Background Low back pain is a widespread condition in sport as in the general population.

Objective The purpose of this study is to investigate the prevalence and determinants of low back pain (LBP) and chronic low back pain (C-LBP) among Italian equestrian athletes

Design Cross-sectional survey conducted using an online cloud-based software.

Setting Competitive athletes, members of the Italian Equestrian Sport Federation older than 18 years old (n=40.932).

Participants 886 athletes participated in the survey: 21,90% were male and 78,10% were female.

Assessment of Risk Factors Gender, age, weight, height, discipline practiced , years of practice, weekly training volume, athletic training were the independent variables considered.

Main Outcome Measurements Prevalence and characteristics of LBP and C-LBP and their determinants.

Results LBP had a prevalence of 91,6% and 74,2% for life-time and 1-year respectively, while C-LBP had a prevalence of 23,9%. Prevalence of LBP in Show-Jumping was 61% , in Dressage 13,6%, in Eventing 6,3%, in Horse Country Riding 2,9% and in Reining 2,2%. Weight has a positive association with LBP (O.R. 1.05 95% CI=[1.02, 1.09] p<0.05), while age has a negative association (O.R. 0.95 95% CI=[0.94, 0.98] p<0.05). Practicing activity more than 5–6 hours a week has a positive association with C-LBP (O.R. 1.21 95% CI=[1.05, 1.4] p<0.05). C-LBP is associated with interrupted activity (p< 0.001), drugs consumption (p< 0.001) and restriction in participation (p< 0.001).

Conclusions LBP and C-LBP are very common conditions in equestrian athletes and their prevalence is higher compared to general population and other sports. LBP is more frequent in show-jumping compared to other disciplines. Age and weight are associated with lifetime LBP, with, respectively, a negative and positive association. Athletes with C-LBP showed more disability in activities of daily living (ADLs) and tendency to suspend sports more frequently.