Background Prevention of low back pain (LBP) requires the identification of modifiable risk factors. Currently there is limited evidence of these risk factors in current and retired athletic populations.

Objective To determine the prevalence and factors associated with LBP among retired international athletes (runners, swimmers, rowers, and hockey players).

Design Cross-sectional survey.

Patients (or Participants) 323 retired international level athletes, aged 30–97 years (median age 62 years), 43% female (n = 139) who had competed internationally for Great Britain.

Interventions (or Assessment of Risk Factors) Data was collected on age (years), sex, height (cm), weight (kg), sport and occupational history, bodily pain, training load, joint flexibility and medical history. A prior injury to the lumbar spine was defined by an injury causing pain > 30 days and requiring medical attention.

Main Outcome Measurements LBP (with or without leg pain) on most days of the past one-month.

Results Overall, the prevalence of LBP was 26.0% (84/323). The prevalence of LBP was 24.1% (21/87) in rowers, 29.2% (35/120) in runners, 31.3% (20/64) in swimmers, and 15.4% (8/52) in hockey players. The odds ratio for LBP increased with a prior significant lumbar spine injury [OR 2.64; 95% CI, 1.43–4.89, p= 0.002], overweight BMI [OR 1.91; 95% CI, 1.11–3.30, p = 0.02], and was less prevalent among those aged 70 years and older [OR 2.37; 95% CI, 1.02–5.54, p = 0.046]. No association was detected between LBP and female sex, a high training load, sporting discipline, heavy occupation post sports career, lumbar spine flexion, or comorbidities (i.e. diabetes, cancer, lung disease, stroke, heart disease).

Conclusions A prior significant lumbar spine injury and increased body mass index were associated with LBP in retired international athletes. Longitudinal follow-up is needed to determine if modification of these factors reduces the occurrence of LBP.