Low back
pain in young elite field hockey players, football players and speed skaters:
Prevalence and risk factors.

Van Hilst J, Hilgersom
NF, Cullman MC, Kaiser PPF, Frings-Dresen MH. Back Musculo Rehabil.
2014. DOI: 10.3233/BMR-140491

Take Home Message: Increased
training time in sports that require a forward lean posture can predispose
young athletes to low back pain.

Low back pain (LBP) is very common
among people in society. It can hinder a person’s daily life and in athletes it
can decrease their performance level. If an athlete experiences LBP it is
important to know what is causing the pain and if it can be treated. Therefore,
Van Hilst and colleagues assessed risk factors for and the prevalence of LBP
among elite youth athletes in 3 different sports: field hockey, speed skating,
and football (American soccer). Risk factors for LBP included a forward lean posture
and twisting in field hockey and speed skating, as well as sprinting in
football. The authors selected members of premier-level teams and groups in the
Netherlands that were 14 to 25 years of age. They provided each athlete a
questionnaire that asked questions regarding episodes of LBP in the previous 12
months, for example: how often does LBP reoccur, and if LBP was severe enough
to lead to medical intervention. The questionnaire also inquired about sport
participation (e.g., hours of practice, number of matches per month), work
(e.g., physical demand of job, hours worked), and events that may have
aggravated the LBP during training or competition. Of the athletes contacted,
61 field hockey players, 45 football players, and 75 speed skaters responded. Overall,
60% of athletes reported LBP in the prior year. The majority of field hockey
(50%) and football players (59%) had 2 or more episodes of LBP in the past 12
months. The authors found that female field hockey players were more likely to
suffer from periods of LBP (67%) as well as have performance hampered by an
episode of LBP (22%) than male field hockey players (33%, 0%, respectively). In
field hockey and speed skating, 45 to 48% of athletes thought that a bent
posture during training caused their LBP. Many speed skaters (48%) also thought
a bent posture during competition triggered their LBP. Furthermore, some speed
skaters (23%) reported that their LBP was caused by the strength training. The
authors also found that increased number of training hours, which may include
performing Pilates and long warm-ups, increase the risk of LBP among speed
skaters. There was no consensus among football athletes about what caused their
pain but some reported causes were strength training (17%), artificial turf during
training (17%), and twisting/turning  during a game (19%). This study also reviewed
training techniques athletes used to prevent LBP, such as stretching, core
stability, and strengthening, but did not elaborate on the effectiveness of
these strategies in the treatment or prevention of LBP.
study makes a strong connection between certain sports and low back pain. The authors
explain that certain motions, stresses, and actions of the athlete may influence
LBP. Results indicate that elite youth athletes are 3 to 5 time more likely to
experience LBP than the general population. This back pain may be a result of
increased training time and or being in a bent over position or a forward lean
posture while playing their sport. The authors suggest there is a U-shaped
exposure response curve between physical activity and LBP, which means that
either being inactive or overactive can increase the risk of LBP. It is
important for athletes to find a medium between being inactive and overactive
to best reduce the occurrence of LBP. From the study, clinicians can now
identify specific factors that may contribute to occurrence of LBP. However, we
must keep in mind that these factors were reported by the athletes who may not
accurately recall the cause of their LBP so it will be important to have future
studies carefully monitor elite athletes over time to see if these risk factors
can be verified. Despite this limitation, these findings can help us be better
prepared to address these factors to aid in prevention and treatment of LBP in
these special populations. Training programs that include a combination of
stretching and strengthening can be implemented to help prevent the onset of LBP
in sports that may predispose athletes to LBP. A bent posture was also a common
action attributed to LBP so it may be important to emphasis proper posture and

Questions for Discussion:
Is there an intervention plan that is effective at reducing the risk of LBP? If
so, how can it be implemented into youth leagues to prevent cases of LBP?

by: Adam Scott and Jan Bruins
by: Kim Pritchard


van Hilst J, Hilgersom NF, Kuilman MC, Kuijer PP, & Frings-Dresen MH (2014). Low back pain in young elite field hockey players, football players and speed skaters: Prevalence and risk factors. Journal of Back and Musculoskeletal Rehabilitation PMID: 24968798