Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes?

Erika Zemková,Zuzana Kováčiková,Ludmila Zapletalová

doi:10.3389/fphys.2020.00894

Abstract

The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.

Highlights

Back injuries and back pain are among the most common health problems in athletes affecting their performance (Trompeter et al, 2017)
Overview of Studies Dealing With Back Pain and/or Injury in Athletes of Individual Sports
The key data elements that were sought for each study were categorized as follows: (1) study design, (2) study population, (3) training characteristics, (4) low back pain information, (5) diagnostic methods used for identification of lumbar spine, low back pain and lower back injuries, and (6) study outcomes

Summary

Introduction

Back injuries and back pain are among the most common health problems in athletes affecting their performance (Trompeter et al, 2017). Wheelchair athletes, who suffer from spine curvature disorders, are at greater risk of back problems (Samuelsson et al, 2001) This is related to mainly those participating in sports that involve trunk rotational motions under loading and unloading conditions (Goosey-Tolfrey, 2010). A recent study demonstrated that wheelchair table tennis players exhibit lower mobility in the thoracic and lumbar regions of the spine during trunk flexion as well as lower lumbar inversion and pelvic retroversion than able-bodied athletes (Zemková et al, 2018b) Their limited range of motion (ROM) during trunk rotations and decreased posterior concavity contributes to lower trunk rotational velocity (Zemková et al, 2018b) and it may increase the risk of spine injury. Velocity of trunk rotational movement is compromised in older athletes, most likely due to their reduced ROM as a result of increased trunk stiffness with aging (Zemková et al, 2018a)

Methods

Results

Conclusion