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Advice to athletes with back pain—get active! Seriously?
  1. Kieran O’Sullivan1,2,
  2. Peter B O’Sullivan3,4,
  3. Tim J Gabbett5,6,
  4. Mary O’Keeffe7
  1. 1 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 School of Allied Health, University of Limerick, Limerick, Ireland
  3. 3 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  4. 4 Bodylogic Physiotherapy, Perth, Western Australia, Australia
  5. 5 Gabbett Performance Solutions, Brisbane, Queensland, Australia
  6. 6 Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
  7. 7 School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Kieran O’Sullivan, Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; kieran.osullivan{at}

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The recent Lancet low back pain (LBP) series1–3 recommended exercise and physical activity, particularly for persistent and debilitating pain. Given a dearth of clinical trials for LBP among athletes, is encouraging activity justifiable for athletes with LBP when they are often already highly active? This editorial teases out the role of exercise and activity for LBP among athletes.

Do athletes get LBP because they are too active already?

The evidence that athletes get LBP because they are excessively active is limited. For example, there are data that LBP intensity among rowers is higher during intense training periods,4 and that highly active teenagers develop more future LBP.5 However, these studies either did not always examine how meaningful or disabling the LBP was4 5 or several other factors were also implicated. What is clear is that being consistently active is associated with less pain and injury. In other words, being active might be a good thing to reduce pain, including LBP, as long as the rate of increase in activity is managed appropriately and other relevant factors (eg, sleep, mood, relationships) are also addressed.

What else could contribute to LBP in athletes other than high activity levels?

It is worth remembering that many factors linked with …

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  • Contributors All authors have made substantial contributions to the conception, design, acquisition, analysis and interpretation of data. All authors have revised it critically for important intellectual content and approved the final version. In doing so, we agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KO’S, PO’S, MO’K and TJG provide professional development workshops for clinicians and coaches. TJG works as a consultant to several high-performance organisations, including sporting teams, industry, military and higher education institutions. Both KO’S and TJG serve in a voluntary capacity as Senior Associate Editors of BJSM. MO’K is a postdoctoral student of one of the authors involved in the Lancet series.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.