Back pain in elite sports: A cross-sectional study on 1114 athletes

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Abstract

Objectives

To establish the prevalence of back pain in German elite athletes; examine the influence of age, sex, sports discipline and training volume; and compare elite athletes with a physically active control group.

Methods

A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to approximately 4,000 German national and international elite athletes, and a control group of 253 physically active but non-elite sports students.

Results

We received responses from 1,114 elite athletes (46.5% male and 53.1% female, mean age 20.9 years ± 4.8 years, mean height 176.5 ± 11.5 cm, mean weight 71.0 ± 10.3 kg) and 166 physically active sports students (74.7% male and 24.1 female, mean age 21.2 ± 2.0 years, mean height 180.0 ± 8.0 cm, mean weight 74.0 ± 14.5 kg). In elite athletes, the lifetime prevalence of back pain was 88.5%, the 12-month prevalence was 81.1%, the 3-month prevalence was 68.3% and the point prevalence was 49.0%, compared with 80.7%, 69.9%, 59.0% and 42.8%, respectively in the control group. The lifetime, 12-month and 3-month prevalences in elite athletes were significantly higher than in the control group. Regarding the individual sports disciplines, the prevalence of back pain was significantly higher in elite rowers, dancers, fencers, gymnasts, track and field athletes, figure skaters and marksmen, and those who play underwater rugby, water polo, basketball, hockey and ice hockey compared with the control group. The prevalence of back pain was significantly lower in elite triathletes.

Conclusions

Back pain is a common complaint in German elite athletes. Low back pain seems to be a problem in both elite athletes and physically active controls. A high training volume in elite athletes and a low training volume in physically active individuals might increase prevalence rates. Our findings indicate the necessity for specific prevention programs, especially in high-risk sports. Further research should investigate the optimal dose-effect relationship of sporting activity for the general population to prevent back pain.

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Most cited references 58

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Grading the severity of chronic pain.

Michael Von Korff, Johan Ormel, Francis Keefe … (1992)

This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.

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No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports.

R Bahr (2009)

Overuse injuries may represent as much of a problem as do acute injuries in many sports. This paper reviews key concepts related to the methodology for recording overuse symptoms. Results from the FIVB Volleyball Injury Study were used to compare two different recording methods. The aim of this paper was to provide recommendations on how standardised methodology can be developed to quantify overuse injuries in surveillance studies. Using beach volleyball data, a "traditional" cohort study approach using a time-loss injury definition suggested that injury risk was very low. In contrast, the data from a survey of past and present pain problems in the shoulder, knees and low back demonstrated that these were prevalent. The following recommendations are made: (1) studies should be prospective, with continuous or serial measurements of symptoms; (2) valid and sensitive scoring instruments need to be developed to measure pain and other relevant symptoms; (3) prevalence and not incidence should be used to report injury risk; (4) severity should be measured based on functional level and not time loss from sports. In conclusion, new approaches are needed to develop more appropriate methodology to quantify overuse injuries in studies.

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Physical activity and low back pain: a U-shaped relation?

H. Susan J. Picavet, Hans Heneweer, Luc Vanhees (2009)

Being physically active is often suggested to be important in the prevention and management of low back pain. This simple view does not take into account that the relation between the level of activity and back pain may be a U-shaped curve - i.e. both inactivity and excessive activities (back-unhealthy activity) present an increased risk for back pain. We explored the U-shaped association between physical activity and chronic low back pain (3 months duration) by analyzing cross-sectional data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort study (DMC(3), 1998) of a sex-age stratified sample of 25 years and older (n=3364). Type of activity (daily routine, leisure time and sport activity), intensity of and time spent on these activities, and back exertion of sport activities were taken into account. Physical activity was not associated with chronic low back pain (CLBP) when studied by the dimension of activity, by the intensity or by the duration of physical activity. Only engaging in sport activity was associated with less CLBP (OR 0.78: 95% CI 0.66-0.93). The extremes of the total physical activity pattern were associated with CLBP. A moderate increased risk for CLBP was found for both participants with a sedentary lifestyle (OR 1.31: 95% CI 1.08-1.58) and for those being involved in physical strenuous activities (OR 1.22: 95% CI 1.00-1.49). This was especially true for women (sedentary: OR 1.44: 95% CI 1.10-1.83; physically active: OR 1.36: 95% CI 1.04-1.78). This study provides some evidence that the relation between physical activity and CLBP is U-shaped.

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Author and article information

Contributors

Brenda Smith: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 29 June 2017

Publication date Collection: 2017

Volume: 12

Issue: 6

Electronic Location Identifier: e0180130

Affiliations

[001]Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany

Oklahoma State University, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceptualization: DF KT PP.
Formal analysis: DF KT PP.
Funding acquisition: PP.
Investigation: DF KT.
Methodology: DF KT PP.
Project administration: DF KT.
Writing – original draft: DF KT.
Writing – review & editing: DF KT PP.

* E-mail: daniela.fett@ 123456rub.de (DF); katharina.trompeter@ 123456rub.de (KT)

Author information

Daniela Fett http://orcid.org/0000-0001-9557-2455

Article

Publisher ID: PONE-D-16-50612

DOI: 10.1371/journal.pone.0180130

PMC ID: 5491135

PubMed ID: 28662110

SO-VID: 279257ad-913b-442b-bed8-2e861688ca30

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 22 December 2016

Date accepted : 10 June 2017

Page count

Figures: 5, Tables: 4, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100007323, Bundesinstitut für Sportwissenschaft;

Award ID: ZMVI1-080102A/11-18

Award Recipient : Petra Platen

The present study was funded by the German Federal Institute of Sport Science ( http://www.bisp.de). The research was realized within the project RAN Rücken (ZMVI1-080102A/11-18). Funding were received by PP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Back pain in elite sports: A cross-sectional study on 1114 athletes

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Most cited references 58

Grading the severity of chronic pain.

No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports.

Physical activity and low back pain: a U-shaped relation?

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