Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school and college football players - A prospective study

Background: Low back pain is a common presenting symptom among players of American football. In Japan, however, skeletal disorders in football players, including low back problems, have been rarely studied, and management to prevent skeletal disorders has not been established. Study Design: An epidemiological study with prospective observation. Methods: The authors analyzed the relationship between lumbar spine abnormalities viewed through radiographs taken during the preparticipation physical examination, and the incidence of low back pain during a 1-year period in 171 high school and 742 college football players. Abnormalities assessed were spondylolysis, disc space narrowing, spinal instability, Schmorl's node, balloon disc, and spina bifida occulta. Results: High school players with spondylolysis had a higher incidence of low back pain (79.8%) than those with no abnormal radiographic results (37.1%). College players with spondylolysis, disc space narrowing, and spinal instability had a higher incidence of low back pain (80.5%, 59.8%, and 53.5%, respectively) than those with no abnormal radiographs (32.1%), and college players with spondylolysis had a higher incidence of low back pain than those with disc space narrowing and spinal instability. Conclusions: The results of the present study suggest that an abnormality such as spondylolysis is the most significant risk factor for low back pain in high school and college football players, and that disc space narrowing and spinal instability are also significant risk factors for low back pain in athletes with greater athletic activity such as college football players.