Sports Medicine Research: In the Lab & In the Field: How Do You Determine Low Back Pain with Young Athletes? (Sports Med Res)


Thursday, April 5, 2012

How Do You Determine Low Back Pain with Young Athletes?

Validation of a New Instrument for Evaluating Low Back Pain in the Young Athlete

D’hemecourt PA, Zurakowski D, D’hemecourt CA, Curtis C, Ugrinow V, Deriu L, Micheli LJ.Clin J Sport Med. 2012 Feb 29. [Epub ahead of print]

There is no question that when an athlete is suffering from low back pain (LBP), their performance is likely going to suffer, too.  Often managing simple day-to-day tasks becomes very difficult.  For mature athletes, there is close to 40 different back-specific questionnaires that researchers and clinicians can utilize to help scale the athlete's perception of pain.  However, these questionnaires do not have much carryover to the young athlete.  With countless adolescents participating in high school, club and other levels, there is great potential for low back pain to occur.  Therefore, the objective of this study was to compare a new low-back specific questionnaire, the Micheli Functional Score (MFS),  geared towards the younger athlete, to an existing low-back measurement technique, the Modified Oswestry Low Back Pain Disability Questionnaire (ODQ), which is considered the gold-standard in mature athletes.  The ODQ is reliable and valid, and is often utilized because it can determine the amount of pain that is interfering with the patient's activities of daily living, but with no real consideration for sporting activity.  The MFS examines the amount of dysfunction associated with spinal flexion and extension, jumping activities, as well as sport limitations and pain quantifications.  It also includes a visual analog scale. For this study 94 subjects were recruited (44 with back pain and 50 age matched healthy controls).  All subjects were asked to complete both questionnaires, and then both groups were divided into 2 age specific subgroups, 12-16 years and 17-22 years in order to differentiate the group based upon growth spurt characteristics and maturity.  Upon analysis, back-pain subjects had significantly higher scores on both tests when compared to the controls.  They also found a high correlation between ODQ scores and MFS scores in both subject pools.  The MFS was able to differentiate LBP patients and healthy controls. It was also able to successfully differentiate younger/older subgroups, as well as, male vs female patients.  These results suggest that the MFS provides a high level of generalizability.  These results suggest that the MFS is both a valid and reliable clinical tool for determining LBP in the younger patient.

This study is important for a number of reasons.  Firstly, adolescent LBP and adult LBP are typically generated from different sources.  Adult LBP is typically discogenic, however in the young athlete it is more related to osseous or muscular problems.  Being able to determine the source of the pain through a short questionnaire, based upon spinal and functional activities, gives clinicians an advantage in evaluating low back pain in young athletes.  Secondly, the questionnaire is short which will decrease the amount of time required to evaluate the athlete and determine the  dysfunction based upon spinal flexion, extension and jumping tests.  Lastly, it takes into consideration the sporting demands of the younger patients. Older patients tend to be more sedentary, but the MFS, with its sports considerations, is more applicable to the young athlete and the high demands that they place on their lower backs during activities.  What are your thoughts on the MFS?  What type of questionnaire are you using to assess LBP in your clinical settings?

Written by:  Mark Rice
Reviewed by: Stephen Thomas

Related Posts
Dʼhemecourt PA, Zurakowski D, Dʼhemecourt CA, Curtis C, Ugrinow V, Deriu L, & Micheli LJ (2012). Validation of a New Instrument for Evaluating Low Back Pain in the Young Athlete. Clinical Journal of Sport Medicine PMID: 22382433


Kyle Kosik said...

This is a great article and an overview of the article. I think it brings up a good point in the fact that as athletic trainers we see more LBP due to musculature imbalance and not due to a pathological reason. Having a questionnaire that is specifically tailored towards the athletic population could be extremely valuable when evaluating an athlete with low back pain. A questionnaire like this would be good for athletic trainers because they would be able to tract an athletes progress throughout a formal rehabilitation program. My question though is, is this questionnaire used for just chronic low back pain, acute, or both?

Mark A. Rice said...

Kyle, thanks for reading and commenting. I haven't been able to find any delineation between acute vs chronic pain. In my experience, kids/adolescents don't typically experience chronic low back pain unless A. they execute repetitive lumbar hyperextension (gymnasts/danceers etc) or B. there is some form of structural/anatomical abnormality. That said, I would think that it's probably more geared towards acute pain, but I can't say that with 100% certainty.

Marisa Rizzo said...

This is a really good article because when treating kids we need to have something that pertains to them not adults. Kids and adults are very different and if you want to correctly diagnosis kids you need to have tools that pertain to kids.

Brandon Green said...

The introduction of a SHORT questionnaire that is able to pin point key areas for LBP in adolescents would be very beneficial to an athletic trainer because it allows the AT to correctly diagnose the problem of LBP and steps into how to correct the mechanics or strength of the athlete. Differentiating adolescent and adult athletes with LBP also eliminates "tunnel vision" that is commonly seen when treating LBP and can help treat the athlete with a more specific treatment regime.

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