The mechanical loading of the spine in physical activities.

PURPOSE: To summarize the mechanical loading of the spine in different activities of daily living and sports. METHODS: Since the direct measurement is not feasible in sports activities, a mathematical model was applied to quantify spinal loading of more than 600 physical tasks in more than 200 athletes from several sports disciplines. The outcome is compression and torque (normalized to body weight/mass) at L4/L5. RESULTS: The data demonstrate high compressive forces on the lumbar spine in sport-related activities, which are much higher than forces reported in normal daily activities and work tasks. Especially ballistic jumping and landing skills yield high estimated compression at L4/L5 of more than ten times body weight. Jumping, landing, heavy lifting and weight training in sports demonstrate compression forces significantly higher than guideline recommendations for working tasks. CONCLUSION: These results may help to identify acute and long-term risks of low back pain and, thus, may guide the development of preventive interventions for low back pain or injury in athletes.

Spinal and Pelvic Kinematics During Prolonged Rowing on an Ergometer vs. Indoor Tank Rowing.

ABSTRACT: Trompeter, K, Weerts, J, Fett, D, Firouzabadi, A, Heinrich, K, Schmidt, H, Brüggemann, GP, and Platen, P. Spinal and pelvic kinematics during prolonged rowing on an ergometer vs. indoor tank rowing. J Strength Cond Res 35(9): 2622-2628, 2021-This investigation aimed to compare spinopelvic kinematics during rowing on an ergometer vs. in a rowing tank and to evaluate changes with progressing fatigue. Spinal and pelvic kinematics of 8 competitive scull rowers (19.0 ± 2.1 years, 179.9 ± 7.6 cm, and 74.8 ± 8.1 kg) were collected during 1 hour of rowing on an ergometer and in a rowing tank using a routine training protocol. Kinematics of the upper thoracic spine, lower thoracic spine, lumbar spine, and pelvis were determined using an infrared camera system (Vicon, Oxford, United Kingdom). There was a greater lumbar range of motion (ROM) and less posterior pelvic tilt at the catch during rowing on the ergometer compared with in the rowing tank (p = 0.001-0.048), but no differences in pelvic ROM. In the rowing tank, the pelvic ROM increased over time (p = 0.002) and the ROM of the lower thoracic spine decreased (p = 0.002). In addition, there was an extended drive phase (when the rower applies pressure to the oar levering the boat forward) and an abbreviated recovery phase (setting up the rower's body for the next stroke) in the rowing tank (p = 0.032). Different rowing training methods lead to differences in spinopelvic kinematics, which may lead to substantially different spinal loading situations. Greater pelvic rotation and lesser lumbar ROM are considered ideal; therefore, the present results indicate that rowing in the rowing tank might facilitate the maintenance of this targeted spinopelvic posture, which might help protect the lower back. Rowers, coaches, and researchers should consider the differences between rowing training methods, especially when giving training recommendations.

Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

OBJECTIVES: In non-athletes, fear-avoidance and endurance-related pain responses appear to influence the development and maintenance of low back pain (LBP). The avoidance-endurance model (AEM) postulates three dysfunctional pain response patterns that are associated with poorer pain outcomes. Whether comparable relationships are present in athletes is currently unclear. This cross-sectional case-control study explored frequencies and behavioral validity of the AEM-based patterns in athletes with and without LBP, as well as their outcome-based validity in athletes with LBP. METHODS: Based on the Avoidance-Endurance Fast-Screen, 438 (57.1% female) young adult high-performance athletes with and 335 (45.4% female) without LBP were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR) or "adaptive" (AR) pattern. RESULTS: Of the athletes with LBP, 9.8% were categorized as FAR, 20.1% as DER, 47.0% as EER, and 23.1% as AR; of the athletes without LBP, 10.4% were categorized as FAR, 14.3% as DER, 47.2% as EER, and 28.1% as AR. DER and EER reported more pronounced endurance- and less pronounced avoidance-related pain responses than FAR, and vice versa. DER further reported the highest training frequency. In athletes with LBP, all dysfunctional groups reported higher LBP intensity, with FAR and DER displaying higher disability scores than AR. CONCLUSIONS: The results indicate that also in athletes, patterns of endurance- and fear-avoidance-related pain responses appear dysfunctional with respect to LBP. While EER occurred most often, DER seems most problematic. IMPLICATIONS: Endurance-related pain responses that might be necessary during painful exercise should therefore be inspected carefully when shown in response to clinical pain.

Prevalence of back pain in a group of elite athletes exposed to repetitive overhead activity.

BACKGROUND: The prevalence of back pain in athletes has been investigated in several studies, but there are still under- or uninvestigated sports discipline like sports exposed to repetitive overhead activity. Elite athletes spend much time in training and competition and, because of the nature of their disciplines, subject their bodies to a great deal of mechanical strain, which puts a high level of stress on their musculoskeletal systems. From this it is hypothesized that elite athletes who engage in repetitive overhead motions experience a higher strain on their spine and thus possibly a higher prevalence of back pain compared with an active control group. OBJECTIVES: To examine the prevalence of back pain and the exact location of pain in a cohort of elite athletes with repetitive overhead activity and in a control group of physically active sport students. Additionally, to examine different characteristics of pain, and to evaluate the influence of confounders on back pain. METHODS: A standardized and validated online back pain questionnaire was sent by the German Olympic Sports Confederation to German national and international elite athletes, and a control group of physically active but non-elite sports students. RESULTS: The final sample comprised 181 elite athletes of the sports disciplines badminton, beach volleyball, handball, tennis and volleyball and 166 physically active controls. In elite athletes, lifetime prevalence of back pain was 85%, 12-month prevalence was 75%, 3-month prevalence was 58% and point prevalence was 38%; for the physically active control group, these prevalences were 81%, 70%, 59% and 43%, respectively. There was no significant group difference in prevalence over all time periods. The lower back was the main location of back pain in elite athletes across all disciplines and in controls; additionally a distinct problem of upper back pain was found among volleyball players. CONCLUSION: Despite the high mechanical load inherent in the sport disciplines included in this study, the elite athletes who engaged in repetitive overhead activities did not suffer more from back pain than the physically active controls. This suggests that other mechanisms may be influencing back pain prevalences in a positive way in these athletes. Furthermore, these disciplines may practice preventive factors for back pain that outweigh their detrimental factors. Therefore, we posit that extensive prevention work is already being implemented in these sports and that there are additional individual protection factors in play. More research is required to explore these suppositions, and should include investigations into which preventive training programs are being used. Nevertheless, in volleyball particularly, a focus on stabilization/preventive training should be applied to the upper back and neck.

Back Pain in Rowers: A Cross-sectional Study on Prevalence, Pain Characteristics and Risk Factors.

OBJECTIVES: To establish the prevalence of back pain in rowers at different competition levels and rowing typologies compared with a non-rowing control group; to determine different time periods, the location on the spine, and different pain characteristics. Additionally to evaluated different risk factors that might be responsible for back pain. METHODS: A standardized and validated online back pain questionnaire was sent to elite and non-elite rowers of different rowing typologies, and a physically active non-rowing control group. RESULTS: Responses from 156 rowers (104 elite and 52 non-elite/ 49 scull and 76 sweep rowers) and 166 controls were received. Back pain prevalence and severity was significantly higher among rowers compared with controls, and among scull compared with sweep rowers. The lower back was the main location of back pain in rowers of all competition levels and typologies, and in controls. Age, sex, and training volume influenced the prevalence of back pain. Rowing kinematics, strength, and ergometer training were the main associated risk factors for back pain in rowers. CONCLUSIONS: Back pain in different spinal locations is a common complaint in rowers of different typologies and competition levels. Rowing kinematics, strength, and ergometer training are the main associated risk factors for developing back pain in rowers. Thus, the spinal load due to rowing kinematics and different types of training should be investigated in future studies. Additionally, training should be monitored by experienced coaches to prevent back pain due to technical mistakes or too-heavy loads.

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

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.

Prevalence of Back Pain in Sports: A Systematic Review of the Literature.

BACKGROUND: Back pain is a frequent health problem in the general population. The epidemiology of back pain in the general population is well researched, but detailed data on the prevalence and risk factors of back pain in athletes are rare. OBJECTIVE: The primary objective was to review articles about back pain in athletes to provide an overview of its prevalence in different sports and compare its prevalence among various types of sports and the general population. DATA SOURCES: A comprehensive search of articles published through May 2015 was conducted. Two independent reviewers searched six databases from inception (PubMed®, Embase, MEDLINE®, Cochrane Library, PsycINFO and PSYNDEX), using specifically developed search strategies, for relevant epidemiological research on back pain in 14- to 40-year-old athletes of Olympic disciplines. The reviewers independently evaluated the methodological quality of reviewed articles meeting the inclusion criteria to identify potential sources of bias. Relevant data were extracted from each study. RESULTS: Forty-three articles were judged to meet the inclusion criteria and were included in the assessment of methodological quality. Of these, 25 were assessed to be of high quality. Lifetime prevalence and point prevalence were the most commonly researched episodes and the lower back was the most common localization of pain. In the high-quality studies, lifetime prevalence of low back pain in athletes was 1-94%, (highest prevalence in rowing and cross-country skiing), and point prevalence of low back pain was 18-65% (lowest prevalence in basketball and highest prevalence in rowing). CONCLUSION: The methodological heterogeneity of the included studies showed a wide range of prevalence rates and did not enable a detailed comparison of data among different sports, within one discipline, or versus the general population. Based on the results of this review, however, it seems obvious that back pain requires further study in some sports.