Sports Medicine Research: In the Lab & In the Field: Could Sport Activity Be a Factor in Disc Degeneration at a Young Age? (Sports Med Res)
Tuesday, February 21, 2017

Could Sport Activity Be a Factor in Disc Degeneration at a Young Age?

Association between adolescent sport activity and lumbar disc degeneration among young adults.

Takatalo J, Karppinen J, Nayha S, Taimela, Ninimaki J, Sequeiros RB, Tammelin T, Auvinen J, and Tervonen O. Mohtadi N, Barber R, Chan D, and Paolucci EO. Scan J Med Sci Sports. 2017. [Epub Ahead of Print].

Take Home Message: Survey participants who reported frequently running and swimming had greater signs of lumbar disc degeneration than those participants who were inactive in those sports.

Greater involvement in sports is a risk factor for long-term degeneration of lumbar intervertebral discs. Understanding the impact of sport involvement in lumbar disc degeneration will help clinicians develop strategies to mitigate the impact of sport on lumbar disc degeneration. Therefore, Takatalo and colleagues evaluated the association between sport involvement and lumbar disc degeneration in an exploratory study. A total of 9,479 children were identified via the Northern Finland Birth Cohort (expected birth between July 1985 and June 1986). Participants received 2 surveys of sporting activity when they were 16 and 18 years old respectively. The authors invited participants who responded to both surveys (1987 participants) to a physical examination and magnetic resonance imaging. A total of 558 participants completed both surveys and completed the magnetic resonance imaging. Magnetic resonance images were grades on a scale of grades 0-5 (0-2 = normal, 3-5 = LDD) by 2 blinded musculoskeletal radiologists. Researchers controlled for body mass index, lifestyle factors, other sports, and socioeconomic status. Overall, 301 (54%) participants were classified with lumbar disc degeneration. Highly active runners/joggers (> 2 times/week) were 3 more likely to have greater lumbar disc degeneration than inactive participants. Furthermore, highly active swimmers were 5 more likely to have greater lumbar disc degeneration than inactive participants. Skaters were less likely to have lumbar disc degeneration.

We can take from this study that some activities (e.g., highly active running and swimming) may have detrimental effects on lumbar discs, while other activities may be protective (skating). It should be noted that this study was exploratory in nature and did not attempt to quantify how much activity would elicit these effects. This limits clinicians from using the current study to influence clinical decision making or counseling. This dose-response association should be looked at further to better help clinicians, parents and athletes fully grasp the impact that certain sports have on lumbar disc degeneration. In the meantime, clinicians should take note that some athletes may be a greater risk for lumbar disc degeneration before 20 years of age. It may be beneficial to ensure these athletes are participating in strengthening programs that may help reduce their chances of developing low back pain. We may need low back pain prevention programs for athletes in certain sports much like how we’ve deployed lower extremity injury prevention programs.

Questions for Discussion: Have you encountered patients in this age range with lumbar disc degeneration? If so, do you believe their activity was a factor in lumbar disc degeneration development?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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Takatalo, J., Karppinen, J., Näyhä, S., Taimela, S., Niinimäki, J., Blanco Sequeiros, R., Tammelin, T., Auvinen, J., & Tervonen, O. (2017). Association between adolescent sport activities and lumbar disc degeneration among young adults Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/sms.12840

2 comments:

B_Green said...

This is an interesting topic and one that I have often wondered about. In my experience with collegiate athletes, I have observed more American football players, specifically offensive linemen, struggle with disc pathologies. Because of my own clinical experiences, I was surprised to see the results of this study suggest lumbar disc degeneration may be associated with running and swimming at least twice a week. However, the authors did address the lack of popularity of American football in Finland as being a limitation to the generalizability of their results.

Overall, I agree that this article does little to impact clinical practice and I am skeptical of the results. Although running, swimming, and to a lesser degree, floorball, were found to be significant, the confidence intervals are wide indicating less precision. On a different note, the authors omitted posture from their analysis and I believe it deserves some consideration. The authors only discussed posture as it relates to a working environment and excluded it on the premise of low work exposure in young adults. However, forward head posture, thoracic kyphosis, lumbar lordosis, or scoliosis as observed in a standing position alter the dispersion of forces down the spinal column and subsequently, the integrity of intervertebral discs. All in all, I second the need for a dose-response exploration…correlation does not mean causation.

Kyle said...

B_Green,

Thanks for the comment. I think many of your points are very sound. I think factoring in posture is the most important factor here. I also think that controlling for the level of activity could be helpful in understanding the role of activity. In your clinical experience, do you feel that you have noticed any specific postural deficits that may be linked to disc pathology? Thanks again for the great comment and I look forward to hearing more about your clinical experience with this.

Kyle Harris

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