Low Back Pain in College Athletes: A Prospective Study Correlating Lower Extremity Overuse or Acquired Ligamentous Laxity With Low Back Pain.

Nadler SF, Wu KD, Galski T, Feinberg JH (University of Medicine and Dentistry of New Jersey, Newark, NJ; Kessler Institute of Rehabilitation, West Orange, NJ), Spine. 1998;23:828-833.

The authors conducted a prospective evaluation of leg-length discrepancy, hip flexor tightness, and acquired laxity or overuse syndrome in the lower extremity as predictive factors for the development of low back pain (LBP) in college athletes. A pilot study had found an association between LBP and these factors.

In 1994, a preparticipation sports physical examination was performed on 257 college athletes (170 men and 87 women) from 7 male and 7 female varsity sports. The men's sports included football, soccer, baseball, track, tennis, basketball, and swimming; the women's sports included volleyball, soccer, softball, track, tennis, basketball, and swimming. The athletes were intensively screened for the presence of muscle inflexibility, leg-length discrepancy, joint line tenderness, acquired ligamentous laxity, musculotendinous overuse, and any residual postsurgical deficits in the lower extremities.

Under the direction of a director of sports medicine, a sports medicine fellow and residents in physical medicine or rehabilitation performed the evaluations. Throughout the ensuing year, athletes were observed prospectively for LBP occurrence. As defined by the authors, LBP occurred when any athlete required treatment for LBP by the team athletic trainer. Athletes were excluded if they had sustained a direct blow to the low back region or had a history of low back surgery. A chi-square analysis was performed to evaluate differences between the involved groups.

The preparticipation physical examination detected 57 athletes (22%) with lower-extremity impairment. Patellar tendinitis and patellofemoral syndrome were the most common overuse injuries, whereas the most common ligamentous laxities were nonpainful ankle instability and postoperative anterior cruciate ligament reconstruction. Of the 257 athletes screened, 24 (9.3%) required treatment for LBP during the ensuing year. Thirteen of 87 women (15%) compared with 11 of 170 men (6%) required treatment for LBP. The difference between the sexes was statistically significant.

Of the initial 57 athletes with lower-extremity impairment, 14 (24%) later experienced LBP, representing 58.3% of all athletes requiring treatment for LBE There was no association between a reported history of LBP and those athletes who required treatment for LBP. There was also no association between leg-length discrepancy or hip flexor tightness and those who required treatment for LBP.

The authors felt that their study helped to corroborate the kinetic chain theory as a plausible cause of injury in college athletes. They believed that a comprehensive preparticipation screening is an important tool that will help team physicians identify athletes at risk for LBP. The study also showed that female athletes were more likely to require treatment for LBP than male athletes. They recommended further study of LBP occurrence in female athletes either independently or in conjunction with current research on knee ligament injuries in women.

William J Barnes, PT Lincoln Work Adjustment Center PC Lincoln, Neb