the inclusion criteria to identify potential sources of bias. Relevant data were extracted from each study. Results Forty-three articles were judged to meet the inclusion criteria and were included in the assessment of methodological quality. Of these, 25 were assessed to be of high quality. Lifetime prevalence and point prevalence were the most commonly researched episodes and the lower back was the most common localization of pain. In the high-quality studies, lifetime prevalence of low back pain in athletes was 1–94%, (highest prevalence in rowing and cross-country skiing), and point prevalence of low back pain was 18–65% (lowest prevalence in basketball and highest prevalence in rowing). Conclusion The methodological heterogeneity of the included studies showed a wide range of prevalence rates and did not enable a detailed comparison of data among different sports, within one discipline, or versus the general population. Based on the results of this review, however, it seems obvious that back pain requires further study in some sports. Electronic supplementary material The online version of this article (doi:10.1007/s40279-016-0645-3) contains supplementary material, which is available to authorized users.
Collapse
|
12
|
Iwai K, Koyama K, Okada T, Nakazato K, Takahashi R, Matsumoto S, Yamamoto Y, Hiranuma K. Asymmetrical and smaller size of trunk muscles in combat sports athletes with lumbar intervertebral disc degeneration. Springerplus 2016; 5:1474. [PMID: 27652049 PMCID: PMC5009060 DOI: 10.1186/s40064-016-3155-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022]
Abstract
Background Lumbar intervertebral disc degeneration (LDD) frequently occurs in athletes. Associations between LDD and trunk muscles still remain unclear. Purpose This study examined whether there is an association between the prevalence of LDD and the symmetry and size of the cross-sectional areas (CSAs) of the trunk muscles in combat sports athletes. Methods Participants in this study were 151 collegiate male combat sports athletes. A total of 755 lumbar intervertebral discs from L1–2 to L5–S1 in 151 athletes were assessed using magnetic resonance imaging (MRI) and a comprehensive grading system of LDD (grades I–V). All 151 athletes were divided into 2 groups: LDD and non-LDD. CSAs of trunk muscles at the L3–4 disc level were measured using MRI. Results Sixty-nine athletes had LDD at 1 or more disc levels (45.7 %). The LDD grade for the lower 2 disc levels was significantly higher than that for the other disc levels (p < 0.001). The CSAs of the left and right sides in trunk muscles were significantly asymmetrical, independent of the LDD which was prevalent in the disc levels (obliques: p = 0.040; quadratus lumborum: p < 0.001). The relative CSAs of trunk muscles to their body weight in the LDD group were significantly smaller than those in the non-LDD group (rectus abdominis: p = 0.011; obliques: p = 0.024; quadratus lumborum: p = 0.006; lumbar erector spinae plus multifidus: p = 0.001). Conclusion This study suggests that the prevalence of LDD is associated with asymmetrical and relatively smaller CSAs of trunk muscles in combat sports athletes.
Collapse
Affiliation(s)
- Kazunori Iwai
- School of Kinesiology, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada ; Hiroshima Maritime College, National Institute of Technology, 4272-1 Higashino Osakikamijima-cho, Toyota-gun, Hiroshima, 725-0231 Japan
| | - Koji Koyama
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Science, 2-9-1 Ariake, Koto-ku, Tokyo, 135-0063 Japan
| | - Takashi Okada
- Faculty of Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508 Japan
| | - Koichi Nakazato
- Graduate School of Health and Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508 Japan
| | - Ray Takahashi
- School of Kinesiology, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - Shingo Matsumoto
- Sports Methodology (Wrestling), Nippon Sport Science University, 1221-1, Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa 227-0033 Japan
| | - Yosuke Yamamoto
- Sports Methodology (Judo), Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508 Japan
| | - Kenji Hiranuma
- Graduate School of Health and Sport Science, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, 158-8508 Japan
| |
Collapse
|
13
|
Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, Luetmer PH. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2015; 36:2394-9. [PMID: 26359154 DOI: 10.3174/ajnr.a4498] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/07/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging features of spine degeneration are common in symptomatic and asymptomatic individuals. We compared the prevalence of MR imaging features of lumbar spine degeneration in adults 50 years of age and younger with and without self-reported low back pain. MATERIALS AND METHODS We performed a meta-analysis of studies reporting the prevalence of degenerative lumbar spine MR imaging findings in asymptomatic and symptomatic adults 50 years of age or younger. Symptomatic individuals had axial low back pain with or without radicular symptoms. Two reviewers evaluated each article for the following outcomes: disc bulge, disc degeneration, disc extrusion, disc protrusion, annular fissures, Modic 1 changes, any Modic changes, central canal stenosis, spondylolisthesis, and spondylolysis. The meta-analysis was performed by using a random-effects model. RESULTS An initial search yielded 280 unique studies. Fourteen (5.0%) met the inclusion criteria (3097 individuals; 1193, 38.6%, asymptomatic; 1904, 61.4%, symptomatic). Imaging findings with a higher prevalence in symptomatic individuals 50 years of age or younger included disc bulge (OR, 7.54; 95% CI, 1.28-44.56; P = .03), spondylolysis (OR, 5.06; 95% CI, 1.65-15.53; P < .01), disc extrusion (OR, 4.38; 95% CI, 1.98-9.68; P < .01), Modic 1 changes (OR, 4.01; 95% CI, 1.10-14.55; P = .04), disc protrusion (OR, 2.65; 95% CI, 1.52-4.62; P < .01), and disc degeneration (OR, 2.24; 95% CI, 1.21-4.15, P = .01). Imaging findings not associated with low back pain included any Modic change (OR, 1.62; 95% CI, 0.48-5.41, P = .43), central canal stenosis (OR, 20.58; 95% CI, 0.05-798.77; P = .32), high-intensity zone (OR = 2.10; 95% CI, 0.73-6.02; P = .17), annular fissures (OR = 1.79; 95% CI, 0.97-3.31; P = .06), and spondylolisthesis (OR = 1.59; 95% CI, 0.78-3.24; P = .20). CONCLUSIONS Meta-analysis demonstrates that MR imaging evidence of disc bulge, degeneration, extrusion, protrusion, Modic 1 changes, and spondylolysis are more prevalent in adults 50 years of age or younger with back pain compared with asymptomatic individuals.
Collapse
Affiliation(s)
- W Brinjikji
- From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.)
| | - F E Diehn
- From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.)
| | - J G Jarvik
- Department of Neurological Surgery and Health Services, Comparative Effectiveness Cost and Outcomes Research Center (J.G.J.) Department of Radiology (J.G.J.), University of Washington, Seattle, Washington
| | - C M Carr
- From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.)
| | - D F Kallmes
- From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.)
| | - M H Murad
- Center for Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.)
| |
Collapse
|
14
|
Koyama K, Nakazato K, Hiranuma K. Etiology and nature of intervertebral disc degeneration and its correlation with low back pain. JPFSM 2015. [DOI: 10.7600/jpfsm.4.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Koji Koyama
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Sciences
| | - Koichi Nakazato
- Graduate School of Health and Sport Sciences, Nippon Sport Science University
| | - Kenji Hiranuma
- Graduate School of Health and Sport Sciences, Nippon Sport Science University
| |
Collapse
|
15
|
Koyama K, Nakazato K, Min SK, Gushiken K, Hatakeda Y, Seo K, Hiranuma K. Anterior Limbus Vertebra and Intervertebral Disk Degeneration in Japanese Collegiate Gymnasts. Orthop J Sports Med 2013; 1:2325967113500222. [PMID: 26535240 PMCID: PMC4555487 DOI: 10.1177/2325967113500222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) studies have shown that gymnasts have a high prevalence of radiological abnormalities, such as intervertebral disk degeneration (IDD) and anterior limbus vertebra (ALV). These 2 abnormalities may coexist at the same spinal level. However, the relationship between IDD and ALV remains unclear. Hypothesis: A significant relationship exists between IDD and ALV in Japanese collegiate gymnasts. Study Design: Case-control study. Methods: A total of 104 Japanese collegiate gymnasts (70 men and 34 women; age, 19.7 ± 1.0 years) with 11.8 ± 3.6 years of sporting experience participated. T1- and T2-weighted MRIs were used to evaluate ALV and IDD. Results: The prevalence among the gymnasts of IDD and ALV was 40.4% (42/104) and 20.2% (21/104), respectively. The prevalence of IDD was significantly higher in gymnasts with ALV than those without ALV, as determined using the chi-square test. Logistic regression analysis demonstrated a significant association between IDD and ALV (adjusted odds ratio [OR], 6.60; 95% confidence interval [CI], 2.14-20.35). IDD was further grouped by whether it was present in the upper lumbar region (L1-2, L2-3, and L3-4 disks) or in the lower lumbar region (L4-5 and L5-S1 disks). Upper IDD had a greater association with ALV (adjusted OR, 33.17; 95% CI, 7.09-155.25) than did lower IDD (adjusted OR, 6.71; 95% CI, 1.57-28.73). Conclusion: In Japanese collegiate gymnasts, ALV is a predictor of IDD, especially in the upper lumbar region. Clinical Relevance: Information regarding ALV is important to prevent IDD in Japanese collegiate gymnasts.
Collapse
Affiliation(s)
- Koji Koyama
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan. ; Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Koichi Nakazato
- Department of Exercise Physiology, Graduate School of Health and Sport Sciences, Nippon Sport Science University, Tokyo, Japan
| | - Seok-Ki Min
- Department of Exercise Physiology, Graduate School of Health and Sport Sciences, Nippon Sport Science University, Tokyo, Japan
| | - Koji Gushiken
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Yoshiaki Hatakeda
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Kyoko Seo
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Kenji Hiranuma
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| |
Collapse
|