TABLE 2.
Training characteristics and identified back problems in athletes of team sports.
| Authors | Study design / diagnostics of back pain and/or injury | Sport and performance level | Subjects | Training | Back pain and/or injury | Main findings |
| Fett et al., 2019 | – A cross-sectional survey – Questionnaire | – Elite athletes (n = 181) of badminton, beach volleyball, handball, tennis, volleyball, and controls – sports students (n = 166) | Age of athletes/controls 19.7 ± 4.7/21.2 ± 2 years, body height 181.9 ± 12.3/ 180.1 ± 8,9 cm, body weight 74.5 ± 14.8/74.0 ± 10.3 kg Men/women controls 75:25%/athletes 54:46% | Training volume athletes/controls 17.3 ± 6.6/10.8 ± 5 h/week; Number of competitions 35.3 ± 16.9/0 Playing experience11.6 ± 4.5 years/0 | Lifetime, 12-, 3-month, and point prevalence of BP in athletes 85, 75, 58, 38%, in controls 81, 70, 59% (non-significant differences) – Non-significant differences between the sports games and controls – Non-significant differences among sports games – BP location mostly identical for athletes and for controls, and in different sports games – LB the most touched area, followed by the NP and upper back pain – Correlations between BP and training load volume in all groups and pain location | – The relationship between training volume and BP confirmed across all groups |
| Farahbakhsh et al., 2018 | – A cross-sectional survey – Interview and questionnaire with 40 questions related to neck pain (NP) and to LBP | – Young top Iran athletes; 452 male athletes participating in the sport Olympiad 2017 in Tehran Province – Soccer (n = 136), volleyball (n = 81), basketball (n = 52), wrestling (n = 69), other athletes (n = 39) | Age15.48 ± 1.81 (other sports) to 16.1 ± 0.93 (soccer); Body height from 165.02 ± 16.55 (other sports) to 176.71 ± 9.09 (basketball); body weight from 57.16 ± 18.10 (other sports) to 72.94 ± 15.44 (wrestling) | Mean training hours/week 9.71 ± 5.68 (soccer), 11.69 ± 6.94 (volleyball), 11.29 ± 4.64 (wrestling), 11.57 ± 8.22 (basketball), 11.37 ± 18.85 (other sports) Mean experience in sport 5.1 ± 2.53 year (soccer), 2.69 ± 1.48 years (volleyball), 3.51 ± 2.91 years (wrestling), 3.77 ± 1.62 years (basketball), 4.43 ± 2.67 years (other sports) | – Basketball players the highest life-time prevalence of NP (57.69%) – Volleyball players the highest life-time prevalence of LBP (67.90%) – Wrestlers the lowest life-time prevalence of NP and LBP (18.84, 10.14%) – Basketball players the highest risk of NP in all time points (1.54–7.25) – Basketball players the highest risk of LBP at most time points – Wrestlers the lowest life-time risk of LBP (0.064–0.36) | – A high prevalence of neck pain and LBP in young athletes – The highest risk of NP and LBP in basketball players and the lowest in wrestlers |
| Leppänen et al., 2015 | – Retrospective analysis as part of 3-year follow-up study; 12-month period – A detailed questionnaire, based on a previous study of sports injuries | – 18 of 20 basketball and floorball teams of the Tampere region; 207 basketball players (boys n = 101, girls n = 106); 194 floorball players (boys n = 112, girls n = 82) | – Floorball players/ basketball players: age 16.6 ± 1.4/ 14.8 ± 1.5 years, BMI (21.9 ± 2.2/ 21.4 ± 3.0 kg/m2, playing experience 7.6 ± 3.0/6.9 ± 2.9 years | Playing experience of basketball players: boys/girls 8.1 ± 3.1/ 6.3 ± 2.6 years, floorball players 7.6 ± 3.0 vs. 6.9 ± 2.9 years. Training session/week of boys/girls 4.3 ± 1.5/3.8 ± 1.2; training session/hour 10.2 ± 3.9/9.0 ± 3.0; game/season 35.2 ± 15.3/37.1 ± 16.5 | – Basketball: boys 44 (45%) overuse injuries, girls 53 (55%), in total 97, 0.47 overuse injuries per athlete/year; most of the overuse injuries at the lower extremities (64 cases, 66%), knee (44 cases, 45%), LBP (27 cases, 13%) without differences between boys and girls; average time loss from training participation 26 ± 50, median 7 days – Floorball: 72 (37%) of players at least one overuse injury (51 boys and 21 girls); the most common injuries location the lower back/pelvis (36, 39%), the second the knee (32, 34%); boys significantly LB and knee overuse injuries than girls; average time loss 16 ± 37 (median 5) days; the ratio of overuse injuries per athlete/year 0.47 | – The prevalence of overuse injuries is rather high already in youth basketball and floorball categories |
| Anza et al., 2013 | – 4 months prospective study – Nordic musculoskeletal questionnaire (NMQ) on prevalence of musculoskeletal symptoms | Volleyball, sport clubs | Boys (n = 19) (185.6 ± 6.72 cm), Girls (n = 19) (171.8 ± 9.28 cm), 14–17 years. Inclusion criterium: at least 1 year of regular training | Weekly training hours: boys 10.78 ± 1.76 h, girls 14.11 ± 2.08 h | – The most symptoms in 4 months found in the back (56.5%), shoulder (52.2%), hips/thighs (52.2%), and knees (52.2%) – Small changes of the prevalence regarding musculoskeletal symptoms and pain in boys/girls in 4 months (LBP in the last 7 days 44.4/43%, in the last 12 months 55.0/56.5; players impaired of sport activities 17.4/11.1%, professional treatment of LBP 11.1/13% of players) | – Training load was not a factor of musculoskeletal symptoms and pain |
| Augustsson et al., 2006 | – Retrospective study – Questionnaire designed by the first author | Volleyball, elite Swedish division players | – 225 volleyball players of 10 men’s and 9 women’s teams – Inclusion criterium: players of regular team line-up including substitutes – Age: men 25 ± 4 years; women 24 ± 4 years – 47% of men and 53% of women returned the questionnaire | – The total time of training and matches 31,972 h – The number of training hours per week for men 9.9 ± 4 h and 9.4 ± 7 h for women – Match playing time 7 h/week for men and 0.6 h/week for women | – Most of the injuries in the ankle (23%), followed by knee (18%) and back (15%) – Most injuries (62%) of minor severity – Most injuries during training (47%), 41% a gradual onset – 96% of players performed prevention training, mostly without supervision (58%) | – Without distinguishing between acute and overuse injuries, 45% of them occurred during blocking, 30% during spiking |
| Bere et al., 2015 | – Prospective registration of injuries during all major FIVB tournaments – Medical reports | – Junior and senior, male and female volleyball players at major FIVB events (23 senior and 9 junior events) – 4-year data obtained through the FIVB Injury Surveillance System (ISS) | – 32 events, 2640 of 2710 report forms from team medical staff, (response rate of 97.4%) – 440 injuries reported (62.5% during match play, 37.5% during training) | – In all age and sex groups, the ankle the most injured body part (25.9%), followed by knee (15.2%), finger/thumb (10.7%), and lumbar/lower back (8.9%); similar distribution between matches and training – The most common injury: joint sprains (32.5%, n = 143) and muscle strains (14.1%, n = 62); most muscle strains in the lower back (n = 19) – Senior players a higher risk of injury than juniors – No difference between males and females – 23.0% of all injuries contact injuries, 20.7% overuse injuries, 17.3% non-contact injury | – Most injuries related to sport-specific movement patterns (repetitive jumping and landing, spiking, blocking and serving) | |
| Bahr and Reeser, 2003 | – Cohort study – Retrospective injury reports with prospective registration of injuries over a 7.5-weeks – Interview/report of tournament medical staff | Beach volleyball, players at the FIVB World Championships 2001 | Professional male and female top beach volleyball players (178 out of 188 participants) from 30 different countries | – 7.5 weeks of training and competitions before World Championships (6 female tournaments and 8 male tournaments on the World Tour, and other national or regional tournaments) – Men: 2410 match hours, 1071 warm up and 6295 h of total training – Women:1832 match hours, 814 warm up and 6493 total training hours | – 54 of acute injuries recorded in the retrospective survey, and 25 in the prospective study – 67 players (38%) 79 overuse injuries in the retrospective survey with medical attention – Most common overuse injuries LBP (15%), knee pain (12%), and shoulder problems (10%) – Injuries in relation to body region in the prospective study similar to that of retrospective study anyway much lower | – Low back (LB) and shoulder overuse problems attributed to frequent spiking and jump serving – LB problems in players depend on the sand quality and its depth, heavy wet balls when raining (larger loads for the shoulder and lumbar spine during spiking and serving) |
| Külling et al., 2014 | – Cross sectional study – Structured interview; MRI examination | – Beach volleyball; – Grand Slam Tournaments – Fully professional male players with or without back pain; a world ranking in the top 100 | Age of players (n = 29) 28 years (19–39 years), body height 187 cm (179–205 cm), body weight 85 kg (63–100 kg), BMI 22.6 kg/m2 (19.7–25.6 kg/m2) | – The average duration of professional beach volleyball activity 9.8 years (2–20 years) – The average training hours/week 18.5 (9–35 h) | – 86% of players LBP during their career, in the last 4 weeks 35% – Averaged pain at a visual analog scale (VAS) 3 points (0–8) – 23 out of 29 players (79%) at least 1 degenerated disc of Pfirrmann grad >3; the most affected spinal levels L4–5 in 14 (48%) and L5–S1 in 15 players (52%); both levels involved in 5 players (17%) – 6 (21%) players a spondylolysis grade 4 according to the Hollenburg classification; spondylolisthesis in 2 players – Non-significant correlation between LBP and MRI abnormalities | – High prevalence of disc degeneration and spondylolysis in the lumbar spine in professional beach volleyball players – No correlations between LBP and MRI abnormalities in the study subjects |
| Bacon and Mauger, 2017 | – Prospective cohort study – Volume and intensity variables derived from GPS (StatSports, Viper Pod, NI) – Injuries collected by a qualified physiotherapist | – Professional youth soccer players (n = 41), Barclays U21/U18 Premier Leagues – Data collection 40 weeks of the competitive season for training sessions and matches | – Season 2012/2013 (n = 18), age 18.7 ± 1.2 years, body height 175.2 ± 4.5 cm, body weight 72.4 ± 3.1 kg – Season 2013/2014 (n = 23), age 17.0 ± 1.1 years, body height 181.3 ± 6.1 cm, body weight 74.9 ± 8.7 kg | – Players either with a signed youth scholarship contract or a professional contract with the club – 6 training sessions per week | – Of the 190 injuries 5.46 IIR, 51.76% (n = 44,5) non-contact – Total distance significantly predict overuse injury rates (F1,39 = 6.482, p = 0.015), high-speed running meters not (F1,39 = 1.003, p = 0.323) – Back injuries very low rate (0.25/1000 h, 2.4%) | – The incidence of overuse injury impact distance covered in training and matches, not the high-speed running meters – Cumulative approach to training load has value when assessing players injury risk |
| Pasanen et al., 2008 | – 6 months prospective study – Structured questionnaire registered by player and verified personally by a physician | Floorball, licensed female players from Finnish top leagues (n = 374) – Players’ level: elite league (n = 164), first division (n = 183), second division (n = 27), – Field position: goalkeeper n = 41, defender n = 120, forward n = 213 | Age 24.2 ± 4.8 years, body height 166.2 2 ± 5.2 cm, body weight 61.6 2 ± 6.5 kg | – 122 practice hours and 5.9 match hours/player in average – Elite league 133 practice hours (95% CI 124.9–141.5 h), first division 111 h (95% CI 103.9–117.9 h), second division 124 h (95% CI 103.9–143.7) – Intensive game load average during the season: elite league players 7.5 h (95% CI 6.8–8.1 h), first-division players 4.7 (95% CI 4.2–5.1 h), second-division players 4.7 h (95% CI 3.8–5.6 h) | – 73% of the injuries traumatic and 27% from overuse – Most of the traumatic injuries in ankle and knee (29/28%) – Most of the overuse injuries in knee, calf/shin (22%) and back (14%) – The injury rate per practice hours 1.8/1000 – Overall injury rate/1000 game hours 40.3, in the elite league 34.3, in the first division 48.0 and in the second division 47.7 – 56% of injuries treated at clinics, 44% by the players themselves, 6% needed hospital admission | – No clear reason of a high incidence of overuse injuries and non-contact injuries – Possible factors – type of floor and shoes, lack of proprioception and conditioning training |
| Haydt et al., 2012 | – Cross sectional study – Pen and paper survey questionnaire on incidence of LBP | – Female NCAA Division III field hockey players (FH); season 2008 (n = 90); age-matched controls from Misericordia University (n = 98), without participation in FH – Inclusion criteria: females 18–24 years with a self-reported LBP lasting more than 24 h not associated with menstruation | Age FH players 19.28 ± 1.19 years; range 18–22 years; controls 19.89 ± 1.45 years; range 18–24 years | – Not mentioned although they were surveyed | – Similarity in incidence of LBP in the FL players and controls (56% in FL players, 55% in controls) – Onset age of LBP for controls and the FH was 16.45 ± 2.12 and 16.23 ± 1.80 years – Duration of symptoms was less than 3 weeks in controls (85%) and FH group (82%) – Episode of LBP of 1 month or longer was 15% in controls and 14% in FH – Similarities in pain distal to the buttock in both groups | – Non-significant differences in the incidence of LBP and pain characteristics between the groups – In both groups a high incidence of LBP (>50%) with an onset of LBP at a mean age of approximately 16 years |
| Jacobson and Tegner, 2007 | – Prospective cohort study – Injuries registered by trainer/coach, in national teams by physiotherapist using standardized protocols (Ekstrand, 1982) – Injured players interviewed by the first author by telephone | Swedish female elite soccer players in premiere league, divided in national (n = 51) and no-national players (n = 144) | – 195 of 269 players (72%) – Age 23 ± 4 years, body height 168 ± 5 cm, body weight 62 ± 7 kg, BMI 22 ± 2 | – On the average 140 ± 48 (24–238) practice sessions and 35 ± 12 (2–48) matches – Players of national teams – 52 practice sessions and 23 matches more – Total football hours national/non-national players 321 ± 134/ 257 ± 78 h | – Traumatic injuries 163/237 (69%, 3.3/1000 h of football) – Overuse injuries 74/237 (1.3/1000 h of soccer) – Overuse injuries mostly during pre- and at the beginning of spring season – The highest incidence in the knee, the lower leg, and the back (39/18/16%; 0.6, 0.3, and 0.2/1000 h of soccer, respectively | – Back the third of most common body location of acute and overuse injuries – National team players and players in the three highest ranked teams although exposed to more playing hours during the year not different in injury incidence as non-national players – Injured players higher practice/game ratio than non-injured players – High amount of re-injuries (>50%) |
| Tunås et al., 2015 | – Prospective cohort study – Standardized Nordic musculoskeletal questionnaire (NMQ) | – Female elite soccer players (2009–2011; 3 years) (n = 267) – Female elite handball players (2007–2011; 5 years) (n = 173) – Female controls (2012) (n = 400) practicing no more than 5 times per week | Soccer/handball players/controls: Mean age 22.4 ± 4/22.3 ± 3/ 25.6 ± 4 years, Body height 167.7 ± 5/173.1 ± 6/ 167.9 ± 7 cm, Body weight 62.6 ± 7/69.0 ± 7/ 66.1 ± 14 kg, Playing at elite level 3.1 ± 4/3.2 ± 4 years | Training volume of players: – Soccer: less than 400 h/year 5.2%; 400–699 h/year 74.5%; more than 700 h/year 20.3% of players; – Handball less than 400 h/year 5.8%; 400–699 h/year 73.4%; more than 700 h/year 20.8% of players | – No differences in the prevalence of LBP among the groups – More than 60% players of the groups experienced LBP ever, more than 50% during previous 12 months and 24–31% in the previous week – Only 3.2% of handball, 3.6% of football players and 4.9% controls had no experience with LBP – More than 70% of football and handball players with LBP stated as the source the overuse, less than 10% traumatic injury | – Non-significant differences in the prevalence of LBP among soccer players, handball players and the control group – High frequency of LBP among examined players; as the main source of LBP stated overuse |
| Haag et al., 2016 | – Cross-sectional survey based on a retrospective data – An iPad-compatible questionnaire; a multiple-logistic-regression model – Nomogram based on the ORs of each parameter | 841 male, 269 female soccer players from Bavarian soccer clubs (74 different clubs, 75.0% from 1480 athletes) | Age of boys 15.96 ± 1.52 years, girls 14.38 ± 1.67 years, body height of boys 174.96 ± 9.03 cm, girls 163.82 ± 6.64 cm; body weight of boys 64.59 ± 11.74 kg; girls 52.64 ± 9.11 kg | Mean soccer training in boys 8976 ± 2.94 years (7–11 years) and in girls 3986 ± 3.5 years (3–8 years) | – The greatest impact on prevalence of back pain (BP) the age, followed by sex and playing surface (U19/U17/U15, 1.84/1.66/1.11) – Female players a greater risk (OR = 1.48) for BP than the boys; higher BMI linked to lower amount of BP (OR = 0.97); longer training history a negative effect on BP (OR = 1.04); more than 6 or less than 3 training h/week significant effects on the prevalence of BP (OR = 0.81); natural grass the highest negative influence (OR = 1.56); goalkeepers specific injury prevalence and incidence | Among all factors, longer training history and very high or low training load have an impact on the prevalence of BP |
| Bowen et al., 2017 | – 2 year prospective study – Workload quantified using GPS (Viper V.2, StatSports, Ireland), data from all on-pitch training sessions and matches – Injury report classified by doctors and physiotherapists | Elite youth soccer players (n = 32), category academy U18, U21 Premier League 2013–2014 and 2014–2015 seasons | Age 17.3 ± 0.9 years, body height 180.0 ± 7.3 cm, body weight: 74.1 ± 7.0 kg | – Training on a full-time basis – Competition: 63% of participants in both seasons and 38% participants in one season | – Very high number of accelerations (≥9254) over 3 weeks associated with the highest relative risk (RR) (RR = 3.84) and non-contact injury risk (RR = 5.11) – Non-contact injury risk higher by combination of high acute high-speed distance (HSD) with low chronic HSD (RR = 2.55), but not with high chronic HSD (RR = 0.47) – Most common non-contact injuries in ankle/foot (2.1/1000 h), hip/groin (1.3/1000 h), knee (1.1/1000 h), and abdomen/back (0.4/1000 h) | – High accumulated and acute workloads are associated with a greater injury risk – The injury risk is greatest by very high number of accelerations accumulated over 3 weeks – Progressive increases of chronic workload develops the players’ tolerance to higher acute loads and reduces injury risk |
| Aasheim et al., 2018 | – Prospective cohort study (7 months) – OSTRC-O questionnaire distributed by email every second Sunday, software SurveyXact V.8.2, Rambøll Management Consulting, Oslo, Norway | – Male handball players aged 16–18 years (n = 145) from South-Eastern Norway during the 2016–2017 season – Complete data from 48% of players | – 61% of players 17 years old, 33% 18 years old and 6% 16 years old; body height 184 ± 7 cm (172–198 cm), body weight 80 ± 11 kg (60–115 kg) – 55% of players participated in two different teams (senior/junior), 28% in one team, 17% in three teams, 10% players in junior national team | – Handball training: 9 ± 2 years (4–14 years). – The median amount of training during the study: 14 h/week, approximately 6 h handball, 4.5 h strength, 3 h alternative training and 30 min handball match play | – Average prevalence of all overuse injuries 39% (95% CI 29–49) – Average prevalence of all substantial overuse injury problems 15% (95% CI 13–17) – Highest average prevalence in shoulder (38% of players), knee (36%), and low back (26%); overuse injuries in each anatomical area after 7 months about 20% higher than at baseline | – The prevalence of overuse injuries is high, especially in the shoulder, knee, and low back – Tendency of worsening during the season |
| Hoskins et al., 2009 | – A cross-sectional study – The questionnaire using Quadruple Visual Analogue Scale of the McGill Pain Questionnaire (short-form) with LBP questions adapted from an Australian LBP epidemiological study | – 271 elite players, 360 semi-elite players, 148 non-athletic controls – At the elite/semi-elite level Australian rugby league players (n = 93/52), rugby union players (n = 19/139), Australian-Rules players (n = 112/90) and soccer players (n = 47/70) | Age of elite/semi-elite/non-athletic controls 23.3 ± 4 years, 23.8 ± 4 years, and 23.9 ± 4.5 years | – | – Almost linear trend of increasing LBP severity from non-athletes, to the semi-elite and elite athletes – Levels of the sensory, affective and total pain score significantly higher in elite athletes – Elite athletes approximately two times more experienced discomforting or greater LBP, and less likely no LBP as other groups; semi-elite athletes less likely experienced discomforting or greater LBP; and non-athletes more likely not experienced LBP (χ2 = 18.67, p < 0.001) – The age of first episode of LBP – between groups non-significant differences – Elite athletes 2–4 times attributed sporting activity as a cause of current LBP | – Elite players had significantly higher levels and more frequent LBP – LBP in elite players was more attributed to sporting activity when compared to semi-elites and non-athletes – The difference of onset of the first time LBP non-significant between groups – Reported etiology between groups is different |