Sports Medicine Research: In the Lab & In the Field: Pain in the Back: Incidence and Risk Factors in Youth Court Sport Athletes (Sports Med Res)

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Tuesday, August 7, 2018

Pain in the Back: Incidence and Risk Factors in Youth Court Sport Athletes

Incidence and risk factors for back pain in young floorball and basketball players: A Prospective study

Rossi MK, Pasanen K, Heinonen A, Myklebust G, Kannus P, Kujala UM, Parkkari J. Scand J Med Sci Sports. 2018 Jun 8. doi: 10.1111/sms.13237. [Epub ahead of print]

Take Home Message: Low back pain, especially recurrent back pain, is common among youth basketball and floorball athletes. Lower limb strength and flexibility measures failed to predict who would develop low back pain.

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Basketball and floorball (floor hockey) include similar sport-specific demands that require an athlete to maintain control of their lower extremity while performing rotational trunk motions. Low back injuries are common among these athletes. However, there is little information on incidence rates and risk factors for back pain among youth basketball and floorball athletes. Therefore, the authors performed a prospective study on 396 youth basketball or floorball athletes in Finland (2011 to 2015) to determine rates of traumatic and non-traumatic back pain in youth athletes. They also tested risk factors for low back pain. Athletes first answered questions to determine personal, medical, and playing history, as well as questions specific to low back health. Investigators also performed a physical examination of the athletes to determine leg and hip strength, limb symmetry, and joint laxity. Athletes were then followed over a one-to-three-year period with weekly check-ins from an investigator to determine incidence of back pain that limited sport participation for at least 1 day, but not as a result of direct player or equipment contact. A physician verified reported low back injuries. Coaches reported the exposure time during games and training. There was a total of ~135,000 training and game hours, which the authors used to put injury rates into context (i.e., injuries per 1000 hours). The authors found that 13% of all athletes (51/396) had an episode of time-loss back pain, with an incidence rate of 0.4 per 1000 exposure hours. 73% of all cases (47/51) were non-traumatic back pain and 61% were recurrent cases (27/47) and not attributed to a specific cause. Acute cases were mainly due to landing or unexpected movements. None of the physical strength, flexibility, or laxity measures assessed at baseline were risk factors for low back pain.

This study reinforced that time-loss back pain is a common issue among youth athletes participating in these court sports. Furthermore, ~6 out 10 episodes of non-traumatic low back pain occurred in someone with a history of low back pain. Non-specific, non-traumatic low back pain, which was centered around the lumbopelvic region, was the most common mechanism and region of the back injuries. Interestingly, the physical exam failed to reveal any specific risk factors for the development of low back pain in these youth athletes. The authors concluded that strength deficits, asymmetry, and range of motion changes seen in the low back pain population may be a result of back pain and not necessarily risk factors. However, the authors noted that similar to a typical team they included athletes with a history of back pain, which may have influenced the findings. Also, the investigators only examined hip and leg musculature and joints for the physical exam. It would be interesting to see how muscle endurance or eccentric activity influences risk, and to evaluate low back musculature strength and range of motion outcomes and their relationship to back pain in this population. In all, this study reflects that back pain is a common complaint among youth basketball and floorball athletes that leads to time lost from sport participation. Lower extremity strength and flexibility alone may not be sufficient to identify youth athletes that are at risk for lower back pain in these sports. This study should also remind clinicians that perhaps one of the strongest predictors of low back pain is a history of low back pain. Hence, we need to be more proactive to help our athletes prevent another episode of low back pain.

Questions for Discussion: What assessments do you include for athletes with lower back pain that have facilitated rehabilitative or preventative interventions? What other considerations do you think would be important to evaluate as potential risk factors of development of low back pain in youth athletes?

Written By: Alexandra F. DeJong
Reviewed By: Jeffrey Driban

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