Introduction Back pain is a frequent health problem in the general population resulting in enormous costs for the health care system. A recent systematic review revealed a high variability in prevalence data for back pain in sports, within one discipline and between disciplines. Compared with prevalence rates in the general population, studies reported similar, higher or lower rates for athletes depending on discipline and investigation. The aim of this investigation was to determine lifetime prevalence, 12-months prevalence and point prevalence of back pain (regarding pain intensity and exact localization at the spine) in German elite athletes compared to an active control group.

Methods The study was designed as a cross-sectional survey among athletes competing at the national elite level in different sports. An online-based questionnaire was sent to N≈4000 athletes from different sports disciplines by the German Olympic Sports Confederation and to a physically active control group. The questionnaire consisted of several validated questionnaires on back pain (Nordic questionnaire [1], questionnaire for grading the severity of chronic pain [2]). Additionally a self-developed questionnaire focusing different aspects of training and competition was used to evaluate the athletic workloads. Statistical analysis was undertaken using SPSS software (version 23, IBM, Armonk, US). Respondents’ characteristics are expressed as the mean and standard deviation. Group means were compared using unpaired t tests for age, height, weight and training volume, and using Pearson’s chi squared test for sex. Differences in the prevalence of back pain between athletes competing in different sporting disciplines (n ≥ 15) and controls were assessed using the chi squared test.

Results A sample of N = 1114 German 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) took part in the survey. Lifetime prevalence of back pain was 88.5%, 12-month prevalence was 81.1% and point prevalence was 49.0%, compared with 80.7%, 70.0 % and 42.8%, respectively in the control group. The lifetime prevalence and 12-month prevalence in elite athletes were significantly higher than the control group. The most often occurred localization was the lower back. Regarding the sports disciplines individually lifetime prevalence of back and low back pain ranged between 58-100% and between 42-93%, respectively. Very high prevalence rates of 95 −100% were found in canoeing, dancing, rowing and water-polo.

Discussion The findings of this investigation indicate that back pain is also a present problem in German elite athletes. Especially sports disciplines with high mechanical loads on the spine seem to be affected. Athletes, physicians, physiotherapists and coaches should be aware of this, and seek to identify specific prevention programs, especially in high-risk sports. Back pain intervention programs should be part of elite athletes’ daily training.

Acknowledgement The study was supported by the Federal Institute for Sport Science, Germany (ZMVI1-080102A/11-18).

References

1. Kourinka I, et al. Appl Ergon1987;18:233–37.

2. von Korff M, et al. Pain1992;50(2):133–48.