Frequency of back pain in the general population and athletes
Back pain, particularly in the lower back, is a common problem and the main cause of absences from work and activity restrictions worldwide. It places a heavy burden on sufferers, society and the healthcare system. Studies show that up to 85 % of people are affected by it in the course of their lives (Trompeter et al., 2017).
The following overview is from the Federal Statistical Office and shows the frequency of back or low back pain in the population aged 15 and over. Around 40% of males and 50% of females complain of pain in these areas. In the general population, the pain is due to heavy physical work, obesity, poor general health, poor posture and low socio-economic status.
Although athletes are less likely to be affected by these factors, they can suffer from stress, fatigue and psychological pressure - all psychosocial factors that could make them susceptible to back pain. In addition, athletes tend to be overactive in some cases and, depending on the type of sport, tend to have one-sided movement patterns. This also makes the target group susceptible to complaints.
What is back pain?
Affected area
Back pain occurs in many different places: It can affect the neck and upper back, the middle back or even the lower back. Pain in the lower back is the most common. According to the European guidelines for the prevention of back pain, LBP (low back pain) is defined as "pain and discomfort localized below the costal arch and above the lower gluteal folds, with or without leg pain" (Burton et al., 2006).
Specific vs. non-specific back pain
The cause of specific back pain is based on a clear cause such as a fracture, a herniated disc or something worse. Only 10% of all back pain is specific.
Much more common is non-specific back pain, which affects around 95% of the back pain population. The causes of such pain are based on a functional problem in the musculature.
Acute vs. chronic back pain
A distinction is made between acute, sub-acute and chronic pain. Pain lasting up to 4 weeks is referred to as acute pain - pain lasting longer than 6 weeks is referred to as chronic pain.
Pain despite good fitness - causes and triggers in athletes
In over 80% of cases, the pain is muscular or, better said, functional in origin.
Although regular exercise can reduce the risk of lower back pain, the relationship between physical activity and back pain is described as U-shaped. Excessive physical activity can increase the risk (Heneweer et al., 2009).
Acute injuries as the cause
Acute lower back pain can be caused by sudden events such as accidents involving trauma, physical altercations in martial arts or lifting heavy weights. These acute incidents can lead to injuries to the intervertebral discs, muscle strains or inflammation in the area of the spine.
Chronic stress as a cause
However, chronic complaints are much more common than acute injuries. Many sports expose the spine and back muscles to high levels of strain over long periods of time. This can cause inflammation, muscle imbalances, muscle tension and, in some cases, injuries to the intervertebral discs and vertebral joints.
Sport-specific stresses
Some sports favor the occurrence of lower back pain due to their specific movement requirements
- Rotation-intensive sports: such as all racquet sports (tennis, golf, field hockey, handball) are particularly susceptible to complaints due to the constant one-sided rotation of the trunk. Muscular imbalances often occur between the dominant and non-dominant side.
- Flexion postures: Cyclists spend a lot of time in a bent-forward position, which puts a lot of strain on the lumbar spine.
- Sports with high impact loads: disciplines such as cross-country skiing, snowboarding and ski freestyle (halfpipe, slope style, big air) show higher prevalence rates for back problems due to repetitive strain on the spine.
Training volume and load management
Another decisive factor for the risk of back pain is the volume of training. High training volumes and repetitive movements can put a lot of strain on the spine. A sudden increase in training volume is particularly critical.
Additional risk factors
Mobility: Restricted mobility, such as a shortened hip flexor or shortened hamstring muscles, forces the lumbar spine into an incorrect position in which the load on the joint is higher.
Core strength: The deep abdominal muscles are responsible for stabilizing the lumbar spine. Therefore, weak core strength often leads to overloading of the lumbar spine (Zemková et al., 2020).
Prevent pain
ACWR
Das Konzept der «Acute-to-Chronic Workload Ratio» (ACWR) bietet eine Möglichkeit, das Trainingsvolumen besser zu steuern. Es beschreibt das Verhältnis zwischen der kurzfristigen (aktuelle durchschnittliche Wochenlast) und der langfristigen (z. B. 4 Wochen) Trainingsbelastung.
A formula for an overview:
ACWR= average load (in the last 7 days) Average load (in the last 4 weeks)
Interpretation
AWCR 0.8- 1.3: Low risk
AWCR > 1.3: Increased risk of overloading
Strengthening and mobility
As already mentioned, both factors are important for good back health. It is therefore worth investing time in good core muscles and flexibility.
Here are a few exercises that might help you:
Strengthening:
Crook Abdominal Crunch (3×10)
Lie on your back, bend your legs and place your feet on the floor. Lift your arms off the floor and pull your chin to your chest. Stretch your hands towards your knees and lift your upper body off the floor. Bring the movement back down in a controlled manner, keeping your chin tucked in.
Short lever side plank with hip abduction (3x20s)
Lie on your side and support your upper body on your elbows.
Your hips should be straight, the knee of the lower leg is bent to 90 degrees, the other knee straight.
Lift the hips off the floor. Stay in this position and lift the top leg straight up towards the ceiling and press the bottom knee against the floor to lift the hips further.
Hold this position for a moment. Control the movement as you return to the starting position.
Hip Bridges (3×15)
Lie on your back, bend your knees and place your feet flat on the floor. Your feet should be hip-width apart with your toes pointing straight ahead. Place your arms at your sides.
Pull the upper part of the pelvis towards the floor, tense the glutes and abdominal muscles and lift the hips towards the ceiling.
Raise your hips as high as possible without arching your back. The aim is to lift the hips so that the body is in a straight line from the knee to the hip to the shoulder.
Squeeze the gluteal muscles as tightly as possible in the top position and hold for two seconds.
Slowly lower your hips to the floor while maintaining tension in your glutes and abdominal muscles.
Mobility
Hip Flexor Stretch (3x 60s)
Place your leg in front of you with your knee bent at a 90° angle and your foot flat on the floor. You can place your hands on your thigh for support. Lean forward and push your hips forward while your foot remains on the floor. Feel the stretch in the front of the thigh and hip. Hold. Return to the starting position. Repeat the exercise on the other side.
Piriformis stretch (3x60s)
Lie flat on your back and bend both legs. Now place the foot of your right leg on the knee of your left leg. Place your hands under the thigh of the left leg and pull the leg upwards. Hold this position for the prescribed time. Repeat the exercise on the other side.
Fighting pain - what are my options?
Physiotherapy
The treatment of back pain has evolved from the search for a specific cause of pain to a more holistic approach. Research and guidelines show that it is usually not necessary to determine the exact tissue structure. Instead, a staged approach is preferred in which treatment is customized according to international guidelines (Koes et al., 2010).
Movement and manual therapy
Joints with limited mobility are treated with manual techniques. Mobilization of the spine in combination with exercise therapy can help reduce pain and improve function (Bardin et al., 2017). Strengthening and stretching exercises are effective for instability and hypermobile joints to improve function and awareness. Individually adapted programs to strengthen core strength, flexibility and muscle strength are recommended. In the case of back pain, we recommend an initial assessment by our physiotherapists to clarify the cause and create a customized treatment plan.
Sources:
Websites
https://www.stiftung-gesundheitswissen.de/wissen/rueckenschmerzen/hintergrund
https://ruecken-zentrum.de/blog/wp-content/uploads/2019/10/LWS-%c3%9cbungsprogramm-Tabelle1.pdf
Papers
Bardin, L. D., King, P., & Maher, C. G. (2017). Diagnostic triage for low back pain: A practical approach for primary care. The Medical Journal of Australia, 206(6), 268-273. https://doi.org/10.5694/mja16.00828
Burton, A. K., Balagué, F., Cardon, G., Eriksen, H. R., Henrotin, Y., Lahad, A., Leclerc, A., Müller, G., van der Beek, A. J., & COST B13 Working Group on Guidelines for Prevention in Low Back Pain. (2006). Chapter 2. European guidelines for prevention in low back pain: November 2004. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 15 Suppl 2(Suppl 2), p136-168. https://doi.org/10.1007/s00586-006-1070-3
Heneweer, H., Vanhees, L., & Picavet, H. S. J. (2009). Physical activity and low back pain: A U-shaped relation? Pain, 143(1), 21-25. https://doi.org/10.1016/j.pain.2008.12.033
Koes, B. W., van Tulder, M., Lin, C.-W. C., Macedo, L. G., McAuley, J., & Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 19(12), 2075-2094. https://doi.org/10.1007/s00586-010-1502-y
Nowotny, A. H., Calderon, M. G., De Souza, P. A., Aguiar, A. F., Léonard, G., Alves, B. M. O., Amorim, C. F., & Da Silva, R. A. (2018). Lumbar stabilization exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: Protocol of a randomized controlled trial. BMJ Open Sport & Exercise Medicine, 4(1), e000452. https://doi.org/10.1136/bmjsem-2018-000452
Trompeter, K., Fett, D., & Platen, P. (2017). Prevalence of Back Pain in Sports: A Systematic Review of the Literature. Sports Medicine, 47(6), 1183-1207. https://doi.org/10.1007/s40279-016-0645-3
Zemková, E., Kováčiková, Z., & Zapletalová, L. (2020). Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes? Frontiers in Physiology, 11. https://doi.org/10.3389/fphys.2020.00894