Treating low back pain in athletes: a systematic review with meta-analysis

Abstract

ObjectiveTo summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement.Data sourcesFive databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS).ResultsAmong 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments.ConclusionsWhile several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers

“…To understand management, we planned a systematic review to evaluate the evidence for non-pharmacological management of LBP in athletes. 8 We then planned an extensive survey of expert and experienced clinicians to investigate current best clinical assessment and management of an acute episode of LBP in rowers. 9 In addition, we planned qualitative research to investigate the athlete's lived experience.…”

“…12 The second group examined the biomechanics associated with rowing-related LBP, 11 and the third reviewed the treatment of LBP in athletes with studies examining rowing-related LBP synthesised where possible. 8 The full methodologies and outputs from each work group are presented as companion papers to this consensus statement. [8][9][10][11][12] The study proposal, interim findings and key questions (from the February 2018 meeting) were presented at the World Rowing Sports Medicine, Science and Coaches Conference in Berlin, November 2018.…”

“…8 The full methodologies and outputs from each work group are presented as companion papers to this consensus statement. [8][9][10][11][12] The study proposal, interim findings and key questions (from the February 2018 meeting) were presented at the World Rowing Sports Medicine, Science and Coaches Conference in Berlin, November 2018.…”

“…It includes end users by highlighting the lived experience of rowers ('rower's voice') from qualitative research and the rowers' and coaches' input into a plain language summary. This document reflects the current state of knowledge and should be read in conjunction with the accompanying systematic reviews and other companion papers, [8][9][10][11][12] which provide context.…”

Low Back Pain in Adolescent Elite Rowers and its Association to Skeletal Muscle Changes Detected by Quantitative Magnetic Resonance Imaging

“…LBP in adolescent athletes can arise from structural spinal injuries [12] . Therefore, it is important to exclude less severe, muscular injuries such as strains due to the performance focus of most athletes and the "return to play" before full resolution of symptoms leading, which might lead to possible delayed treatment of a structural spine injury [13,14] Structural changes of the skeletal muscle can be assessed non-invasively using Quantitative Magnetic Resonance Imaging (qMRI). T1-weighted mapping sequences can be used as a biomarker for muscle atrophy and fatty muscle in ltration [15] , while T2-weighted mapping sequences can visualize conditions such as in ammation or necrosis but also exercise-related transient tissue changes in water metabolism and therefore already have a widespread clinical use for the assessment of idiopathic myopathies, exercise injury and muscle fatigue [16][17][18][19][20] .…”