Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis

Effect of virtual reality therapy on pain relief in sports rehabilitation for young adults: A systematic review and meta-analysis

BACKGROUND

Virtual reality is an emerging technology that intends to promote motor and perceptual-cognitive skills, which could benefit people with sports injuries. However, there is a lack of meta-analyses on its effectiveness in sports injury rehabilitation for young adults.

OBJECTIVE

This systematic review and meta-analysis of randomised controlled trials evaluated the effectiveness of virtual reality therapy (VRT) on sports-related musculoskeletal rehabilitation in reducing pain and improving functional levels and balance among young adults.

METHODS

Studies and relevant reviews were searched using PubMed, CINAHL, EMBASE, CENTRAL, Web of Science, Scopus, grey literature in Google Scholar, ProQuest Dissertation and Theses, and manual searching of reference lists. Studies published up to 19 March 2024 involving young adults aged 18-40 with sports-related injuries undergoing VRT were included. The comparator was conventional rehabilitation. Meta-analysis was done by pooling standardised mean differences (SMD) or mean differences (MD) of pain, functional levels, and balance outcomes using the random-effects model. Quality appraisal was done using the Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

RESULTS

Eleven studies (n = 507 participants) were included. VRT seems significantly superior to conventional therapy in improving pain post-intervention (pooled SMD -5.16, 95% CI -7.36 to -2.97) and at long-term follow-up (pooled SMD -10.08, 95% CI -12.46 to -8.01). However, outcomes for functional levels and balance measured using the Star Excursion Balance Test were non-significant. Five trials had a low risk of bias, 3 were at high risk, and 3 had an unclear risk of bias. Outcomes were of very low to low certainty.

CONCLUSION

VRT seems able to significantly improve pain among young adults with sports-related musculoskeletal injuries. Therapists and clinicians can consider incorporating VRT in rehabilitation to engage participants and improve outcomes. Limited research has investigated the effect of VRT on function and balance.

Isometric Back Extensor Endurance and Chronic Low Back Pain in University Athletes: A Cross-Sectional Study

CONTEXT

Chronic low back pain (CLBP) is a common problem among university athletes, negatively affecting their performance and overall health. Deconditioned back muscles due to CLBP can reduce endurance. However, there is limited research on CLBP in university athletes, especially comparing those with and without the condition. Additionally, the connection between back muscle endurance and CLBP in university athletes is unclear, and there is insufficient data on normal levels of back muscle endurance. The present study aimed to establish normal back extensor muscle endurance values in university athletes, both with and without CLBP, and to investigate the link between back extensor endurance and CLBP.

DESIGN

Cross-sectional study.

METHODS

The study included 90 university-level athletes (45 with CLBP and 45 without CLBP; age: 18-30 y). Athletes underwent assessments on demographics, sports, and CLBP-related factors, as well as the Sorensen test. Appropriate statistical tests were applied to the obtained data.

RESULTS

Results showed a significant difference (P < .001) in Sorensen test holding duration between athletes with and without CLBP. The correlation analysis revealed a significant association (r = -.79, P = .02) between Sorensen test time and CLBP.

CONCLUSIONS

University athletes with CLBP exhibit lesser back extensor endurance than those without CLBP. There is a significant association between CLBP and Sorensen test hold time. The study's implications include using the Sorensen test for CLBP prediction and tracking therapeutic advancements in clinical practice.

Longitudinal Assessment of Intersegmental Abnormalities in the Lumbar Spine of Adolescent Competitive Alpine Skiers Over 48 Months

BACKGROUND

Overuse-related intersegmental abnormalities in the spine of competitive alpine skiers are common findings. However, longitudinal changes in intersegmental abnormalities and symptoms throughout adolescence have not been assessed.

PURPOSE

To longitudinally assess and compare overuse-related spinal intersegmental abnormalities in adolescent competitive alpine skiers over 48 months and to compare magnetic resonance imaging (MRI) findings in asymptomatic and symptomatic skiers.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Adolescent competitive alpine skiers were prospectively recruited between November 2108 and February 2019 and underwent 3-T MRI of the lumbar spine at baseline and after 48 months. All MRI scans were assessed for intersegmental changes of the intervertebral disk, vertebral body, and facet joints. At both time points, athletes' low back pain (LBP) symptoms were assessed via retrospective interviews relating to the 12-month period before the MRI study. Athletes were classified as symptomatic if at least 1 substantial episode of health problems related to back overuse had occurred in the 12 months before the MRI examination. The Wilcoxon signed-rank test and Pearson chi-square test were used to compare the measurements.

RESULTS

A total of 63 athletes (mean age at follow-up, 19.6 ± 1.2 years; 25 female) were included in the study. A significant increase in LBP affecting training and competition was observed at follow-up, with only 2 athletes reporting a history of spinal trauma (baseline, n = 13; follow-up, n = 20; P = .04). Of the athletes with LBP (n = 27), 59% (n = 16) reported recurrent LBP, 15% (n = 4) reported permanent LBP, and 26% (n = 7) reported 1-time LBP since baseline. Assessment of intersegmental changes revealed a significant increase in the number of athletes with disk signal reduction (baseline, n = 10; follow-up, n = 21; P = .001), disk bulging (baseline, n = 7; follow-up, n = 19; P = .002), or disk herniation (follow-up, n = 2; P = .04). Overall, intersegmental abnormalities did not correlate with LBP within the last year (P = .53).

CONCLUSION

Overuse-related intersegmental abnormalities of the lumbar spine are common in adolescent competitive alpine skiers and are often clinically silent at this age. These abnormalities may persist throughout skeletal maturation and even worsen during adolescence.

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

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

Pickleball Primer: An Overview of Common Injuries, Treatment, and Optimization Strategies in Pickleball Athlete

Pickleball is one of the fastest growing sports in the United States with millions of players nationwide. It is a relatively appealing sport because of its ease of access, low impact, and highly social atmosphere, allowing players of all ages to participate. As the number of players continues its dramatic increase, player injuries are certain to increase in turn. There is little to no orthopaedic research on pickleball-related injuries and a paucity of data regarding treatment and prevention strategies. This summary was designed to familiarize orthopaedic surgeons with the basics of the sport and highlight potential pickleball-related injuries they may encounter in practice.

Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review

OBJECTIVES

The aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes.

DESIGN

Retrospective chart review.

METHODS

This retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC).

RESULTS

Non-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34 %). This was closely followed by spondylolysis (28 %). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90 %) and SI-joint related pain (89 %) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50 %). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing.

CONCLUSIONS

An awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.

Prevalence of Lower Back Pain in Portuguese Equestrian Riders

Lower back pain is prevalent in equestrian athletes, but its prevalence and associated factors are unknown in the Portuguese equestrian population. A questionnaire regarding lower back pain and possible associated factors was answered by 347 respondents. Of the respondents, 214 (61.7%) stated having experienced lower back pain in the past 12 months and therefore completed the Roland Morris disability questionnaire. Among the latter, 63.1% stated that lower back pain impaired their performance. The probability of suffering from lower back pain was higher in individuals with higher weekly riding workloads, who reported equestrianism as their main occupation, and who performed daily stable duties. Considering a Roland Morris disability score of 4 as the cut-off value for dysfunction, this sample had an average score of 5.39 ± 4.42. Individuals who stated equestrianism was their main occupation showed a significantly higher risk (OR = 1.759, p = 0.041) of exhibiting a score ≥ 4 than those who stated equestrianism as a hobby. Age (p = 0.029), body mass index (p = 0.047), and daily performance of stable duties (p = 0.030) were also associated with a higher Roland Morris disability score. Further research is needed to understand the full impacts of lower back pain in Portuguese equestrian athletes.

Factors associated with non-specific low back pain in field hockey: A cross-sectional study of Premier and Division One players

OBJECTIVE

To determine the extent to which various factors are associated with greater or lesser odds of reporting non-specific low back pain (NS-LBP) in field hockey.

METHODS

To meet the objective of the study, a cross-sectional study design was used with a purposive sampling strategy. A total of 194 responses (~18% of those accessible) from Premier and Division One players within the UK were received using a UK-based online survey. Data collected included information on NS-LBP, participant characteristics, injury history, training related factors, and work and personal factors. The overall and category-specific prevalence of NS-LBP was calculated. Univariable and multivariable logistic regression was used in conjunction with clinical value to identify associations.

RESULTS

The overall prevalence of NS-LBP was 44.0%, with this varying from 23.5 to 70.0% for categories with responses of "yes" and "no" to experiencing NS-LBP. A total of ten individual factors associated with a greater odds ratio (OR) of reporting NS-LBP (OR = 1.43-7.39) were identified in Premier and Division One players. Five individual factors were associated with reduced odds (OR = 0.11-0.60) of reporting NS-LBP. Seven factors (age, stature, playing position, playing internationally, performing a drag flick, low back stiffness/tightness and occupational factors) were deemed particularly pertinent to those working in field hockey given the magnitude of association and clinical value to clinicians.

CONCLUSIONS

Clinicians working in field hockey can consider the key risk factors identified in this study that are associated with NS-LBP when assessing injury risk, movement screening approaches, and overall athlete management.

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.

Potential neurophysiological and biomechanical risk factors for sport-related back problems: A scoping review

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).

LOW BACK PAIN ESTIMATES IN PROFESSIONAL SOCCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective

To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players.

Methods

Systematic review and meta-analysis.

Results

The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days).

Conclusion

Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

Association of meeting 24-hour movement guidelines with low back pain among adults

Background

According to recently published 24-hour movement guidelines, adults should spend: ≥150 minutes/week in moderate-to-vigorous physical activity (MVPA); <8 hours/day in sedentary behaviour (SB); and 7-9 hours/day sleeping.

Objective

We explored the association between meeting these recommendations and low back pain (LBP)-the most common musculoskeletal disorder.

Methods

We collected self-reported data from 2333 adults about: MVPA, SB and sleep duration; frequency and intensity of LBP; and sociodemographic and lifestyle characteristics.

Results

Meeting a combination of SB and sleep recommendations was associated with lower odds of LBP in the past week and past month (adjusted odds ratio [OR]: 0.64 and 0.52, respectively; p < 0.05 for both). Among LBP sufferers, meeting any combination of recommendations that includes sleep was associated with lower odds of frequent (OR range: 0.49-0.61; p < 0.05 for all) and intense (OR range: 0.39-0.66; p < 0.05 for all) LBP in the past week, while meeting a combination of SB and sleep recommendations or all three recommendations was associated with lower odds of intense LBP in the past month and past year (OR range: 0.50-0.68; p < 0.05 for all). The likelihood of experiencing higher frequency and intensity of LBP decreased with the number of recommendations met (p for linear trend < 0.05).

Conclusion

Meeting the SB and sleep recommendations in combination is associated with a lower likelihood of LBP, while adhering to the overall 24-hour movement guidelines or any combination of recommendations that includes sleep is associated with lower frequency and intensity of LBP among LBP sufferers.

What Factors Do Clinicians, Coaches, and Athletes Perceive Are Associated With Recovery From Low Back Pain in Elite Athletes? A Concept Mapping Study

OBJECTIVE: Identify factors that elite sport clinicians, coaches, and athletes perceive are associated with low back pain (LBP) recovery. DESIGN: Concept mapping methodology. METHOD: Participants brainstormed, sorted (thematically), and rated (5-point Likert scales: importance and feasibility) statements in response to the prompt, "What factors are associated with the recovery of an elite athlete from low back pain?" Data cleaning, analysis (multidimensional scaling, hierarchical cluster analysis, and descriptive statistics), and visual representation (cluster map and Go-Zone graph) were conducted following concept mapping guidelines. RESULTS: Participants (brainstorming, n = 56; sorting, n = 34; and rating, n = 33) comprised 75% clinicians, 15% coaches, and 10% athletes and represented 13 countries and 17 sports. Eighty-two unique and relevant statements were brainstormed. Sorting resulted in 6 LBP recovery-related themes: (1) coach and clinician relationships, (2) inter-disciplinary team factors, (3) athlete psychological factors, (4) athlete rehabilitation journey, (5) athlete non-modifiable risk factors, and (6) athlete physical factors. Participants rated important recovery factors as follows: athlete empowerment and psychology, coach-athlete and athlete-clinician relationships, care team communication, return-to-sport planning, and identifying red flags. CONCLUSION: Factors perceived as important to LBP recovery in elite athletes align with the biopsychosocial model of community LBP management. Clinicians should consider that an athlete's psychology, relationships, care team communication, and rehabilitation plan may be as important to their LBP recovery as the formulation of a diagnosis or the medications or exercises prescribed. J Orthop Sports Phys Ther 2023;53(10):1-16. Epub 10 August 2023. doi:10.2519/jospt.2023.11982.

Low back pain in adolescent rowers: Association to muscle changes detected by magnetic resonance imaging

Adult elite rowers are at risk of developing low back pain (LBP). However, LBP data on adolescent elite rowers is currently insufficient. Therefore, the aim of this study was to assess LBP prevalence, LBP intensity and training characteristics in male adolescent elite rowers and a healthy control group. Twenty rowers (mean age 15.8 ± 1.2 years) and a non-athletic control group matched by age and gender (n = 13) were prospectively enrolled and underwent LBP assessment with a validated questionnaire and magnetic resonance imaging (MRI) of the lumbar spine muscles, which included a T2-mapping sequence. From the quantitative image data, T2 relaxation times were calculated. The prevalence of LBP in the last 24 hours and 3 months in the rowing group was 55.0% and 85.0%, respectively, compared to 23.1% and 30.8% in the control group (p < 0.001). Rowers had significantly longer T2 relaxation times of the paraspinal muscles compared to controls (p ≤ 0.041). LBP intensity was associated with longer T2 relaxation times (p < 0.001). Adolescent rowers had a higher prevalence of LBP compared to an age-matched control group. The observed increase in T2 relaxation might be explained by muscle soreness due to strenuous exercise, which is correlated with short-term pain intensity.

A cross-sectional investigation of back pain beliefs and fear in physiotherapy and sport undergraduate students

BACKGROUND

Although low back pain (LBP) beliefs have been well investigated in mainstream healthcare discipline students, the beliefs within sports-related study students, such as Sport and Exercise Science (SES), Sports Therapy (ST), and Sport Performance and Coaching (SPC) programmes have yet to be explored. This study aims to understand any differences in the beliefs and fear associated with movement in students enrolled in four undergraduate study programmes-physiotherapy (PT), ST, SES, and SPC.

METHOD

136 undergraduate students completed an online survey. All participants completed the Tampa Scale of Kinesiophobia (TSK) and Back Beliefs Questionnaire (BBQ). Two sets of two-way between-subjects Analysis of Variance (ANOVA) were conducted for each outcome of TSK and BBQ, with the independent variables of the study programme, study year (1st, 2nd, 3rd), and their interaction.

RESULTS

There was a significant interaction between study programme and year for TSK (F(6, 124) = 4.90, P < 0.001) and BBQ (F(6, 124) = 8.18, P < 0.001). Post-hoc analysis revealed that both PT and ST students had lower TSK and higher BBQ scores than SES and SPC students particularly in the 3rd year.

CONCLUSIONS

The beliefs of clinicians and trainers managing LBP are known to transfer to patients, and more negative beliefs have been associated with greater disability. This is the first study to understand the beliefs about back pain in various sports study programmes, which is timely, given that the management of injured athletes typically involves a multidisciplinary team.

The effect of pelvic floor muscle-strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials

BACKGROUND

Low back pain is a musculoskeletal disorder (MSD), and Kegel exercise is considered as one of the non-surgical management methods. Therefore, the present systematic review and meta-analysis aimed to estimate the results of randomized clinical trials (RCT) about the effect of pelvic floor muscle-strengthening exercises on reducing low back pain‏.‏ METHODS: The present study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline (2020) to January 2022. The relevant studies were searched in the MagIran, SID, PubMed, Embase, Web of Science (WoS), Scopus, ClinicalTrials.gov databases and Google Scholar motor engine using related MeSH/Emtree terms, which were combined with free text word. The heterogeneity of the studies was checked using I² statistic.

RESULTS

Finally, 19 RCTs with a sample size of 456 subjects in the intervention group and 470 in the control group were included in the meta-analysis. The low back pain intensity in the intervention group decreased up to 1.261 ± 0.213 (SMD ± 95% CI) with I² = 87.60 more than that in the control group (P <0.001). The low back pain intensity in postpartum women decreased up to 1.614 ± 0.312 (95% CI) followed by pregnant women as 1.282 ± 0.479 (SMD ± 95% CI) more than that in other populations. But due to high the heterogeneity in all sub-groups (I² > 80%) this result should be considered with caution. Meta-regression analysis showed the effect of pelvic floor muscle-strengthening exercises increased by increasing the year of publication, quality assessment score of the article, and the number of weeks of intervention (P<0.05).

CONCLUSION

Based on the results of the present meta-analysis, pelvic floor muscle-strengthening exercises significantly reduce the low back pain intensity. Therefore, these exercises can be regarded as a part of a low back pain management plan.

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

Background

Low back pain (LBP) is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods.

Purpose

The purpose of this scoping review was to explore the breadth and depth of the LBP literature in rowing and to identify areas for future research.

Study Design

Scoping review.

Methods

PubMed, Ebsco and ScienceDirect were searched from inception to November 1, 2020. Only published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing were included for this study. Arksey and O'Malley's framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool.

Results

Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use.

Conclusion

A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and barriers to injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.

Low Back Pain and the Social Determinants of Health: A Systematic Review and Narrative Synthesis: A Critically Appraised Paper

Focused Clinical Question: In adult patients with persistent low back pain, what relationship do social determinants of health have on pain frequency or severity? Bottom Line: This systematic review identified several particular social risk factors (including education status, socioeconomic status, and occupational factors) that are consistently associated with adverse low back pain outcomes. In addition, the analysis of the population-representative (cross-sectional) studies demonstrated support for important associations between specific social determinants of health, such as low socioeconomic status/income status and employment status and chronic low back pain prevalence.

Sport and non-specific low back pain in athletes: a scoping review

BACKGROUND

The contribution of sport in non-specific low back pain (NS-LBP) remains unknown, due to a large heterogeneity in the methods applied in research. The aims of this scoping review (ScR) were to systematically map and summarize findings concerning studies reporting data on NS-LBP among athletes.

METHODS

This ScR was developed referring to the 2020 version of the "Joanna Briggs Institute Methodological Guidance" and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. Five medical databases (Pubmed, Cochrane, Central, Embase, Pedro and Scopus) were searched up to November 2021. No limitations in terms of study design and language were applied. Results were presented numerically and thematically.

RESULTS

A total of 4061 records were identified through the initial search; 114 articles met the inclusion criteria. Publications have increased over the years, since 1990. Most of the studies were conducted in the USA (17.5%), even if most research was conducted in Europe (53.5%). Analytic observational (42%) and cross-sectional studies (37%) were the most used designs, followed by case reports (12%) and systematic reviews (9%). Boating (7%), football, soccer, volleyball, running and gymnastics (4.4% each) were the most investigated, although the majority of the studies considered sports in general (36.8%). The overall sample size median was 181, mean age 22 ± 10.2; 68% of athletes were professional and 32% amateur. Most of the studies (38%) did not detail the frequency of training. Sport was reported as a risk factor for developing NS-LBP in 67.5% of cases, especially in those studies which assessed activities implying high or repeated loading on the spine.

CONCLUSIONS

This is the first ScR to provide a comprehensive overview on this topic. The increased number of publications on the association between sport practice and NS-LBP demonstrates a growing interest over the years on this topic. Some sport activities seem to be more involved than others in LBP development; however, research methods are extremely varied, thus more standardized observational research may focus on specific disciplines to properly contribute to research and clinical practice.

Which typical floor movements of men's artistic gymnastics result in the most extreme lumbar lordosis and ground reaction forces?

Back pain is prevalent among gymnast populations and extreme flexion or extension of the lumbar spine along with high ground reaction forces (GRFs) are known to increase intervertebral stress. The aim of this study was to determine which postures and dynamic conditions among common floor movements provide the greatest risk of injury in men's artistic gymnastics (MAG). For this purpose, lumbar spine curvatures, obtained through a full-body subject-specific kinematic model fed by motion capture data, and GRFs on feet and hands were compared between typical floor movements of MAG (pike jump, round off back handspring, front handspring, forward and backward tucked somersaults) performed by six adolescent gymnasts. The round off back handspring and the pike jump resulted respectively in the largest lumbar extension and flexion, and the forward tucked somersault take-off in the highest GRF. At ground impacts, the largest lumbar flexion was during the backward tucked somersault landing and only the back handspring hands ground contact phase led to lumbar extension. Such identification of high-risk conditions should enable better back pain management in gymnastics through more tailored training adaptations, particularly in case of pathologies or musculoskeletal specificities.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

BACKGROUND

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

OBJECTIVE

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

METHODS

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

RESULTS

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I2 = 82%; females: 63%, 95% CI 53-71, I2 = 84%; males: 50%, 95% CI 42-58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high.

CONCLUSION

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study

AIM

This study aimed to establish the prevalence of chronic low back pain (CLBP) in university-level athletes and to examine the influence of age, sex, body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP. The secondary purpose was to check the association of certain variables in athletes having CLBP with the sports discipline and chronicity of LBP.

METHODS

A total of 340 players (100% response rate) from different sports, aged 18-30 years with at least 1 year of participation in sports at the university level were screened for the present study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their demographic variables, personal and pain-related factors. The study was registered on the clinical trials registry, India (CTRI/2021/09/036675).

RESULTS

The results revealed the sport-wise point prevalence as follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%), badminton (7.7%) and tennis (7.7%). A higher number of years at university-level participation (>4 years), smoking, anxiety and BMI (>25 kg/m²) are risk factors for CLBP. The type of LBP, the intensity of the pain (current and last week), variation of the pain intensity, disability, intake of oral medications, physiotherapy for CLBP, number of missed days of training and number of missed matches are not significantly related to the chronicity of LBP or the sports discipline. Only the number of missed days of training had a significant association with the chronicity of LBP.

CONCLUSIONS

CLBP is a common complaint in Indian university athletes, and our findings indicate the necessity for a specific prevention program.

The effect of head movement restriction on the kinematics of the spine during lifting and lowering tasks

This study aimed to examine the effects of head movement restriction on relative angles and their derivatives using the stepwise segmentation approach during lifting and lowering tasks. Ten healthy men lifted and lowered a box using two styles (stoop and squat), with two loads (i.e. 10% and 20% of body weight); they performed these tasks with two instructed head postures [(1) Flexing the neck to keep contact between chin and chest over the task cycle; (2) No instruction, free head posture]. The neck flexion significantly affected the flexion angle of all segments of the spine and specifically the lumbar part. Additionally, this posture significantly affected the derivatives of the relative angles and manifested latency in spine segments movement, that is, cephalad-to-caudad or caudad-to-cephalad patterns. Conclusively, neck flexion as an awkward posture could increase the risk of low back pain during lifting and lowering tasks in occupational environments. Practitioner summary: Little information is available about the effects of neck flexion on other spine segments' kinematics and movement patterns, specifically about the lumbar spine. The result of this experimental study shows that neck flexion can increase the risk of low back pain by increasing lumbar flexion angle and spine awkward posture.

The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis

It is assumed that mechanical restriction of hamstring tightness disrupts sagittal spine–pelvis–leg alignment and alters the lumbar–pelvic rhythm predisposing to low back pain (LBP) in athletes; however, this association is not clear. A prospective cross-sectional cohort study was conducted to determine the influence of hamstring extensibility (HE) on sagittal pelvic tilt, sagittal spinal curves, and LBP in 94 soccer and basketball players (61 man and 33 woman) with (n = 36) and without recurrent LBP (n = 58). Descriptive analysis displayed significant gender differences for HE, sagittal pelvic tilt, and lumbar curve. Differences were found between the low-HE and high-HE groups in lumbosacral angle in for the maximum trunk forward flexion (LH-MTFP). Low-HE was associated with LH-MTFP, lumbar curve and LBP in male players (p ≤ 0.023). In female players, LH-MTFP and lumbar curve were associated with low-HE (p ≤ 0.020). Low-HE predicted LH-MTFP (p = 0.000; OR = 65.6950) and LBP (p = 0.028; OR = 13.915) in male players. The decision tree analysis showed that 50.8% of the players were classified with restricted LH-MTFP, 77.4% with low-HE among male players. The 100% of male players with recurrent LBP had low-HE. The 65% of female players with low-HE had restricted LH-MTFP. Measurement of HE, lumbar curve, and LH-MTFP are important in making training decisions for to reduce the incidence of recurrent LBP in soccer and basketball players.

Prevalence of low back pain among intensive care nurses: A meta-analysis

BACKGROUND

Low back pain (LBP) is a ubiquitous health problem affecting most of healthcare staff. However, there have been not effort to derive robust prevalence estimates of LBP among intensive care unit (ICU) nurses.

AIMS AND OBJECTIVES

To determine the prevalence of LBP among ICU nurses.

METHODS

A systematic review and meta-analysis was conducted. Five databases were searched: Web of Science, PubMed, MEDLINE (Ovid), Embase, and CINHAL databases. Original research that reported the prevalence of LBP among ICU nurses using a 12-month recall period were included. In order to assess methodological quality, we used a quality rating system which is specifically developed for LBP studies. Cochran's Q and the I² test were applied to assess heterogeneity. Subgroup analysis was applied to identify factors that may contribute to heterogeneity. Presence of potential publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots.

RESULTS

Twenty-seven studies reporting data from 2004 to 2020 on the prevalence of LBP in a defined ICU nurses were included (participants:6258; range: 3-1345). Twenty-one (77.8%) studies were of "high" quality. Among the included studies, the lowest and the highest prevalence were found to be 34.5% and 100.0%, respectively. Meta-analysis of included studies yielded a pooled prevalence of 12-month LBP at 76.0% (95% CI, 69.0%-81.8%). (I²  = 96.0%, Chi-squared = 722, P-value < .01).

CONCLUSION

LBP is prevalent among ICU nurses. Greater attention is urgently needed to address this burdensome health problem among ICU nurses, particularly with an emphasis to develop preventive strategies.

RELEVANCE TO CLINICAL PRACTICE

The results of our meta-analysis have important consequences for ICU nurse managers. Our finding of high prevalence rate of LBP among ICU nurses suggests that more attention should be devoted to develop and apply prevention programs for ICU nurses to manage this global issue.

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers

PURPOSE

To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice.

METHODS

There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice. In step two, working groups examined current evidence relating to key scope questions and summarised key issues. In step three, we synthesised evidence for each group and used a modified Delphi process to aid in the creation of the overall consensus statements. Finally, in step four, we combined information from step three with the findings of the clinician survey (and with athlete and coach input) to produce recommendations for clinical practice.

RESULTS

The scope of the consensus statement included epidemiology; biomechanics; management; the athlete's voice and clinical expertise. Prevention and management of LBP in rowers should include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy should be considered. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged.

CONCLUSION

Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to all aspects of prevention and management of LBP in rowers be intensified.