Back pain prevalence in adolescent athletes

Swimming for low back pain: A scoping review

BACKGROUND

Guidelines recommend exercise for treatment of chronic low back pain and prevention, but the amount and quality of evidence for different exercise modes is highly variable. Swimming is commonly recommended by health professionals, but the extent and quality of research supporting its relationship with back pain is not clear.

OBJECTIVES

The aim of this scoping review was to map the extent, characteristics and findings of research investigating the relationship between swimming and low back pain.

DESIGN

Scoping review.

METHOD

Four electronic databases (MEDLINE, EMBASE, CINAHL, and SPORT Discus) were searched from inception to February 2023. We included primary studies and reviews that reported an association between swimming and low back pain. Hydrotherapy studies were excluded.

RESULTS

3093 articles were identified, and 44 studies included. Only one randomised controlled trial and one longitudinal cohort study were included. Most studies were cross-sectional (37/44; 84.1%), included competitive athletes (23/39; 59.0%), and did not primarily focus on the association between swimming and low back pain in the aims (41/44; 93.2%). Instead, most data available were largely incidentally collected or a secondary outcome. The reported associations between swimming and low back pain were highly variable regardless of whether the comparison was to other sports (odds ratio: 0.17 to 17.92) or no sport (odds ratio: 0.54 to 3.01).

CONCLUSION

Most available literature investigating swimming and low back pain is cross-sectional in design. We did not identify any clear pattern of association between swimming and low back pain, based on the available literature.

Clinical characteristics of early-stage lumbar spondylolysis detected by magnetic resonance imaging in male adolescent baseball players

BACKGROUND

Many adolescent athletes experience low back pain; the most common cause is lumbar spondylolysis. Although early identification of lumbar spondylolysis in adolescent athletes is critical, few studies have focused on identifying the early stages of spondylolysis in baseball players. This study aimed to investigate the clinical characteristics of early-stage spondylolysis in male adolescent baseball players.

METHODS

The participants comprised male junior and high school baseball players. Before magnetic resonance imaging, we recorded their demographic data, low back pain characteristics, and physical findings (lumbar flexion, extension, Kemp's test and the provocative tenderness of a spinous process). After the imaging evaluation, the association among low back pain characteristics, physical findings and the final diagnosis (early-stage spondylolysis or not) were investigated using univariate and multivariable analyses.

RESULTS

A total of 171 players were included in this study. Univariate analyses indicated that the characteristics associated with early-stage spondylolysis were longer duration of low back pain (P = 0.0085), low back pain-related interference while running (P = 0.0022), low back pain starting with laterality (P = 0.0001), lumbar extension (P = 0.022), positive Kemp's test (P = 0.020), and the tenderness of a spinous process (P = 0.0003). After adjusting for confounding factors (age and position), we found that early-stage spondylolysis was significantly associated with low back pain duration ≥4 weeks (odds ratio 3.13, 95% confidence interval 1.42-6.92; P = 0.0048), low back pain-related interference while running (odds ratio 2.89, 95% confidence interval 1.30-6.46; P = 0.0094), low back pain starting with laterality (odds ratio 2.78, 95% confidence interval 1.24-6.27; P = 0.0133), and the tenderness of a spinous process (odds ratio 3.00, 95% confidence interval 1.36-6.57; P = 0.0062).

CONCLUSIONS

Male adolescent baseball players with early-stage spondylolysis might have low back pain duration of more than four weeks, low back pain-related interference while running, and a history of low back pain starting with laterality. The tenderness of a spinous process might be helpful in the diagnosis of early-stage spondylolysis in male adolescent baseball players.

Lower back pain in young climbers: a retrospective cross-sectional study

Objective

The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers.

Methods

The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS).

Results

A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes.

Conclusions

This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.

Instruments for assessing back pain in athletes: A systematic review

Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.

Incidence of lumbar spondylolysis in athletes with low back pain: A systematic evaluation and single-arm meta-analysis

BACKGROUND

Low back pain (LBP) is a common chief complaint from athletes. Lumbar spondylolysis (LS) is a common sport injury. Severe LS is likely to cause spinal instability, resulting in lumbar spondylolisthesis or lumbar disc herniation, and even damage to the spinal nerve roots. The incidence of LS is approximately 5% in the adult population, and nearly half of young athletes with LBP are diagnosed with LS. This meta-analysis analyzed the incidence of LS in athletes with LBP.

METHODS

PubMed, Embase, Cochrane (Cochrane Central Register of Controlled Trials), and Web of Science databases were systematically searched for published case report and retrospective analyses related to the topic from the date of database creation to January 1,2023. Relevant literature was screened and information extracted, and risk of bias was assessed for included studies using the methodological index for non-randomized-studies scale. Single-arm Meta-analysis was performed using R4.04 software. Heterogeneity was quantified by Cochran Q test and Higgins I2. Funnel plots were used to visualize publication bias, and Egger test and Begg test were used to statistical tests.

RESULTS

A total of 9 studies (835 patients) were included in this study. Meta-analysis revealed that the prevalence of LS in athletes with LBP was estimated at 41.7%, [95% CI = (0.28-0.55)], but this prevalence varied considerably with the gender and age of the athletes.

CONCLUSION

The estimated prevalence of LS in athletes with LBP is 41.7%, and future correlations between the prevalence of LS in adolescent athletes worldwide need to be assessed from different perspectives, including biomechanical, hormonal, anatomical, behavioral, and gender differences.

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

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.

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.

Prevalence and Incidence of Injury during Olympic-style Shooting Events: A Systematic Review

BACKGROUND

Shooting sports are included in collegiate and Olympic events. However, there is minimal evidence examining injury prevalence and incidence for these athletes.

HYPOTHESIS/PURPOSE

The purpose of this study was to systematically review the literature to examine the available evidence regarding the incidence, prevalence, and types of injuries that affect athletes in Olympic-style shooting events.

STUDY DESIGN

Systematic review.

METHODS

The electronic databases PubMed, Cochrane Library, Cinahl, MEDLINE, and SPORTDiscus were searched utilizing terms related to shooting and injuries. Studies were included if they reported prevalence or incidence of injury in collegiate or Olympic shooting events, and were excluded if inclusion criteria were not met, full text was unavailable, or not in English. Two reviewers independently screened articles in two phases: 1) screening of titles/abstracts 2) full text review. A third reviewer resolved conflicts.

RESULTS

Nineteen studies were ultimately included. The sports identified were biathlon, rifle, pistol, and shotgun. Shooting events in both winter and summer Olympics had low percentages of injuries compared to other sports. Winter shooting events had a higher percentage of injuries (6.9%) compared to summer (2.3%). In summer, females demonstrated a higher percentage of injuries (6.9%) compared to males (1.7%). In winter, males had a higher percentage of injuries (8.6%) versus females (5.1%).

CONCLUSION

Injury incidence and prevalence was low for athletes in shooting sports in the Olympics. Injury rate was higher in the winter Olympic shooting events likely from increased physiological demand. With injury surveillance focusing on acute injuries rather than chronic, the number of injuries may be underestimated. Females had higher injury rates than males in the summer Olympics while the opposite was observed in the winter Olympics, likely from sex differences and differences in physiological demand for each event.

LEVEL OF EVIDENCE

Level 3.

Low Back Pain in Young Sports Players: A Cross-sectional Study in Japan

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

The purpose of this large cohort study was to assess the prevalence of low back pain (LBP) among young players participating in several types of sports.

SUMMARY OF BACKGROUND DATA

LBP is a significant problem among young sports players. Sport discipline among young players is thought to be associated with LBP. However, similar previous studies did not specifically analyze LBP by age and sex.

METHODS

A cross-sectional study was conducted with young sports players (ages 6-15 years, n = 7277) using a self-reported questionnaire. The prevalence of LBP was assessed using the variables of age, sex, and sport discipline.

RESULTS

The point prevalence of LBP among young sports players was 5.0%. The participants between 6 and 8 years' old had the lowest prevalence of LBP (0.4%-1.3%), which increased with aging and reached the highest proportion of 13.5% to 14.8% at 13 to 14 years. Furthermore, female players had significantly higher proportions of LBP than male players (8.1% vs. 3.7%). Regarding sport discipline, the prevalence of LBP was higher in basketball, handball, and volleyball.

CONCLUSION

The prevalence of LBP among young sports players was different for age, sex, and sport discipline. Further studies are needed to clarify the association of sport-specific movements to LBP in each sport discipline. This may assist in developing programs or strategies for preventing LBP among young sports players.Level of Evidence: 3.

Motor performance and back pain in children and adolescents: A systematic review

BACKGROUND AND OBJECTIVE

Motor performance during childhood and adolescence is recognized as a relevant determinant of present and future health, but its effects on back pain (BP) remain unclear. In this systematic review, we aimed to identify the association between motor performance and BP in children and adolescents.

DATABASES AND DATA TREATMENT

A literature search was performed in the MEDLINE, Scopus, Embase, SPORTDiscus and CINAHL databases. We included cross-sectional, cohort, case-control and controlled clinical trials (data from control groups). The inclusion criteria were as follows: (a) participants aged 6-19 years; (b) assessment motor performance components; (c) assessment of BP and (d) reported measures of association. The risk of bias was assessed by the Downs and Black instrument and the quality of evidence by the grading of recommendations, assessment, development and evaluation (GRADE).

RESULTS

A total of 2360 articles were identified, 25 of which were included in our systematic review. Of the 25 studies, 19 were evaluated as having a low risk of bias. GRADE indicated that 20 studies presented low or very low quality. Most of the studies evaluated flexibility (n = 16), muscle endurance (n = 18) and muscle strength (n = 9). Aerobic capacity, balance and speed were also examined in some studies (n < 5). Overall, motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of the supporting evidence. Prospective studies with a low risk of bias are warranted to further clarify this relationship in childhood and adolescence and findings may support more targeted and effective health promotion interventions.

SIGNIFICANCE

This systematic review shows that motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP in children and adolescents. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of supporting evidence.

Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain

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.

Orthopaedic medical examination for young amateur athletes: a repeated cross-sectional study from 2014 to 2018

OBJECTIVES

Medical examinations for adult elite athletes are performed all over the world, however, no studies in the relevant English literature have reported on orthopaedic medical examinations for young amateur athletes. The purpose of this study was to report the results of orthopaedic medical examinations of the spine and lower extremities in young amateur athletes.

METHODS

This repeated cross-sectional study from 2014 to 2018 included a total of 323 young amateur athletes (age, 12-18 years) who were active in one of the following four sports: boxing, canoeing, weightlifting and track and field. The orthopaedic medical examination consisted of six assessments (physical examinations, the generalised joint laxity, muscle and joint tightness, static alignment and muscle volume of the lower extremities and the medial longitudinal arch of the foot). Questions regarding pain in the spine and lower extremities were also performed.

RESULTS

Among 323 young amateur athletes, 17 (5.3%) had received orthopaedic treatment at the time of the medical examination, with spondylolysis being the most common cause (29.4%, 5/17). Among 306 young athletes who had not received orthopaedic treatment, 61 (19.9%) had at least one positive finding in physical examinations or had pain in the spine or lower extremities. Anterior drawer test of the ankle and Kemp test for the spine accounted for 34% and 28% of positive findings, respectively. Low back pain and knee pain accounted for 58% and 16% of pain, respectively.

CONCLUSIONS

The present study showed that approximately one-fifth of young amateur athletes who had not received orthopaedic treatment had pain in the spine and lower extremities and positive findings in physical examinations that may require orthopaedic treatments. In addition to the early detection of injuries, orthopaedic medical examinations for young amateur athletes provide an opportunity to educate such athletes.

Motor performance and back pain in children and adolescents: a systematic review and meta-analysis protocol

BACKGROUND

The relationship between motor performance and back pain in children and adolescents remains unclear. This article describes the protocol for a systematic review to summarize the knowledge about the association between motor performance, such as agility, flexibility, balance, strength, muscle endurance, and cardiorespiratory fitness, and back pain. Thus, our aim is to identify the influence of motor performance on back pain among children and adolescents.

METHODS

Two independent researchers will search MEDLINE, Scopus, Embase, SPORTDiscus, and CINAHL databases, with no period or language restrictions. We will include cross-sectional, cohort, case-control, and controlled clinical trial studies based on the following criteria: (a) participants from 6 to 19 years of age, (b) assessment of motor performance, (c) assessment of back pain, and (d) report measures of associations between motor performance and back pain. Study quality and risk of bias will be assessed using an adapted version of the Downs and Black instrument. Grading of Recommendations, Assessment, Development, and Evaluations will be used to assess the strength of the body of evidence. Meta-analyses of association measures will be performed for each type of motor performance, separately for different study types. The results will be reported using forest to show the pooled effect of findings and funnel plots to assess precision of the data. If studies are not homogeneous, results from the meta-analyses will not be reported. Associations will then be synthesized descriptively using a pragmatic approach.

DISCUSSION

This systematic review will provide critical insights into the association between motor performance and back pain among children and adolescents; this information may help support clinical practice guidelines as well as public health programs.

ETHICS AND DISSEMINATION

Protocol was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020178496.

Comparison of symptomatic spondylolysis in young soccer and baseball players

BACKGROUND

Spondylolysis is the main cause of low back pain (LBP) in young athletes. There are few studies analyzing the difference of spondylolysis among young athletes with different sports activities. The purpose of this study was to compare the clinical factors and distribution of the lesions of spondylolysis on magnetic resonance imaging (MRI) scans in young soccer and baseball players with symptomatic spondylolysis.

METHODS

The medical records of 267 young athletes aged 7 to 18 years old who underwent MRI to evaluate the cause of LBP between 2017 and 2020 were retrospectively reviewed to identify patients with spondylolysis. Of the young athletes with symptomatic spondylolysis, clinical factors and MRI findings in soccer and baseball players were retrospectively evaluated. The clinical factors were age, sex, interval from onset of LBP to MRI, and side of the dominant leg in the sports field. MRI findings included number, lumbar level, and side of the lesions.

RESULTS

A total of 33 soccer players (mean age, 15.4 ± 1.4 years) and 49 baseball players (mean age, 15.4 ± 1.6 years) with symptomatic spondylolysis were enrolled. All patients were male. No significant differences were noted in age and the interval from onset of LBP to MRI between the groups. Soccer players had greater numbers of multiple (p < 0.001) and bilateral (p < 0.001) lesions than baseball players. The dominant side of the hand for pitching or batting was correlated with the contralateral-side lesions in baseball players (p = 0.001).

CONCLUSIONS

The distribution of the lesions of spondylolysis differed in young soccer and baseball players. Pitching or batting with the dominant-side hand would be associated with contralateral-side lesions in baseball players. Sports-specific movements and the side of the dominant leg should be considered when treating young athletes with symptomatic spondylolysis.

Association Among Dyskinesia of the Lumbar Spine Segment, Inclination Angle of the Lumbosacral Spine, and Low Back Pain in Young Athletes: A Predictive Correlational Study

OBJECTIVE

This predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine.

METHODS

The study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2). The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression.

RESULTS

There was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra.

CONCLUSION

There was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.

French preparticipation physical evaluation for children in 2020: What has changed?

At the end of 2019, there was discussion in France about whether to abolish the obligatory medical certificate of no contraindication for a minor to obtain a sports license. It was finally decided not to abolish the certificate, but it raises the question of which steps should be taken to assess the physical capacities of children. General practitioners or pediatricians are responsible for the preparticipation physical evaluation of children wishing to obtain a sports license, in particular involving over 20 mandatory consultations between the ages of 0 and 18. The purpose of the article is to propose a course of action to be taken considering the French legislation and general pediatric resources concerning the medical examination and warning signs that should lead to vigilance.

Development of a preliminary multivariable diagnostic prediction model for identifying active spondylolysis in young athletes with low back pain

AIMS

The primary aim of this study was to develop a diagnostic cluster of common clinical findings that would assist in ruling out an active spondylolysis in adolescent athletes with low back pain (LBP).

DESIGN

Retrospective case-series.

SETTING

Hospital-based sports medicine clinic.

PATIENTS

One thousand and twenty-five adolescent athletes with LBP (age 15.0 ± 1.8 years, 56% female) were reviewed. Active spondylolytic injuries were identified in 22% (n = 228) of these patients.

MAIN OUTCOME MEASURE

presence or absence of active spondylolysis on advanced imaging.

RESULTS

Through logistic regression analysis, pain with extension (p < 0.001), difference between active and resting pain ≥3/10 (p < 0.001), and male sex (p = 0.002) were identified as significantly associated with active spondylolysis. The clinical cluster had a sensitivity of 88% (95% CI 83%-93%) to help rule out active spondylolysis. The negative likelihood ratio was 0.34 (95% CI 0.23-0.51) and the negative predictive value was 90% (95% CI 86%-93%). Diagnostic accuracy of the cluster was acceptable (area under the curve = 0.72 (95% CI 0.69, 0.76; p < 0.001).

CONCLUSION

This study found a cluster of three patient characteristics that may assist in ruling out active spondylolysis in adolescent athletes with LBP.

Association between lower back pain and lower extremity pain among young volleyball players: A cross-sectional study

BACKGROUND

Lower back pain (LBP), as well as lower extremity injuries, are major problems among young volleyball players. Nevertheless, only few studies have focused on the relationship between lower extremity injuries and LBP.

OBJECTIVE

This study investigated the association between LBP and lower extremity pain, including knee and ankle pain, among young volleyball players.

DESIGN

Cross-sectional study.

SETTING

Amateur sports association.

PARTICIPANTS

Elementary and middle school-aged athletes (6-15 years of age).

MAIN OUTCOME MEASURES

LBP and lower extremity pain.

RESULTS

A total of 566 young volleyball players participated in this study. The point prevalence of LBP among young volleyball players was 9.5%. Using absence of lower extremity pain as a reference, the adjusted odds ratio (95% confidence interval) for LBP was 11.07 (5.64-21.71) in the presence of lower extremity pain.

CONCLUSIONS

LBP is associated with Lower extremity pain among young volleyball players. Careful attention should be paid to lower extremity complaints to prevent and treat LBP among young volleyball players.

Core Stability and Symmetry of Youth Female Volleyball Players: A Pilot Study on Anthropometric and Physiological Correlates

The aim of the present study was to examine the variation in core stability and symmetry of youth female volleyball players by age, and its relationship with anthropometric characteristics, the 30 s Wingate anaerobic test (WAnT), and the 30 s Bosco test. Female volleyball players (n = 24, age 13.9 ± 1.9 years, mean ± standard deviation) performed a series of anthropometric, core stability tests (isometric muscle endurance of torso flexors, extensors, and right and left lateral bridge), WAnT (peak power, mean power, Pmean, and fatigue index, FI) and Bosco test (Pmean). Flexors-to-extensors ratio and right-to-left lateral bridge ratio were also calculated. Participants were grouped into younger (n = 12, 12.3 ± 1.2 years) or older than 14 years (n = 12, 15.4 ± 1.0 years), and into normal (flexors-to-extensors ratio < 1; n = 17) or abnormal flexors-to-extensors ratio (≥1; n = 7). The older age group was heavier (+11.3 kg, mean difference; 95% CI, 2.0, 20.6) and with higher body mass index (+2.8 kg m−2; 95% CI, 0.4, 5.1) than the younger age group. The group with abnormal flexors/extensors had larger flexors muscle endurance (+77.4 s; 95% CI, 41.8, 113.0) and higher flexors/extensors ratio (+0.85; 95% CI, 0.61, 1.10) than the normal group. Body fat percentage (BF) correlated moderately-to-largely with flexors (r = −0.44, p = 0.033), extensors (r = −0.51, p = 0.011), and left lateral bridge (r = −0.45, p = 0.027); WAnT Pmean moderately-to-largely with right (r = 0.46, p = 0.027) and left lateral bridge (r = 0.55, p = 0.006); FI moderately-to-largely with right (r = −0.45, p = 0.031) and left lateral bridge (r = −0.67, p < 0.001), and right/left ratio (r = 0.42, p = 0.046); Bosco Pmean correlated moderately-to-largely with right (r = 0.48, p = 0.020) and left lateral bridge (r = 0.67, p = 0.001). A stepwise regression analysis indicated FI and BF as the most frequent predictors of core stability. The findings of the present study suggested that increased core stability was related to decreased BF and increased anaerobic capacity. A potential misbalance between torso flexors and extensors might be attributed to bidirectional variations (either high or low scores) of flexors muscle endurance rather than decreased extensors muscle endurance.

Trunk peak torque, muscle activation pattern and sudden loading compensation in adolescent athletes with back pain

OBJECTIVE

To evaluate trunk peak torque and muscle activation pattern during isokinetic and sudden trunk loading (STL) between adolescent athletes with/without back pain.

METHODS

Nine adolescent athletes with back pain (BP) (m/f 2/7; 15.6 ± 1.2 y; 177 ± 9 cm; 67 ± 13 kg; 22.5 ± 9.8 h/week) and nine matched controls (m/f 2/7; 15.7 ± 1.4 y; 177 ± 12 cm; 65 ± 9 kg; 16.5 ± 8.0 h/week training) were included. Trunk strength in rotation and flexion/extension was assessed. Sudden trunk loading was measured during eccentric extension and rotation (30∘/s) with additional perturbation. Trunk muscle activity was measured using a 12 lead-EMG (electromyography). Main outcome measures were peak torque [Nm] and MVC normalized EMG-amplitudes (RMS [%]) for each muscle. Additionally, the mean EMG-RMS for four areas of the trunk was calculated (right/left ventral, right/left dorsal).

RESULTS

Back pain showed lower trunk peak torque for all conditions in extension/flexion, but not for rotation. EMG amplitudes were increased for BP athletes with statistical significant differences for dorsal muscles in rotation and extension (p< 0.0042), not for ventral muscles in flexion.

CONCLUSIONS

The evaluation of strength and muscle activity in isokinetic and sudden trunk loading presents altered trunk function in adolescent back pain athletes. Training interventions focusing on trunk strength and muscular activation pattern appears reasonable.

Differences in Trunk Strength Between Weightlifters and Wrestlers

Investigations of trunk strength with high-level athletes are limited. The purpose of this study was to compare maximal concentric isokinetic trunk extension and flexion torque, power, and strength ratios between high-level weightlifters (n = 20), wrestlers (n = 20) and a control (n = 25) population. Isokinetic dynamometry was used to evaluate peak torque, power and strength ratios during seated trunk extension/flexion actions at 60°/s and 180°/s. There were no significant anthropometric differences between groups. Overall, trunk isokinetic force variables as a function of the increase in angular velocity, showed a decrease in peak torque, but an increase in power (athletes and controls). Compared to the control group, athletes demonstrated significantly higher trunk extension torque (+67.05 N·m, ES = 0.81) and power (+49.28 N·m, ES = 0.82) at 60°/s and 180°/s, respectively. Athletes produced significantly greater trunk flexion-extension ratios at 60°/s and 180°/s (ES = 0.80-0.47) than controls. Weightlifters and wrestlers exhibited significantly higher extensor than flexor torque at all angular velocities. Weightlifters demonstrated greater torque (ES = 0.79) than wrestlers at 60°/s. The wrestlers’ average power was significantly higher (ES = 0.43) than weightlifters at 180°/s. There were no significant ratio differences between wrestlers (66.23%) and weightlifters (72.06%). Weightlifters had stronger extensor muscles at 60°/s, whereas wrestlers had higher power at 180°/s for extensor muscles. It was postulated that the extensor muscles were stronger than the flexors to ensure trunk stabilisation, and for prevention of injuries. These differences seem to be associated to the movements that occur in each sport in terms of both muscle actions and contractile forces.

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.

Orthopedic Injury Profiles in Adolescent Elite Athletes: A Retrospective Analysis From a Sports Medicine Department

Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics. Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11-14/15-17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (α = 0.05). Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005). Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.

Prevalence of back pain in a group of elite athletes exposed to repetitive overhead activity

Background

The prevalence of back pain in athletes has been investigated in several studies, but there are still under- or uninvestigated sports discipline like sports exposed to repetitive overhead activity. Elite athletes spend much time in training and competition and, because of the nature of their disciplines, subject their bodies to a great deal of mechanical strain, which puts a high level of stress on their musculoskeletal systems. From this it is hypothesized that elite athletes who engage in repetitive overhead motions experience a higher strain on their spine and thus possibly a higher prevalence of back pain compared with an active control group.

Objectives

To examine the prevalence of back pain and the exact location of pain in a cohort of elite athletes with repetitive overhead activity and in a control group of physically active sport students. Additionally, to examine different characteristics of pain, and to evaluate the influence of confounders on back pain.

Methods

A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to German national and international elite athletes, and a control group of physically active but non-elite sports students.

Results

The final sample comprised 181 elite athletes of the sports disciplines badminton, beach volleyball, handball, tennis and volleyball and 166 physically active controls. In elite athletes, lifetime prevalence of back pain was 85%, 12-month prevalence was 75%, 3-month prevalence was 58% and point prevalence was 38%; for the physically active control group, these prevalences were 81%, 70%, 59% and 43%, respectively. There was no significant group difference in prevalence over all time periods. The lower back was the main location of back pain in elite athletes across all disciplines and in controls; additionally a distinct problem of upper back pain was found among volleyball players.

Conclusion

Despite the high mechanical load inherent in the sport disciplines included in this study, the elite athletes who engaged in repetitive overhead activities did not suffer more from back pain than the physically active controls. This suggests that other mechanisms may be influencing back pain prevalences in a positive way in these athletes. Furthermore, these disciplines may practice preventive factors for back pain that outweigh their detrimental factors. Therefore, we posit that extensive prevention work is already being implemented in these sports and that there are additional individual protection factors in play. More research is required to explore these suppositions, and should include investigations into which preventive training programs are being used. Nevertheless, in volleyball particularly, a focus on stabilization/preventive training should be applied to the upper back and neck.

Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes: A Longitudinal Study

Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.

Back pain in elite sports: A cross-sectional study on 1114 athletes

OBJECTIVES

To establish the prevalence of back pain in German elite athletes; examine the influence of age, sex, sports discipline and training volume; and compare elite athletes with a physically active control group.

METHODS

A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to approximately 4,000 German national and international elite athletes, and a control group of 253 physically active but non-elite sports students.

RESULTS

We received responses from 1,114 elite athletes (46.5% male and 53.1% female, mean age 20.9 years ± 4.8 years, mean height 176.5 ± 11.5 cm, mean weight 71.0 ± 10.3 kg) and 166 physically active sports students (74.7% male and 24.1 female, mean age 21.2 ± 2.0 years, mean height 180.0 ± 8.0 cm, mean weight 74.0 ± 14.5 kg). In elite athletes, the lifetime prevalence of back pain was 88.5%, the 12-month prevalence was 81.1%, the 3-month prevalence was 68.3% and the point prevalence was 49.0%, compared with 80.7%, 69.9%, 59.0% and 42.8%, respectively in the control group. The lifetime, 12-month and 3-month prevalences in elite athletes were significantly higher than in the control group. Regarding the individual sports disciplines, the prevalence of back pain was significantly higher in elite rowers, dancers, fencers, gymnasts, track and field athletes, figure skaters and marksmen, and those who play underwater rugby, water polo, basketball, hockey and ice hockey compared with the control group. The prevalence of back pain was significantly lower in elite triathletes.

CONCLUSIONS

Back pain is a common complaint in German elite athletes. Low back pain seems to be a problem in both elite athletes and physically active controls. A high training volume in elite athletes and a low training volume in physically active individuals might increase prevalence rates. Our findings indicate the necessity for specific prevention programs, especially in high-risk sports. Further research should investigate the optimal dose-effect relationship of sporting activity for the general population to prevent back pain.

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.

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.

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.