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


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