Incidence and risk
factors for back pain in young floorball and basketball players: A Prospective
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
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.
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.
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.
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?
By: Alexandra F. DeJong
By: Jeffrey Driban