Article Text

Download PDFPDF
Treating low back pain in athletes: a systematic review with meta-analysis
  1. Jane S Thornton1,2,
  2. J P Caneiro3,
  3. Jan Hartvigsen4,5,
  4. Clare L Ardern6,7,
  5. Anders Vinther8,
  6. Kellie Wilkie9,
  7. Larissa Trease10,11,
  8. Kathryn E Ackerman12,13,
  9. Kathryn Dane14,
  10. Sarah-Jane McDonnell15,
  11. David Mockler14,
  12. Conor Gissane14,
  13. Fiona Wilson14
  1. 1Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  2. 2Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  3. 3Physiotherapy, Curtin University, Perth, Western Australia, Australia
  4. 4Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  5. 5Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
  6. 6Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden
  7. 7Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  8. 8Physiotherapy and Occupational Therapy and QD research-unit, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
  9. 9Tasmania Institute of Sport, Hobart, Tasmania, Australia
  10. 10Heathcare in remote and extreme environments, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  11. 11Orthopedics ACT, Canberra, New South Wales, Australia
  12. 12Sports Medicine Division, Boston Children’s Hospital, Boston, Massachusetts, USA
  13. 13Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  14. 14School of Medicine, Trinity College Dublin, Dublin, Ireland
  15. 15Sport Ireland Institute, Dublin, Ireland, Dublin, Ireland
  1. Correspondence to Dr Jane S Thornton, Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, ON N6A 3K7, Canada; jane.s.thornton{at}


Objective To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement.

Data sources Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS).

Results Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments.

Conclusions While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.

  • sport
  • treatment
  • injuries
  • lower back
  • athlete

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @janesthornton, @clare_ardern, @DrLarissaTrease, @drkateackerman, @fionawilsonf

  • Correction notice This article has been corrected since it published Online First. The provenance and peer review statement has been included.

  • Contributors Study concept, design and management: JST, FW, AV, KW. Data analysis: JST, FW, S-JM, LT, KW. Data review and interpretation: all authors. Manuscript writing: all authors.

  • 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 None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.