While non-pharmacological management of low back pain in athletes can be effective, there still isn’t enough evidence to determine which are the best treatment options, according to a new systematic review.
Best Low Back Pain Treatment for Athletes Still Unclear
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Secondary#returntosport#biomechanicalmodifications#manualtherapy
“The prevalence of low back pain is highly variable across different sports (18%-65%) yet it is consistently reported as a common reason for activity avoidance. While low back pain is influenced by a dynamic interaction among biological, psychological and social factors, prevention and management strategies are likely to be different between athletes and the general population,” the researchers of “Treating low back pain in athletes: a systematic review with meta-analysis,” wrote.
“In athletes, a previous episode of low back pain, high training volume, periods of load increase and years of exposure increase the risk of low back pain, impair performance and may contribute to early retirement.”
The study published online on June 01, 2021, in the British Journal of Sports Medicine,” summarizes current evidence on non-pharmacological management of low back pain in athletes.
The researchers searched five databases including EMBASE, Medline, CINAHL, Web of Science and Scopus from the database’s inception to September 2020. The primary outcomes were pain, disability and return to sport.
In total 14 randomized controlled trials with 541 athletes were included in the systematic review. The treatments assessed included exercise, biomechanical modifications, and manual therapy. None of the trials included surgery or injections.
The researchers found that exercise was the most frequently studied treatment, however, there was no return to sport data available for any of the exercise interventions.
Overall, the athletes in the study did see improvements in pain and disability after all the treatments.
“While several treatments for low back pain in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with low back pain, but the effect on return to sport is unknown,” the researchers wrote.
“No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High quality randomized-controlled trials are urgently needed to determine the effect of commonly used interventions in treating low back pain in athletes.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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