Sport and non-specific low back pain in athletes: a scoping review

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The aims of this scoping review (ScR) were to systematically map and summarize findings concerning studies reporting data on NS-LBP among athletes. Methods: This ScR was developed referring to the 2020 version of the JBIRM and the PRISMA-ScR. Five medical databases were searched up to November 2021. No limitations in terms of study design and language were applied. Results were presented numerically and thematically. Results: A total of 4061 records were identified through the initial search; 114 articles met the inclusion criteria. Publications had increased over years since 1990. Most of the studies (17.5%) were conducted in the USA, even if most research (53.5%) was conducted in Europe. Analytic observational (42%) and cross-sectional studies (37%) were the most used designs, followed by case reports (12%) and systematic reviews (9 %). Boating (7%), football, soccer, volleyball, running and gymnastics (4.4% each) were the most investigated, although the majority of the studies considered sports in general (36.8%). The overall sample size median was 181, mean age 22+/-10.2; 68% of athletes were professional and 32% amateur. Most of the studies (38%) did not detail the frequency of training. Sport was reported as a risk factor in 67.5% of cases. Conclusions: This is the first ScR to provide a comprehensive overview on this topic. Publications have shown an increasing interest over the last years. Currently research is more centered on the effects of sport practice in general. Research methods are extremely varied and often not adequate to produce strong levels of evidence. Higher-quality, standardized observational research focused on specific sports activities is needed to properly address clinical practice and further research. Sport Low back pain Epidemiology Scoping review Athlete Risk factor Figures Figure 1 Figure 2 Figure 3 Background Low back pain (LBP) is considered as one of the most significant health problems worldwide, with a global prevalence of 38.9% [ 1 ]. LBP represents a multifactorial disease with several underlying causes such as occupational and psychological factors, age, gender and other social-demographic features, but also lifestyle and mechanical issues [ 2 ]. These aspects inevitably create an important burden to different degrees, including individual-, community- and economic-based difficulties [ 3 ]. Furthermore, a large amount of LBP can be defined as non-specific (NS-LBP), referring to a condition where an identifiable source of pain is not recognizable [ 4 ]. While most of the above-mentioned factors are generally acknowledged as risk conditions for NS-LBP, the impact of physical stress on the lumbar spine due to sports seems conflicting [ 5 – 8 ]. A recent meta-analysis suggests how leisure time physical activities moderately protect from the risk of developing NS-LBP [ 9 ], while there is inconsistent evidence in favor or against more intensive physical training [ 10 , 11 ]. A previous literature search showed how several studies investigated a possible association between sport activities and NS-LBP, despite a wide variety of methods and results [ 6 , 12 ]. Several differences were found in the retrieved studies, including population types, sport activities, characteristics of training, modalities of LBP assessments and risk analyses [ 6 , 12 ]. For such reasons, currently, it appears difficult that a systematic review investigating the impact of different sports on NS-LBP could lead to firm recommendations. However, there is a need to highlight some general aspects on this topic, such as the main sport activities which the literature focuses on, the settings where they are performed, the sample characteristics or the training modalities (e.g. frequency, intensity, duration), as well as the study designs actually adopted. According to the Joanna Briggs Institute (JBI), a scoping review (ScR) represents the most useful approach to map literature and to clarify key concepts and possible shortcomings a specific research area may have [ 13 ]. Hence, such a comprehensive report may be interesting, in order to inform and provide more indications in sports’ practice for subjects with NS-LBP [ 13 , 14 ]. As to our knowledge, a complete overview of NS-LBP among athletes is missing; this study’s aim was threefold: ì) to undertake a ScR to systematically map and summarize the literature reporting epidemiological data on sport activities and NS-LBP; ìì) to identify any possible shortcomings in knowledge concerning this topic; ììì) to provide cues and suggestions for clinicians, researchers and stakeholders. Methods Registration and reporting This scoping review was developed referring to the “2020 version of the Joanna Briggs Institute Reviewers’ Manual” [ 13 ] and the “Preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews” (PRISMA-ScR) checklist [ 15 ]. The protocol was stored on the OSF with the following registration number: 10.17605/OSF.IO/9BEX8 [ 16 ]. Research question The aim of this paper was to map the existing literature concerning the possible association between the practice of the main sports activities and LBP occurrence. Hence, the following research question was posed: “what is known from the current literature about the association between sports and LBP in athletes”? Inclusion and exclusion criteria As recommended, studies were included when they met specific criteria in terms of population, concept and context [ 17 ]. Specifically, we considered original research dealing with athletes of any country (elite or amateur, male or female, adolescent or adult), who practice different types of sport. Studies focused on leisure-time physical activity were excluded. The concept was focused on the association between the sport activity and NS-LBP onset, in each possible context, such as professional teams, amateur clubs or colleges. As a consequence, we included only articles in which epidemiological indicators (e.g. relative risk, odds ratio, frequency distributions, incidence and prevalence) concerning the association “sport activity and NS-LBP” were present. Conversely, studies investigating only peculiar aspects, such as physical characteristics (e.g. flexibility, muscle size, physical performances, etc.) in relation to NS-LBP were excluded. Examples of the sports considered are football, soccer, volleyball, basketball, tennis, running, golf and cycling, even if other types of activities were included if retrieved in the search results. Only observational studies (both analytical and descriptive) and systematic reviews were accepted, without any restrictions in terms of time, setting and country; narrative reviews, commentary and letters to editors were excluded. Only articles in English were accepted. We excluded studies considering some particular activities (such as car racing and fishing), where movement does not represent the central element in the potential association with NS-LBP. Search strategy The literature search was carried out by consulting the main biomedical databases such as Pubmed (Medline), Cochrane, Central (Cochrane), Embase, Pedro and Scopus. Gray literature was considered via Google Scholar. In order to avoid any possible relevant source, additional records were periodically searched through cross-referencing. Searches were conducted until November 2021. Study Selection and data extraction The search strategy results were managed through “Rayyan – the intelligent systematic review” web app ( www.rayyan.ai ) [ 18 ]. Duplicates were automatically deleted and records were screened firstly by title and/or abstract and secondly by full-text reading. Two blinded authors (GC, MS) independently screened the articles and any possible conflicts were resolved through a discussion with three expert authors (FDF, FA, and MM). Specific details of the selection process are better illustrated in the PRISMA flow diagram (Fig. 1 ). The main features of the included studies in relation to the aim of the review were reported in a data extraction form. This form was previously developed, discussed, implemented and accepted by all the authors of the study. The major characteristics extracted from the included works were: year of publication and country, type of journal (sport medicine journal or not), study aim, study design and duration, sample size, description of the sport activity (typology, rate of attendance, etc.). Finally, a summary of the main results was reported. Synthesis of results Data were reported numerically and thematically. Descriptive statistics was used reporting means, standard deviation (SD), median, mode, interquartile ranges (IQR) and percentages for all the considered outcomes, such as period of publication, country, study design, characteristics of participants, sports activity and results. Considering the large number of variables, we opted to report our results using several graphs in order to facilitate the reader with the interpretation of the results. Results A total of 4061 articles were identified through the initial database search; 503 records were detected as duplicated and consequently removed. Overall, 3558 articles were screened for title and abstract and 3314 of them did not meet the inclusion criteria and were therefore rejected. Following the full-text reading, 24 records were excluded with reasons. As a result, 114 articles were definitively included in the qualitative synthesis. Further details concerning the study selection process are reported in the PRISMA flow diagram (Fig. 1 ). Please insert Fig. 1 approximately here Study Characteristics Among the 114 included works, 104 (91%) belong to primary research (observational studies, both descriptive and analytical). Conversely, 10 (9%) are systematic reviews and/or meta-analyses. In detail, 48 articles (42%) are analytical studies (case-control or cohort), 42 studies (37%) consist of cross-sectional investigations, 13 (11.5%) are case reports and only 1 (< 1%) is a case-series. The distribution of study designs among the included works is graphically reported in Figure A1 (Appendix A). Most of the studies (n = 20, 17.5%) were carried out in the United States, despite Europe -as a whole- publishing the majority of studies (n = 61, 53.5%). Other countries which gave a substantial contribution to the topic were Japan (n = 13, 11.5%), Germany (n = 11, 9.5%), Italy (n = 9, 8%) and Sweden (n = 8, 7%). Further details regarding all of the countries involved in this research context are reported in Fig. 2 . Publications increased over the years. However, most of them are concentrated in the time period 2015–2020. Specifically, in the years 2015 and 2020 eleven articles (n = 22, 19%) were published, followed by 2016 and 2019, respectively with 10 (9%) and 7 (6%) publications (Fig. 3 ). Approximately half of the included studies (52%) were published in sports medicine journals. Furthermore, 70 studies (66%) considered in their sample only sports people, while the remaining 36 works compared them to people who didn’t practice sport. Please insert Fig. 2 approximately here Please insert Fig. 3 approximately here Population The included studies analyzed a total of 98657 participants (mean: 941 ± 2889, median: 181, mode: 1, IQR: 566.5); 42240 of the subjects were females (43%). The mean age of the overall sample size was 22 ± 10.2 years (median: 20; mode: 20; min. age: 10; max. age: 56; IQR: 10). 68% of this population were professionals, 32% of athletes were classified as amateurs. Specific details concerning sample characteristics are reported in Table 1 . Table 1 Characteristics of the overall sample of the included studies Gender N. of subjects Female 42240 Male 56613 Age Years Mean (SD): 22.02 (10.2) Median 20 Mode 20 Min-Max 10–56 IQR 10 (25–15) Athletes N. of studies Amateurs 33 Professionals 71 Sample characteristics N. of studies Mixed sample 36 Only sports people: 70 Sample size N. of subjects Total 98853 Mean (SD) 941.46 (2889.7) Median 181 Mode 1 Min-Max 1-26766 IQR 566.5 (633.5–67) Please insert Table 1 approximately here Sports Several sports were considered, even if the vast majority of the studies investigated the combination of more than one activity as a risk factor for NS-LBP (42 works, representing 37% of the total). The most widely investigated sports were boating (7 studies, 6%), football, soccer, gymnastics, volleyball and running (5 studies, 4.5% each), basketball, tennis, dancing, swimming and skiing (4 studies, 3.5% each). Further examined sports and relative frequencies are specifically detailed in Table B1 (Appendix B). Context Research was predominantly carried out by sports associations (53%), such as club teams, followed by clinical settings (clinic 10.5%, hospital 10.5% and private practice 7%) and colleges (19%). Mostly, authors did not specify the athletes’ frequency of training (39 studies, 38%); in 17 works (16.5%) the sports people trained 5 times per week, in 16 cases (15.5%) 3 times per week, in 15 studies 4 times per week. Two studies investigated athletes who underwent training sessions every day of the week and twice per week (2%). Only one study (< 1%) considered one training session per week. Almost half of the included studies (n = 51, 48.2%) were managed by physicians only, followed by physiotherapists (n = 10, 9.4%), chiropractors (n = 3, 3%) and sport science operators (n = 1, < 1%); in 23 studies (21.7%), the research was conducted by physicians and physiotherapists together. Further details are reported in Figure A2 (Appendix A). In the assessment modality of NS-LBP, some differences are also present across studies. In 49% of cases (n = 52), a combination of interview, physical examination and pain-related questionnaires (scales) were administered by the personnel involved. In 38 studies (36%) only questionnaires were considered and in 11 articles (10%) only the physical evaluation was reported. Low back pain and sports All the reviewed studies aimed to investigate a possible association existing between sport and NS-LBP. The large majority of those works (n = 77, 67.5%) indicated sport as a possible predisposing factor. Conversely, 21 studies (18.5%) did not find any association and in 16 cases (14%) the association was referred to as “unclear”. Discussion Summary of evidence To the best of our knowledge, this is the first scoping review aimed at providing a comprehensive overview of the literature regarding the association between sport activities and NS-LBP. To date, two systematic reviews [ 6 , 19 ] investigated prevalence and incidence of LBP in sports in general, highlighting important levels of methodological heterogeneity in the included studies. Thus, authors concluded that a complete synthesis of evidence was not possible up until then. Furthermore, results show an increasing interest in this field, with a clear trend of growth in the number of publications over the last years. In this context, this ScR represents a proper systematic mapping of the current literature, potentially addressing clinical practice and future research [ 14 ]. Theme: major focus on sport in general One of the main themes that emerged from the results is represented by the investigated sports. As reported in the above section, the large majority of the studies considered the role of sport in general, including in their sample athletes who practice different activities. Similarly, some reviews [ 6 , 19 – 21 ] focused on this topic as well, attempting to estimate an overall synthesis of the risk. Such a methodological choice provides information about the impact of the physical load. However, it prevents the understanding of the exact role of specific movement patterns related to the athletic gesture. This fact could represent an issue, since previous research confirmed a strong association between LBP and flexed, rotated and awkward positions of the lumbar spine [ 22 , 23 ], or with repeated bending and twisting [ 24 , 25 ]. Moreover, highly technical sports seemed to be at higher risk for LBP rather than endurance activities [ 26 ]. For all these reasons, investigations on specific sports activities should be encouraged. Theme: greater focus on the most popular sports As outlined in the results section, research on this topic appears as a prerogative of western countries: Europe, United States and Canada provided by far the larger number of studies. Not surprisingly, the most investigated sport activities were football, swimming, volleyball, basketball and tennis, widely practiced in these countries [ 27 ]. Boating and dancing have also been widely considered, whereas other practices (e.g. martial arts, cricket) were investigated occasionally. This fact has probable implications, since the focus of the research seems more influenced by the popularity of the activity, rather than by other variables such as the gestures, loading stress, solicitations and postures. Theme: wide differences in research methods The included studies appeared heterogeneous with regards to the characteristics of training sessions. Firstly, most of the studies did not provide any information concerning parameters such as duration, frequency and intensity of the practice. In addition, several studies presented many differences, although those parameters are considered crucial to define the dose-response rate for the risk assessment [ 28 ]. This aspect assumes even more relevance if we consider the supposed “U-shaped” relationship between physical activity and NS-LBP. [ 29 ]. Such a relationship would address the detrimental effect of both low and strenuous levels of physical activity [ 30 ]. Other relevant considerations are related to the study designs adopted by researchers. Cross-sectional investigations appear to be by far the most frequently used. From another point of view, data showed how 51% of the included studies (cross-sectional surveys and descriptive reports) were not primarily useful to assess the epidemiological relationship between sports and NS-LBP. Another 9% of the included works is represented by secondary research (reviews). Furthermore, only a minor part of studies compared athletes to non-athletes. As is known, only analytical cohort studies provide the best way to investigate such a relationship [ 31 , 32 ]. For these reasons, the large percentage of studies (67.5%) reporting sports practice as a risk factor for NS-LBP should be considered carefully. Lastly, LBP assessment methods appeared different across studies, with only half of the works considering a multidimensional evaluation of the recruited subjects. Theme: the usefulness of descriptive reports A relatively large number of the included records were case reports. These were predominantly descriptions of particular painful conditions, originally classified as NS-LBP and successively revealed to be related to other areas (e.g. hip problems, ileo-tibial syndrome) or to a specific type of LBP (mostly stress fractures or spondylolysis). As is well known, LBP assessment often represents a diagnostic challenge [ 33 ] and these reports provide valuable cues to help clinicians in the difficult evaluation of such painful conditions [ 34 , 35 ]. Implications for clinical practice According to the results of the current review, the relationship between sports and NS-LBP is still far from being demonstrated. Recent systematic reviews considered different sports as a whole, underlining the role of duration, intensity and frequency of sessions as possible risk factors [ 6 , 19 – 21 ]; from another point of view, several studies highlighted biomechanics and specific athletic gestures as important for LBP onset [ 36 , 37 , 38 ]. It is our assumption that clinicians should consider both of these hypotheses during their assessment, without forgetting the distinctive clinical features of each single subject. Secondly, a multidisciplinary approach seems to be essential in NS-LBP [ 39 ]. At the moment, most of the research is mainly led by physicians, sometimes in combination with physiotherapists. Other practitioners such as sport science operators, manual therapists and chiropractors contributed occasionally, although their role could be of considerable importance [ 40 – 43 ]. For the same reasons, sports associations and clubs should be equipped with a team of clinicians, preferably experts in specific LBP clinical management. As previously discussed, the remarkable presence of case reports in literature confirms the above-mentioned difficulties during the assessment process [ 33 ]. Implications for research As a direct consequence of the results obtained in this study, research should be more directed towards analytical studies. In particular, high-quality prospective double-parallel cohort designs are preferably needed to provide the best possible evaluation of the risk in the association “sports - NS-LBP” [ 32 ]. Case-control studies could represent an option, as long as their major exposure to biases is considered [ 44 ]. Furthermore, research focus should be oriented in two distinctive directions: on the one hand, more evidence is needed on single activities, especially regarding movement patterns and their connection to LBP onset. On the other hand, the characteristics of training should be further investigated. In this regard, it is of crucial importance that future research be more similar in terms of exposure to physical efforts and that relative parameters (e.g duration, intensity and frequency of training) also be well documented [ 22 ]. Lastly, some sports such as martial arts, baseball, hockey and weightlifting are studied little and require more in-depth research. Limitations As this study consists in a comprehensive mapping of the literature, our search strategy might have lost some pertinent records. Thus, results and relative conclusions could have been influenced. Another possible limitation can be related to the term “athlete”. In practice, we accepted the definition reported by the authors of each work. However, some differences are probably present among the included studies. For the sake of synthesis, we decided to exclude narrative reviews, letters and editorials from the selection of the studies. Although these formats do not produce real evidence, they represent a form of contribution to literature that is not present in our reporting. Conclusions This review mapped the literature and identified 114 studies investigating the potential relationships between sports and NS-LBP. Results showed an increasing interest in this topic since 1990. Currently, research is more centered on sport as a whole, investigating the effects of sport practice in general. Some activities are more investigated than others, probably on the basis of their popularity in the countries active in the research field. At the moment, research methods are extremely various and often not completely adequate to produce strong levels of evidence. High-quality observational research, mainly focused on specific sport activities and with higher levels of homogeneity is needed. This could help to properly address clinical practice and further research. Abbreviations Non-specific low back pain (NS-LBP), scoping review (ScR), low back pain (LBP), Joanna Briggs Institute (JBI), Preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews” (PRISMA-ScR), standard deviation (SD), interquartile ranges (IQR). Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions FDF conceptualized the study and the methodology, and was the major contributor in writing the original draft preparation, reviewing and editing; FA was a data curator, conducted the investigation, collaborated in writing and reviewing the original draft and was in charge for the data visualization; GC was a data curator and collaborated in the investigation process; MS was a data curator and collaborated in the investigation process; EP collaborated in writing and reviewing the original draft; MM conceptualized the study, was the supervisor for the study and collaborated in the writing and review process. Acknowledgements Not Applicable. References Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012 Jun;64(6):2028–37. 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Supplementary Files AppendixA.docx AppendixB.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 02 Nov, 2022 Reviews received at journal 20 Oct, 2022 Reviewers agreed at journal 11 Oct, 2022 Reviewers invited by journal 11 Oct, 2022 Editor assigned by journal 11 Oct, 2022 Editor invited by journal 10 Oct, 2022 Submission checks completed at journal 10 Oct, 2022 First submitted to journal 20 Sep, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2085257","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":143169774,"identity":"590cedc1-19b9-471b-8f48-dc08688db520","order_by":0,"name":"Fulvio Dal Farra","email":"","orcid":"","institution":"University of Cagliari","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fulvio","middleName":"Dal","lastName":"Farra","suffix":""},{"id":143169777,"identity":"ab7c10e8-c688-4e9a-9190-8dbb042a8e9e","order_by":1,"name":"Federico Arippa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYFACxgYgIScHYh54QIIWY2OwlgQSrDJOBGlkIEoL/+zDbY8LagzS54cdfgi0xU5Ot4GAFolzie3GM44Z5G68nWYA1JJsbHaAkDVnGNukedj+5G6cnQDSciBxGyEt8mAt/wzSDWenfyBOiwFIC2+bQYK8dA6RthieYWw3ntlnYLhBOqfgQIIBEX6RO8P+7HHBNwN5+dnpmz98qLCTI+x9BgY2ZrALwSoNCCtHaJFvIE71KBgFo2AUjEAAAOLuRBEBPDolAAAAAElFTkSuQmCC","orcid":"","institution":"University of Cagliari","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Federico","middleName":"","lastName":"Arippa","suffix":""},{"id":143169778,"identity":"91fab5e5-5601-4d2c-a86c-8f2c89cd885c","order_by":2,"name":"Giuseppe Carta","email":"","orcid":"","institution":"University of Cagliari","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Giuseppe","middleName":"","lastName":"Carta","suffix":""},{"id":143169779,"identity":"0fcb1f22-6f69-4d09-a34a-fcea0056d017","order_by":3,"name":"Marco Segreto","email":"","orcid":"","institution":"University of Cagliari","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marco","middleName":"","lastName":"Segreto","suffix":""},{"id":143169781,"identity":"7df4e405-df5a-4f53-9959-9f82199ef1b4","order_by":4,"name":"Elisa Porcu","email":"","orcid":"","institution":"University of Rome Tor Vergata","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Elisa","middleName":"","lastName":"Porcu","suffix":""},{"id":143169783,"identity":"2cb3dc91-c364-45a2-9717-790cbe907ba1","order_by":5,"name":"Marco Monticone","email":"","orcid":"","institution":"University of Cagliari","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marco","middleName":"","lastName":"Monticone","suffix":""}],"badges":[],"createdAt":"2022-09-20 13:59:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2085257/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2085257/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27689774,"identity":"1ce2d7b1-71ed-42e4-b520-c4ccc79a5501","added_by":"auto","created_at":"2022-10-12 16:37:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49751,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFlow diagram based on PRISMA statement (www.prisma-statement.org).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/cc91f69c534892298912620a.png"},{"id":27690248,"identity":"056ea2eb-2309-4c34-bc91-68e9ef724cf0","added_by":"auto","created_at":"2022-10-12 16:42:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":152346,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDistribution of research publications worldwide.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/b0e45005c342b1638633130f.png"},{"id":27689778,"identity":"6a48df90-47e3-4f38-8238-ed74d9fb02e5","added_by":"auto","created_at":"2022-10-12 16:37:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":70213,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDistribution of publications over years since 1990.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/0c8dd321a2ba077ebea57ff0.png"},{"id":27690672,"identity":"49118138-cdf9-4c22-bcc7-48aa587b3f94","added_by":"auto","created_at":"2022-10-12 16:47:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":738413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/50916dd6-ad84-45c2-8a5c-575fdfcba719.pdf"},{"id":27689777,"identity":"73744a5c-937e-436e-a415-89fafd09aee1","added_by":"auto","created_at":"2022-10-12 16:37:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":323491,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/ac4c0328f7ffc17fb929c5d2.docx"},{"id":27690660,"identity":"679e9c07-aec3-44de-941a-a4e583001475","added_by":"auto","created_at":"2022-10-12 16:47:14","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15061,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixB.docx","url":"https://assets-eu.researchsquare.com/files/rs-2085257/v1/b0ce87a76a0ffbfe4f779e64.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sport and non-specific low back pain in athletes: a scoping review","fulltext":[{"header":"Background","content":"\u003cp\u003eLow back pain (LBP) is considered as one of the most significant health problems worldwide, with a global prevalence of 38.9% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. LBP represents a multifactorial disease with several underlying causes such as occupational and psychological factors, age, gender and other social-demographic features, but also lifestyle and mechanical issues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These aspects inevitably create an important burden to different degrees, including individual-, community- and economic-based difficulties [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, a large amount of LBP can be defined as non-specific (NS-LBP), referring to a condition where an identifiable source of pain is not recognizable [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile most of the above-mentioned factors are generally acknowledged as risk conditions for NS-LBP, the impact of physical stress on the lumbar spine due to sports seems conflicting [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A recent meta-analysis suggests how leisure time physical activities moderately protect from the risk of developing NS-LBP [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], while there is inconsistent evidence in favor or against more intensive physical training [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA previous literature search showed how several studies investigated a possible association between sport activities and NS-LBP, despite a wide variety of methods and results [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Several differences were found in the retrieved studies, including population types, sport activities, characteristics of training, modalities of LBP assessments and risk analyses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For such reasons, currently, it appears difficult that a systematic review investigating the impact of different sports on NS-LBP could lead to firm recommendations.\u003c/p\u003e \u003cp\u003eHowever, there is a need to highlight some general aspects on this topic, such as the main sport activities which the literature focuses on, the settings where they are performed, the sample characteristics or the training modalities (e.g. frequency, intensity, duration), as well as the study designs actually adopted. According to the Joanna Briggs Institute (JBI), a scoping review (ScR) represents the most useful approach to map literature and to clarify key concepts and possible shortcomings a specific research area may have [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Hence, such a comprehensive report may be interesting, in order to inform and provide more indications in sports\u0026rsquo; practice for subjects with NS-LBP [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs to our knowledge, a complete overview of NS-LBP among athletes is missing; this study\u0026rsquo;s aim was threefold: \u0026igrave;) to undertake a ScR to systematically map and summarize the literature reporting epidemiological data on sport activities and NS-LBP; \u0026igrave;\u0026igrave;) to identify any possible shortcomings in knowledge concerning this topic; \u0026igrave;\u0026igrave;\u0026igrave;) to provide cues and suggestions for clinicians, researchers and stakeholders.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eRegistration and reporting\u003c/h2\u003e \u003cp\u003eThis scoping review was developed referring to the \u0026ldquo;2020 version of the Joanna Briggs Institute Reviewers\u0026rsquo; Manual\u0026rdquo; [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and the \u0026ldquo;Preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews\u0026rdquo; (PRISMA-ScR) checklist [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The protocol was stored on the OSF with the following registration number: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17605/OSF.IO/9BEX8\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/9BEX8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eResearch question\u003c/h2\u003e \u003cp\u003eThe aim of this paper was to map the existing literature concerning the possible association between the practice of the main sports activities and LBP occurrence. Hence, the following research question was posed: \u0026ldquo;what is known from the current literature about the association between sports and LBP in athletes\u0026rdquo;?\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eAs recommended, studies were included when they met specific criteria in terms of population, concept and context [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Specifically, we considered original research dealing with athletes of any country (elite or amateur, male or female, adolescent or adult), who practice different types of sport. Studies focused on leisure-time physical activity were excluded. The concept was focused on the association between the sport activity and NS-LBP onset, in each possible context, such as professional teams, amateur clubs or colleges. As a consequence, we included only articles in which epidemiological indicators (e.g. relative risk, odds ratio, frequency distributions, incidence and prevalence) concerning the association \u0026ldquo;sport activity and NS-LBP\u0026rdquo; were present. Conversely, studies investigating only peculiar aspects, such as physical characteristics (e.g. flexibility, muscle size, physical performances, etc.) in relation to NS-LBP were excluded.\u003c/p\u003e \u003cp\u003eExamples of the sports considered are football, soccer, volleyball, basketball, tennis, running, golf and cycling, even if other types of activities were included if retrieved in the search results. Only observational studies (both analytical and descriptive) and systematic reviews were accepted, without any restrictions in terms of time, setting and country; narrative reviews, commentary and letters to editors were excluded. Only articles in English were accepted. We excluded studies considering some particular activities (such as car racing and fishing), where movement does not represent the central element in the potential association with NS-LBP.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eThe literature search was carried out by consulting the main biomedical databases such as Pubmed (Medline), Cochrane, Central (Cochrane), Embase, Pedro and Scopus. Gray literature was considered via Google Scholar. In order to avoid any possible relevant source, additional records were periodically searched through cross-referencing. Searches were conducted until November 2021.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection and data extraction\u003c/h2\u003e \u003cp\u003eThe search strategy results were managed through \u0026ldquo;Rayyan \u0026ndash; the intelligent systematic review\u0026rdquo; web app (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"10.17605/OSF.IO/9BEX8\" target=\"_blank\"\u003ewww.rayyan.ai\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.rayyan.ai\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuplicates were automatically deleted and records were screened firstly by title and/or abstract and secondly by full-text reading. Two blinded authors (GC, MS) independently screened the articles and any possible conflicts were resolved through a discussion with three expert authors (FDF, FA, and MM). Specific details of the selection process are better illustrated in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The main features of the included studies in relation to the aim of the review were reported in a data extraction form. This form was previously developed, discussed, implemented and accepted by all the authors of the study. The major characteristics extracted from the included works were: year of publication and country, type of journal (sport medicine journal or not), study aim, study design and duration, sample size, description of the sport activity (typology, rate of attendance, etc.). Finally, a summary of the main results was reported.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSynthesis of results\u003c/h2\u003e \u003cp\u003eData were reported numerically and thematically. Descriptive statistics was used reporting means, standard deviation (SD), median, mode, interquartile ranges (IQR) and percentages for all the considered outcomes, such as period of publication, country, study design, characteristics of participants, sports activity and results. Considering the large number of variables, we opted to report our results using several graphs in order to facilitate the reader with the interpretation of the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 4061 articles were identified through the initial database search; 503 records were detected as duplicated and consequently removed. Overall, 3558 articles were screened for title and abstract and 3314 of them did not meet the inclusion criteria and were therefore rejected. Following the full-text reading, 24 records were excluded with reasons. As a result, 114 articles were definitively included in the qualitative synthesis. Further details concerning the study selection process are reported in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePlease insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e approximately here\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eStudy Characteristics\u003c/h2\u003e \u003cp\u003eAmong the 114 included works, 104 (91%) belong to primary research (observational studies, both descriptive and analytical). Conversely, 10 (9%) are systematic reviews and/or meta-analyses. In detail, 48 articles (42%) are analytical studies (case-control or cohort), 42 studies (37%) consist of cross-sectional investigations, 13 (11.5%) are case reports and only 1 (\u0026lt;\u0026thinsp;1%) is a case-series. The distribution of study designs among the included works is graphically reported in Figure A1 (Appendix A).\u003c/p\u003e \u003cp\u003eMost of the studies (n\u0026thinsp;=\u0026thinsp;20, 17.5%) were carried out in the United States, despite Europe -as a whole- publishing the majority of studies (n\u0026thinsp;=\u0026thinsp;61, 53.5%). Other countries which gave a substantial contribution to the topic were Japan (n\u0026thinsp;=\u0026thinsp;13, 11.5%), Germany (n\u0026thinsp;=\u0026thinsp;11, 9.5%), Italy (n\u0026thinsp;=\u0026thinsp;9, 8%) and Sweden (n\u0026thinsp;=\u0026thinsp;8, 7%). Further details regarding all of the countries involved in this research context are reported in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePublications increased over the years. However, most of them are concentrated in the time period 2015\u0026ndash;2020. Specifically, in the years 2015 and 2020 eleven articles (n\u0026thinsp;=\u0026thinsp;22, 19%) were published, followed by 2016 and 2019, respectively with 10 (9%) and 7 (6%) publications (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Approximately half of the included studies (52%) were published in sports medicine journals.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFurthermore, 70 studies (66%) considered in their sample only sports people, while the remaining 36 works compared them to people who didn\u0026rsquo;t practice sport.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePlease insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e approximately here\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003ePlease insert Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e approximately here\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section4\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThe included studies analyzed a total of 98657 participants (mean: 941\u0026thinsp;\u0026plusmn;\u0026thinsp;2889, median: 181, mode: 1, IQR: 566.5); 42240 of the subjects were females (43%).\u003c/p\u003e \u003cp\u003eThe mean age of the overall sample size was 22\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 years (median: 20; mode: 20; min. age: 10; max. age: 56; IQR: 10).\u003c/p\u003e \u003cp\u003e68% of this population were professionals, 32% of athletes were classified as amateurs.\u003c/p\u003e \u003cp\u003eSpecific details concerning sample characteristics are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the overall sample of the included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN. of subjects\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYears\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.02 (10.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (25\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAthletes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN. of studies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmateurs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSample characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN. of studies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed sample\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly sports people:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN. of subjects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e941.46 (2889.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-26766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e566.5 (633.5\u0026ndash;67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePlease insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e approximately here\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eSports\u003c/h2\u003e \u003cp\u003eSeveral sports were considered, even if the vast majority of the studies investigated the combination of more than one activity as a risk factor for NS-LBP (42 works, representing 37% of the total). The most widely investigated sports were boating (7 studies, 6%), football, soccer, gymnastics, volleyball and running (5 studies, 4.5% each), basketball, tennis, dancing, swimming and skiing (4 studies, 3.5% each). Further examined sports and relative frequencies are specifically detailed in Table B1 (Appendix B).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eContext\u003c/h2\u003e \u003cp\u003eResearch was predominantly carried out by sports associations (53%), such as club teams, followed by clinical settings (clinic 10.5%, hospital 10.5% and private practice 7%) and colleges (19%).\u003c/p\u003e \u003cp\u003eMostly, authors did not specify the athletes\u0026rsquo; frequency of training (39 studies, 38%); in 17 works (16.5%) the sports people trained 5 times per week, in 16 cases (15.5%) 3 times per week, in 15 studies 4 times per week. Two studies investigated athletes who underwent training sessions every day of the week and twice per week (2%). Only one study (\u0026lt;\u0026thinsp;1%) considered one training session per week.\u003c/p\u003e \u003cp\u003eAlmost half of the included studies (n\u0026thinsp;=\u0026thinsp;51, 48.2%) were managed by physicians only, followed by physiotherapists (n\u0026thinsp;=\u0026thinsp;10, 9.4%), chiropractors (n\u0026thinsp;=\u0026thinsp;3, 3%) and sport science operators (n\u0026thinsp;=\u0026thinsp;1, \u0026lt;\u0026thinsp;1%); in 23 studies (21.7%), the research was conducted by physicians and physiotherapists together. Further details are reported in Figure A2 (Appendix A).\u003c/p\u003e \u003cp\u003eIn the assessment modality of NS-LBP, some differences are also present across studies. In 49% of cases (n\u0026thinsp;=\u0026thinsp;52), a combination of interview, physical examination and pain-related questionnaires (scales) were administered by the personnel involved. In 38 studies (36%) only questionnaires were considered and in 11 articles (10%) only the physical evaluation was reported.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLow back pain and sports\u003c/h2\u003e \u003cp\u003eAll the reviewed studies aimed to investigate a possible association existing between sport and NS-LBP. The large majority of those works (n\u0026thinsp;=\u0026thinsp;77, 67.5%) indicated sport as a possible predisposing factor. Conversely, 21 studies (18.5%) did not find any association and in 16 cases (14%) the association was referred to as \u0026ldquo;unclear\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSummary of evidence\u003c/h2\u003e \u003cp\u003e To the best of our knowledge, this is the first scoping review aimed at providing a comprehensive overview of the literature regarding the association between sport activities and NS-LBP. To date, two systematic reviews [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] investigated prevalence and incidence of LBP in sports in general, highlighting important levels of methodological heterogeneity in the included studies. Thus, authors concluded that a complete synthesis of evidence was not possible up until then.\u003c/p\u003e \u003cp\u003eFurthermore, results show an increasing interest in this field, with a clear trend of growth in the number of publications over the last years. In this context, this ScR represents a proper systematic mapping of the current literature, potentially addressing clinical practice and future research [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eTheme: major focus on sport in general\u003c/h2\u003e \u003cp\u003eOne of the main themes that emerged from the results is represented by the investigated sports. As reported in the above section, the large majority of the studies considered the role of sport in general, including in their sample athletes who practice different activities. Similarly, some reviews [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] focused on this topic as well, attempting to estimate an overall synthesis of the risk. Such a methodological choice provides information about the impact of the physical load. However, it prevents the understanding of the exact role of specific movement patterns related to the athletic gesture. This fact could represent an issue, since previous research confirmed a strong association between LBP and flexed, rotated and awkward positions of the lumbar spine [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], or with repeated bending and twisting [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Moreover, highly technical sports seemed to be at higher risk for LBP rather than endurance activities [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. For all these reasons, investigations on specific sports activities should be encouraged.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eTheme: greater focus on the most popular sports\u003c/h2\u003e \u003cp\u003eAs outlined in the \u003cspan refid=\"Sec9\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section, research on this topic appears as a prerogative of western countries: Europe, United States and Canada provided by far the larger number of studies. Not surprisingly, the most investigated sport activities were football, swimming, volleyball, basketball and tennis, widely practiced in these countries [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Boating and dancing have also been widely considered, whereas other practices (e.g. martial arts, cricket) were investigated occasionally.\u003c/p\u003e \u003cp\u003eThis fact has probable implications, since the focus of the research seems more influenced by the popularity of the activity, rather than by other variables such as the gestures, loading stress, solicitations and postures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eTheme: wide differences in research methods\u003c/h2\u003e \u003cp\u003eThe included studies appeared heterogeneous with regards to the characteristics of training sessions.\u003c/p\u003e \u003cp\u003eFirstly, most of the studies did not provide any information concerning parameters such as duration, frequency and intensity of the practice. In addition, several studies presented many differences, although those parameters are considered crucial to define the dose-response rate for the risk assessment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This aspect assumes even more relevance if we consider the supposed \u0026ldquo;U-shaped\u0026rdquo; relationship between physical activity and NS-LBP. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Such a relationship would address the detrimental effect of both low and strenuous levels of physical activity [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther relevant considerations are related to the study designs adopted by researchers. Cross-sectional investigations appear to be by far the most frequently used. From another point of view, data showed how 51% of the included studies (cross-sectional surveys and descriptive reports) were not primarily useful to assess the epidemiological relationship between sports and NS-LBP. Another 9% of the included works is represented by secondary research (reviews). Furthermore, only a minor part of studies compared athletes to non-athletes. As is known, only analytical cohort studies provide the best way to investigate such a relationship [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. For these reasons, the large percentage of studies (67.5%) reporting sports practice as a risk factor for NS-LBP should be considered carefully.\u003c/p\u003e \u003cp\u003eLastly, LBP assessment methods appeared different across studies, with only half of the works considering a multidimensional evaluation of the recruited subjects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eTheme: the usefulness of descriptive reports\u003c/h2\u003e \u003cp\u003eA relatively large number of the included records were case reports. These were predominantly descriptions of particular painful conditions, originally classified as NS-LBP and successively revealed to be related to other areas (e.g. hip problems, ileo-tibial syndrome) or to a specific type of LBP (mostly stress fractures or spondylolysis). As is well known, LBP assessment often represents a diagnostic challenge [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and these reports provide valuable cues to help clinicians in the difficult evaluation of such painful conditions [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eImplications for clinical practice\u003c/h2\u003e \u003cp\u003eAccording to the results of the current review, the relationship between sports and NS-LBP is still far from being demonstrated. Recent systematic reviews considered different sports as a whole, underlining the role of duration, intensity and frequency of sessions as possible risk factors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; from another point of view, several studies highlighted biomechanics and specific athletic gestures as important for LBP onset [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. It is our assumption that clinicians should consider both of these hypotheses during their assessment, without forgetting the distinctive clinical features of each single subject.\u003c/p\u003e \u003cp\u003eSecondly, a multidisciplinary approach seems to be essential in NS-LBP [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. At the moment, most of the research is mainly led by physicians, sometimes in combination with physiotherapists. Other practitioners such as sport science operators, manual therapists and chiropractors contributed occasionally, although their role could be of considerable importance [\u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. For the same reasons, sports associations and clubs should be equipped with a team of clinicians, preferably experts in specific LBP clinical management. As previously discussed, the remarkable presence of case reports in literature confirms the above-mentioned difficulties during the assessment process [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eImplications for research\u003c/h2\u003e \u003cp\u003eAs a direct consequence of the results obtained in this study, research should be more directed towards analytical studies. In particular, high-quality prospective double-parallel cohort designs are preferably needed to provide the best possible evaluation of the risk in the association \u0026ldquo;sports - NS-LBP\u0026rdquo; [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Case-control studies could represent an option, as long as their major exposure to biases is considered [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, research focus should be oriented in two distinctive directions: on the one hand, more evidence is needed on single activities, especially regarding movement patterns and their connection to LBP onset. On the other hand, the characteristics of training should be further investigated. In this regard, it is of crucial importance that future research be more similar in terms of exposure to physical efforts and that relative parameters (e.g duration, intensity and frequency of training) also be well documented [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLastly, some sports such as martial arts, baseball, hockey and weightlifting are studied little and require more in-depth research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAs this study consists in a comprehensive mapping of the literature, our search strategy might have lost some pertinent records. Thus, results and relative conclusions could have been influenced.\u003c/p\u003e \u003cp\u003eAnother possible limitation can be related to the term \u0026ldquo;athlete\u0026rdquo;. In practice, we accepted the definition reported by the authors of each work. However, some differences are probably present among the included studies.\u003c/p\u003e \u003cp\u003e For the sake of synthesis, we decided to exclude narrative reviews, letters and editorials from the selection of the studies. Although these formats do not produce real evidence, they represent a form of contribution to literature that is not present in our reporting.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis review mapped the literature and identified 114 studies investigating the potential relationships between sports and NS-LBP. Results showed an increasing interest in this topic since 1990.\u003c/p\u003e \u003cp\u003eCurrently, research is more centered on sport as a whole, investigating the effects of sport practice in general. Some activities are more investigated than others, probably on the basis of their popularity in the countries active in the research field.\u003c/p\u003e \u003cp\u003eAt the moment, research methods are extremely various and often not completely adequate to produce strong levels of evidence. High-quality observational research, mainly focused on specific sport activities and with higher levels of homogeneity is needed. This could help to properly address clinical practice and further research.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNon-specific low back pain (NS-LBP), scoping review (ScR), low back pain (LBP), Joanna Briggs Institute (JBI), Preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews\u0026rdquo; (PRISMA-ScR), standard deviation (SD), interquartile ranges (IQR).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFDF conceptualized the study and the methodology, and was the major contributor in writing the original draft preparation, reviewing and editing; FA was a data curator, conducted the investigation, collaborated in writing and reviewing the original draft and was in charge for the data visualization; GC was a data curator and collaborated in the investigation process; MS was a data curator and collaborated in the investigation process; EP collaborated in writing and reviewing the original draft; MM conceptualized the study, was the supervisor for the study and collaborated in the writing and review process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eHoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. 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Low back pain. Lancet. 2021 Jul;398(10294):78\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVandenbroucke JP. In defense of case reports and case series. Ann Intern Med. 2001 Feb;20(4):330\u0026ndash;4. 134(.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGrimes DA, Schulz KF. Descriptive studies: What they can and cannot do. Lancet. 2002 Jan;359(9301):145\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSmith JA, Hawkins A, Grant-Beuttler M, Beuttler R, Lee SP. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Sports Health. 2018 Nov;21(6):538\u0026ndash;46. 10(.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMaselli F, Storari L, Barbari V, Colombi A, Turolla A, Gianola S, et al. Prevalence and incidence of low back pain among runners: A systematic review. BMC Musculoskelet Disord. 2020 Dec 3;21(1):343.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSwain CTV, Bradshaw EJ, Ekegren CL, Whyte DG. The epidemiology of low back pain and injury in dance: A systematic review. J Orthop Sports Phys Ther. 2019 Apr;49(4):239\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015 Feb;18(feb18 5):h444\u0026ndash;4. 350(.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis. Complement Ther Med. 2021 Jan;56:102616.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBlanchette MA, Stochkendahl MJ, Borges Da Silva R, Boruff J, Harrison P, Bussi\u0026egrave;res A. Effectiveness and economic evaluation of chiropractic care for the treatment of low back pain: A systematic review of pragmatic studies. PLoS One. 2016 Aug 3;11(8):e0160037.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVergeld V, Ginis KAM, Jenks AD. Psychological Interventions for Reducing Fear Avoidance Beliefs Among People With Chronic Back Pain. Rehabil Psychol. 2021 Nov;66(4):386\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021 Sep 28;2021(9).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSchulz KF, Grimes DA. Case-control studies: Research in reverse. Lancet. 2002 Feb;359(9304):431\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sport, Low back pain, Epidemiology, Scoping review, Athlete, Risk factor","lastPublishedDoi":"10.21203/rs.3.rs-2085257/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2085257/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u0026nbsp;\u003c/strong\u003eThe contribution of sport in non-specific low back pain (NS-LBP) remains unknown, due to a large heterogeneity in methods. The aims of this scoping review (ScR) were to systematically map and summarize findings concerning studies reporting data on NS-LBP among athletes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis ScR was developed referring to the 2020 version of the JBIRM and the PRISMA-ScR. Five medical databases were searched up to November 2021. No limitations in terms of study design and language were applied. Results were presented numerically and thematically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 4061 records were identified through the initial search; 114 articles met the inclusion criteria. Publications had increased over years since 1990. Most of the studies (17.5%) were conducted in the USA, even if most research (53.5%) was conducted in Europe. Analytic observational (42%) and cross-sectional studies (37%) were the most used designs, followed by case reports (12%) and systematic reviews (9 %). Boating (7%), football, soccer, volleyball, running and gymnastics (4.4% each) were the most investigated, although the majority of the studies considered sports in general (36.8%). The overall sample size median was 181, mean age 22+/-10.2; 68% of athletes were professional and 32% amateur. Most of the studies (38%) did not detail the frequency of training. Sport was reported as a risk factor in 67.5% of cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis is the first ScR to provide a comprehensive overview on this topic. Publications have shown an increasing interest over the last years. Currently research is more centered on the effects of sport practice in general. Research methods are extremely varied and often not adequate to produce strong levels of evidence. Higher-quality, standardized observational research focused on specific sports activities is needed to properly address clinical practice and further research.\u003c/p\u003e","manuscriptTitle":"Sport and non-specific low back pain in athletes: a scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-12 16:37:12","doi":"10.21203/rs.3.rs-2085257/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-02T15:52:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-20T15:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e415feef-1686-45c6-8237-fd2f35ff00a0","date":"2022-10-11T15:03:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-10-11T10:09:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-10-11T10:00:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-10-10T15:55:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-10-10T15:52:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2022-09-20T13:57:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc17607b-5f2c-47a7-94c1-bbbdb3c32ded","owner":[],"postedDate":"October 12th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-12-13T09:44:31+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-12 16:37:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2085257","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2085257","identity":"rs-2085257","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}