BACKGROUND & OBJECTIVE
The British Journal of Sports Medicine (BJSM) published an editorial in 2018 titled: ‘Advice to athletes with back pain - get active! Seriously?’. Three colleagues and I conceived this editorial topic following some reflections on the Lancet low back pain (LBP) series. The Lancet series highlighted the critical role of physical activity and exercise in the treatment of LBP. Clinicians (particularly in the sports domain) started asking: how do I apply, or do I need to apply, this knowledge to people who are already substantially active, for example, athletes? A brilliant question!
Before reading my review, it is first crucial to acknowledge the lack of robust research in the area of LBP in athletes. The absence of high-quality clinical trials in this population is a limitation. Interestingly, despite this lack of evidence base, strong yet inaccurate claims about the origins of LBP in athletes, and the most beneficial treatments available, are plentiful. This editorial attempted to unravel the relationship between activity and LBP in athletes and make some recommendations. Below is a summary of the key takeaways.
DO ATHLETES GET BACK PAIN BECAUSE THEY ARE TOO ACTIVE?
Like most back pain, back pain in athletes is saddled in many unhelpful myths, and dogma about too much activity causing injury is particularly commonplace. However, the evidence that athletes get LBP because they are too active is limited. For example, while a sudden increase in load is associated with increased risk of pain or injury in cricketers and rowers, a high chronic load (in bowling, at least) is associated with a lower risk of pain. Perhaps a more nuanced interpretation of the activity literature is required.
WHY STOPPING ACTIVITY FOR THE ATHLETE WITH LBP MAY NOT ALWAYS BE THE BEST APPROACH
Is activity good or bad for back pain in athletes? It depends!