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Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis
  1. Julia Wall1,
  2. William P Meehan III2,
  3. Katharina Trompeter3,4,
  4. Conor Gissane1,
  5. David Mockler5,
  6. Nicol van Dyk6,7,
  7. Fiona Wilson1
  1. 1 Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
  2. 2 The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, Massachusetts, USA
  3. 3 Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Nordrhein-Westfalen, Germany
  4. 4 Department of Sports Medicine and Sports Nutrition, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
  5. 5 John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
  6. 6 High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
  7. 7 Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  1. Correspondence to Julia Wall, Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland; wallju{at}


Objective To investigate the incidence, prevalence, risk factors and morphological presentations of low back pain (LBP) in adolescent athletes.

Design Systematic review with meta-analysis.

Data sources Medline, Embase, CINAHL via EBSCO, Web of Science, Scopus.

Eligibility criteria for selecting studies Studies evaluating the incidence and/or prevalence of LBP in adolescent athletes across all sports.

Results There were 80 studies included. The pooled incidence estimate of LBP in adolescent athletes was 11% (95% CI 8% to 13%, I2=0%) for 2 years, 36.0% (95% CI 4% to 68%, I2=99.3%) for 12 months and 14% (95% CI 7% to 22%, I2=76%) for 6 months incidence estimates. The pooled prevalence estimate of LBP in adolescent athletes was 42% (95% CI 29% to 55%, I2=96.6%) for last 12 months, 46% (95% CI 41.0% to 52%, I2=56%) for last 3 months and 16% (95% CI 9% to 23%, I2=98.3%) for point prevalence. Potential risk factors were sport participation, sport volume/intensity, concurrent lower extremity pain, overweight/high body mass index, older adolescent age, female sex and family history of LBP. The most common morphology reported was spondylolysis. Methodological quality was deemed high in 73% of cross-sectional studies and in 30% of cohort studies. Common reasons for downgrading at quality assessment were use of non-validated survey instruments and imprecision or absence of LBP definition.

Summary/conclusion LBP is common among adolescent athletes, although incidence and prevalence vary considerably due to differences in study methodology, definitions of LBP and data collection.

PROSPERO registration number CRD42020157206.

  • Adolescent
  • Athletes
  • Back
  • Sport

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  • Twitter @NicolvanDyk, @fionawilsonf

  • Contributors JW, FW and WPM were responsible for review conception and design. JW and FW screened and assessed for study eligibility. JW, FW, NvD and WPM assisted with writing and editing. CG analysed data. DM designed the search strategy. KT and JW reviewed studies for methodological quality. All review authors reviewed and approved the final manuscript.

  • 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 WPM receives royalties from ABC-Clio publishing for the sale of the books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; from Springer International for the book Head and Neck Injuries in Young Athlete; and from Wolters Kluwer for working as an author for UpToDate. WPM’s research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from a grant from the National Football League.

  • 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.