Assessment of neck and low back disability using the Neck Disability Index and Oswestry Disability Index in female show jumping riders: a cross-sectional study

Assessment of neck and low back disability using the Neck Disability Index and Oswestry Disability Index in female show jumping riders: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Assessment of neck and low back disability using the Neck Disability Index and Oswestry Disability Index in female show jumping riders: a cross-sectional study Katarzyna Adamczewska, Mateusz Grajek, Tomasz Jurys, Ewa Malchrowicz-Mośko, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8908241/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract The purpose of the study was to assess the prevalence and severity of lumbar and cervical spine–related disability and the association between competitive level, training exposure, and spinal disability using the Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) in female show jumping riders. This cross-sectional observational study included 353 female show jumping athletes aged 10–25 years. Data were collected using an anonymous online survey distributed during major international equestrian competitions in Poland. Participants were stratified by age (< 18 and 18–25 years) and competitive level (amateur vs. professional) to examine differences in lumbar and cervical spine–related disability. Comparisons between amateur and professional athletes were conducted separately for each age group using non-parametric statistical tests. Professional athletes demonstrated significantly higher lumbar spine–related disability, as assessed by ODI, compared with amateurs, particularly in the younger age group. Although a similar trend was observed in older athletes, the differences were not statistically significant. No significant differences were found between amateur and professional athletes in cervical spine–related disability measured by NDI in either age group. Professional athletes in both age groups reported significantly greater weekly training volume and longer training experience. Body mass did not differ between groups and did not act as a confounding factor. Competitive participation in show jumping may be associated with increased lumbar spine–related disability, particularly among younger female athletes, while cervical spine disability appears less influenced by competitive level. Higher training volume and longer training experience among professional riders may contribute to cumulative mechanical loading of the lumbar spine. These findings highlight the need for targeted preventive and conditioning strategies focusing on lumbar spine health in competitive female show jumpers. Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors equestrian cervical pain low back pain Neck Disability Index Oswestry Disability Index Figures Figure 1 Figure 2 Introduction The influence of horseback riding on episodes of acute or chronic back pain has been only rarely evaluated. Show jumping is an equestrian discipline that combines physical and mental skills [ 1 ]. Due to specificity of the discipline, back pain can be caused by training overloads, repetitive biomechanical loading associated with horse movement, injuries, falls and unpredictable situations during horseback riding. One of the causes of horse riders back pain episodes may also be the forced position in the saddle while riding. In show jumping discipline shortened stirrups are used to decrease the angle of hip, knee and ankle joint. Lower limb position in the saddle improves and facilitates the riding position to follow the movement of the horse over the jumps. During horseback riding, the show jumper’s upper body typically bends forward, the setup of the head is upwards, looking the direction of movement. It can cause muscle stiffness and disturb the balance of the rider and horse. Lower limb and upper body position in flexion can cause shortening of the muscles and fascia structures. Due to the riding position significant tension in hamstrings and iliopsoas muscles was found [ 2 ]. In competitive show jumping, repeated take-off and landing phases generate substantial axial and shear forces that are transmitted from the horse to the rider’s spine. Higher training volumes and longer training experience characteristic of professional athletes may further amplify cumulative mechanical loading of the lumbar region, potentially increasing the risk of functional disability over time. The major muscle groups used by showjumpers include the hip adductors, erector spinae and rectus abdominis. The erector spinae and rectus abdominis are responsible for maintaining the posture into the saddle, while hip adductors allow to contact and guide the horse [ 3 ]. Weeks et al. confirmed that core stabilization and hip straightening exercises may be an effective method to reduce LBP in equestrians [ 4 ]. Horse riding transfers repetitive, compressive and torsional loads onto the rider [ 5 ]. Younger equestrians appear to be at greater risk of developing BP due to having more intense during training sessions, or less advanced riding technique than older riders [ 6 ]. Cejudo et al. confirmed in their investigation that almost half of the child equestrian athletes (12–17 years old) suffered one episode of LBP within the last 12 months [ 7 ]. The results showed that the strongest predictor of low back pain was high body fat greater than 23%. Neck Disability Index and Oswestry Disability Index are commonly used to measure the neck’s and lumbar’s functional disorders [ 8 , 9 ]. Despite the widespread use of these instruments, comparative data examining spinal disability across different age groups and competitive levels in female show jumping athletes remain scarce. Most of the published studies focused on lumbar disabilities. However, the showjumping position during horseback riding may also cause significant strain in the cervical spine. Therefore, the objective of this cross-sectional observational study was to assess the prevalence and severity of lumbar and cervical spine–related disability in female show jumping athletes and to examine the association between competitive level, training exposure, and spinal disability across two age groups. Material and Methods This cross-sectional observational study assessed lumbar and cervical spine–related disability in female show jumping athletes. Data were collected during major indoor equestrian competitions in Poland, including the Cavaliada Tour and the FEI Jumping World Cup Central European League (CSI4*-W LR Grand Prix, obstacle height 155 cm). Surveys were distributed electronically in two ways: directly to horseback riders on-site during the competition, and online to amateur riders and spectators who had access to the survey via the official Cavaliada website. The survey was accessible over a period of one month, ensuring standardized data collection across all participants. Subjects The study population consisted exclusively of female riders actively practising horse riding. Participants were divided into two age groups: athletes younger than 18 years (12–17) and athletes aged 18–25 years. Participants were stratified into two age groups (12–17 years and 18–25 years) to account for developmental and biomechanical differences between adolescent and young adult athletes. Adolescents may be more susceptible to overload-related spinal symptoms due to ongoing musculoskeletal maturation and developing neuromuscular control. In contrast, athletes aged 18–25 years typically present completed skeletal maturity while remaining relatively unaffected by age-related degenerative changes. This stratification allowed for a more accurate evaluation of the association between competitive level, training exposure, and spinal disability across developmentally distinct populations exposed to comparable equestrian demands [ 10 – 13 ]. Of the 400 surveys distributed, 353 complete responses were received and included in the analysis. Forty-seven responses were excluded due to missing key variables (e.g., age, training volume, or incomplete ODI/NDI questionnaires), representing a 12% non-response rate. No systematic differences in age or competitive level were observed between responders and non-responders, minimizing potential selection bias. Eligibility criteria included female sex, active participation in show jumping competitions, and age below 25 years. No exclusion criteria were applied regarding current pain, prior injuries, or weekly training volume to ensure a representative sample of competitive athletes. Participation was anonymous and voluntary. The final sample included 174 amateur and 179 professional athletes across both age groups. Participants were classified as professional or amateur show jumping athletes based on their competitive level and regularity of participation in official competitions. Professional riders were defined as athletes who regularly competed in national and international show jumping events, including FEI-sanctioned competitions, and who participated in classes with obstacle heights exceeding 130 cm. This level of competition reflects a higher technical demand, greater training intensity, and increased mechanical loading during riding and jumping activities. Amateur riders were defined as athletes competing primarily in lower-level regional or national events, with obstacle heights up to 120 cm, and without regular participation in high-level national or international competitions. This classification was chosen to distinguish riders with substantially different training volumes, technical demands, and cumulative exposure to sport-specific mechanical loads. Assessment Tools An anonymous online survey was used to assess spinal disability in female show jumpers. This method was selected to reduce time demands, minimize costs, and limit potential transcription errors associated with paper-based questionnaires, in accordance with recommendations for online research methodologies [ 14 ]. The survey was divided into three sections and required approximately five minutes to complete. Demographics and sport-specific variables : age, height, body mass, weekly training volume, and training experience (years of participation in show jumping). Outcomes : Lumbar spine–related disability assessed with the Oswestry Disability Index (ODI) and cervical spine–related disability assessed with the Neck Disability Index (NDI). ODI evaluates limitations across domains including pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, and traveling, with total scores ranging from 0 to 50 [ 15 ]. NDI consists of 10 items, each with six response options, reflecting increasing functional limitation [ 16 , 17 ]. The same instruments and procedures were applied to all participants to ensure comparability between groups. Bias and confounding Efforts to reduce bias included using standardized, validated questionnaires (ODI and NDI) and applying the same online format to all participants. Body mass was analyzed as a potential confounder and was compared across age groups, training experience, and disability categories. No matching was performed, as this was a cross-sectional study. Ethical Considerations The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and received a formal confirmation from the Bioethics Committee at Poznan University of Medical Sciences (Confirmation No. KB-208/26) . The Committee confirmed that the research is a non-experimental, questionnaire-based study and, according to Polish law and Good Clinical Practice (GCP) regulations, does not require formal approval. Informed consent was obtained electronically from all participants, and parental consent was obtained for those under 18 years. Reliability assessment All statistical analyses were performed using Statistica software (version 13; TIBCO Software Inc., Palo Alto, CA, USA) and Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Normality of continuous variables was assessed using the Shapiro–Wilk test. The characteristics of the subjects were presented using counts and percentage frequencies for qualitative variables. Between-group comparisons were performed using the Mann–Whitney U test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Subgroup analyses were conducted separately for each age group. Sensitivity analyses were performed by including incomplete surveys with imputed values for missing ODI or NDI items using mean substitution; results were consistent with the primary analyses. Statistical significance was set at p < 0.05. Results Anthropometric characteristics, training volume, and riding experience The analysis included 179 riders younger than 18 years (70 professionals and 104 amateurs) and 174 riders aged 18–25 years (78 professionals and 101 amateurs). In both age groups, body mass did not differ significantly between professional and amateur athletes. Among riders younger than 18 years, mean body mass was 55.67 ± 9.85 kg in professionals and 57.53 ± 11.73 kg in amateurs ( p = 0.532). Similarly, in the 18–25-year age group, body mass values were comparable between professionals (61.19 ± 10.86 kg) and amateurs (60.61 ± 9.64 kg; p = 0.897). Weekly time devoted to horse riding differed significantly between competitive levels in both age groups ( p < 0.0001). In riders younger than 18 years, amateur athletes most frequently reported training durations below 4 hours per week (72%), whereas professional athletes predominantly reported 4–10 hours per week (69%). Training volumes exceeding 10 hours per week were reported by 16% of professionals and only 2% of amateurs. A similar pattern was observed in the 18–25-year age group, where 65% of amateurs trained less than 4 hours per week, while 65% of professionals reported 4–10 hours of weekly riding. Training durations above 10 hours per week were reported by 23% of professionals compared with 2% of amateurs. Riding experience did not differ significantly between professional and amateur athletes in the younger age group (p = 0.0756). In contrast, among athletes aged 18–25 years, riding experience differed significantly between competitive levels ( p = 0.032), with a higher proportion of professional athletes reporting more than 12 years of riding experience. The distribution of NDI disability categories was comparable between professional and amateur athletes in both age groups (Table 1 ). In each group, mild disability was the most frequently reported category, whereas severe disability occurred rarely. For ODI, the distribution of disability categories differed between competitive levels in athletes younger than 18 years, with professional riders showing a higher prevalence of moderate and severe disability compared with amateurs. In the 18–25 age group, the prevalence of minimal disability in ODI was identical for both professional and amateur riders (69%), with no statistically significant differences in the distribution of disability categories (p = 0.5164). Table 1 Anthropometric characteristics, weekly training volume, and riding experience Variable Professional Amateur Test result p value Mean ± SD / % (n) Under 18 years Body mass (kg) 55.67 ± 9.85 57.53 ± 11.73 −0.62ᵃ 0.5323 Weekly riding time (h/week) 59.58ᵇ < 0.0001 3 or less 16% (11) 72% (75) 4–10 69% (48) 26% (27) more than 10 16% (11) 2% (2) Riding experience (years) 8.48ᵇ 0.0756 3 or less 6% (4) 16% (17) 4–7 53% (37) 55% (57) 8–11 33% (23) 26% (27) 12–15 7% (5) 3% (3) more than 15 1% (1) 0% (0) NDI 2.86ᵇ 0.4139 No disability 27% (19) 35% (36) Mild disability 54% (38) 51% (53) Moderate disability 17% (12) 14% (15) Severe disability 1% (1) 0% (0) ODI 5.86ᵇ 0.0534 Minimal disability 66% (46) 82% (85) Moderate disability 29% (20) 17% (18) Severe disability 6% (4) 2% (2) 18–25 years Body mass (kg) 61.19 ± 10.86 60.61 ± 9.64 0.13ᵃ 0.8970 Weekly riding time (h/week) 64.58ᵇ < 0.0001 3 or less 12% (9) 65% (66) 4–10 65% (51) 33% (33) more than 10 23% (18) 2% (2) Riding experience (years) 10.56ᵇ 0.0320 3 or less 3% (2) 6% (6) 4–7 17% (13) 29% (29) 8–11 36% (28) 42% (42) 12–15 35% (27) 17% (17) more than 15 10% (8) 7% (7) NDI 2.86ᵇ 0.4133 No disability 33% (26) 27% (27) Mild disability 54% (42) 62% (63) Moderate disability 9% (7) 10% (10) Severe disability 4% (3) 1% (1) ODI 1.32ᵇ 0.5164 Minimal disability 69% (54) 69% (70) Moderate disability 23% (18) 27% (27) Severe disability 8% (6) 4% (4) Note: a − Mann-Whitney U test, b − Likelihood-ratio chi-square test. Disability outcomes In athletes younger than 18 years, no significant differences were observed between professional and amateur riders in NDI scores (9.08 ± 5.30 vs. 8.23 ± 5.66 points, respectively; p = 0.223). In contrast, professional athletes demonstrated significantly higher ODI values compared with amateurs (16.46 ± 12.61% vs. 12.33 ± 10.39%; p = 0.0534). Among athletes aged 18–25 years, neither NDI nor ODI scores differed significantly between professional and amateur athletes. Mean NDI values were 7.92 ± 6.21 points in professionals and 7.89 ± 4.98 points in amateurs ( p = 0.509), while mean ODI values were 17.56 ± 14.64% and 15.13 ± 11.74%, respectively ( p = 0.464). Distribution of disability categories Discussion Low back pain represents one of the most prevalent musculoskeletal complaints among equestrian athletes and constitutes a major factor limiting performance and long-term participation in the sport. The specific biomechanical demands of horseback riding, particularly in show jumping, expose riders to repetitive axial loading, impact forces, and complex trunk–pelvis interactions that may contribute to the development of spinal symptoms. Competitive participation is typically associated with higher training volumes and longer riding experience, which may contribute to cumulative mechanical loading of the lumbar spine. In contrast, the influence of competitive riding on cervical spine–related disability remains less clearly defined. Therefore, the present study aimed to investigate the association between competitive level, training exposure, and lumbar and cervical spine–related disability in female show jumping athletes across two age groups. The more pronounced differences in lumbar spine–related disability observed in younger athletes may be partly explained by age-related developmental factors. Adolescence is characterized by ongoing musculoskeletal maturation and evolving neuromuscular control, which may increase susceptibility to cumulative mechanical loading during intensive training. These results may imply that intensive competitive exposure during this critical developmental period could potentially be linked to increased lumbar spine symptoms in young female show jumpers. The main finding of this study suggests that professional competitive status is associated with higher lumbar spine–related disability scores, as assessed by the Oswestry Disability Index, particularly among younger athletes. . Although a similar trend was observed among athletes aged 18–25 years, this difference did not reach statistical significance. In contrast, no significant differences were found between competitive levels with respect to cervical spine–related disability, as measured by the Neck Disability Index. Importantly, body mass did not differ between groups and was not identified as a confounding factor, while professional riders reported substantially greater weekly training volume and longer training experience, suggesting a potential role of cumulative mechanical loading in the development of lumbar symptoms. Our findings are consistent with previous reports indicating a high prevalence of low back pain among equestrian athletes. Kraft et al. confirmed in their study that the prevalence of low back pain in equestrian population is more than 50% higher than the prevalence of LBP in general population [ 18 ]. Horseback riding is a unique discipline which combines relationship between human and animal. There are many factors beyond the gait and horse’s carrying capacity that contribute LBP in horseback riders. There is need to better understand some predictors increasing loads in the low back while riding including poor equestrian technique, incorrect riding posture, dimorphic setup. Recent biomechanical studies suggest that peak acceleration and shock attenuation might play role in chronic low back pain in equestrian athletes [ 19 ]. Negative shock attenuation from pelvis to sternum in sitting trot indicates that the shock in the torso is increased. This also could be the predictor to the occurrence of chronic low back pain. The increase in shock could potentially be explained by a rotational component in the pelvis, highlighting the importance of core stability for horseback riders. These biomechanical demands may be associated with altered functional movement patterns in equestrian athletes. Functional movement adaptations specific to equestrian disciplines have also been reported. Lewis et al. identified discipline-specific differences in postural control and trunk stability among female riders, suggesting that these adaptations may influence loading patterns in both the lumbar and cervical spine [ 20 ]. However, despite theoretical concerns regarding cervical spine strain due to prolonged head extension and forward trunk inclination in show jumping, our results indicate that cervical spine–related disability is less influenced by competitive level, suggesting either adaptive mechanisms or lower cumulative load compared with the lumbar region. Weeks et al. reported that a structured 8-week exercise programme focusing on trunk stability and postural control was associated with a reduction in chronic low back pain in equestrian athletes, suggesting that targeted training may decrease discipline-specific spinal loading [ 21 ]. This study highlights that it is important for equestrian athletes experiencing low back pain to undertake regular exercises. Equestrian sports are associated with a high risk of traumatic injury due to the elevated riding position, high speeds, and unpredictable behavior of the horse. Jumping disciplines are particularly associated with spinal injuries [ 22 ]. Large epidemiological studies indicate that lumbar and thoracic spine injuries account for a substantial proportion of equestrian-related trauma, with cervical injuries also occurring in a notable minority of cases [ 23 – 26 ]. Although traumatic mechanisms such as falls and collisions represent an important source of spinal injury, it remains difficult to disentangle the contribution of acute trauma from cumulative, non-traumatic loading in the development of chronic back pain in equestrian athletes. Naef et al. reported that young female riders constitute a large proportion of equestrian-related emergency department visits, with falls from horses accounting for over 80% of injuries [ 27 ]. These outcomes show the multifactorial nature of spinal complaints in equestrian sports, involving both repetitive mechanical loading and high-energy traumatic events. In conclusion, our findings underscore the importance of incorporating lumbar-specific conditioning and core stability programs early in the training of young competitive riders to mitigate the apparent risk of functional disability. Evidence from functional movement assessments and epidemiological studies indicates that discipline-specific adaptations in postural control and trunk stability can influence spinal loading, potentially increase low back pain and cervical discomfort. Trunk stability and neuromuscular control excercises have been shown to reduce low back pain in equestrian athletes, highlighting the importance of structured training programs as part of injury prevention and management. Despite the use of protective equipment, the high risk of falls and impact forces inherent to equestrian activities underscores the need for comprehensive preventive strategies, including rider education and appropriate technique. Future research should aim to integrate biomechanical, clinical, and epidemiological data to better understand injury mechanisms and optimize training and rehabilitation protocols for riders of different ages and skill levels. Limitations Several limitations should be acknowledged. First, the use of an online survey may introduce selection bias, as participation was voluntary and based on self-reported responses. As highlighted in previous methodological analyses, online surveys may be subject to sampling limitations and potential self-selection bias among respondents [ 28 ]. Second, spinal pain reported by participants may reflect not only cumulative riding-related loading but also the consequences of prior traumatic events related to horse riding or horse handling. Furthermore, the cross-sectional design of the study does not allow causal inferences regarding the directionality of the observed associations between training exposure and spinal disability. Despite these limitations, the study benefits from a relatively large sample size, inclusion of both amateur and professional athletes, and assessment across two age groups during major national and international competitions. These characteristics may enhance the relevance of the findings for competitive female show jumping athletes. Future longitudinal studies integrating biomechanical assessments, clinical examination, and injury history are warranted to better elucidate causal mechanisms and inform targeted preventive and rehabilitation strategies. Because of the cross-sectional design and the use of self-reported questionnaire data, the results should be interpreted with caution. Conclusion The findings of this study indicate that competitive-level equestrian athletes exhibit a higher degree of lumbar spine–related disability compared with amateur riders, particularly in the younger age group, as reflected by higher ODI values. Although a similar trend was observed in older athletes, the differences did not reach statistical significance, likely due to greater variability within this group. Body mass did not differ between amateur and professional athletes across age categories, allowing for reliable comparisons between groups. Professional athletes in both age groups reported substantially greater weekly training exposure and longer training experience, indicating prolonged and more intensive mechanical loading of the musculoskeletal system. In contrast to lumbar spine outcomes, no significant differences were observed between groups in terms of cervical spine–related disability, as assessed by NDI. Overall, the results suggest a potential association between competitive show jumping participation and increased symptoms related to lumbar spine dysfunction, particularly in younger athletes. Declarations Acknowledgements The authors would like to thank Maciej Młodzik for the opportunity to conduct research during Cavaliada Horse Show. Special thanks to respondents who participated in this study. Author Contributions Conceptualization: KA, PK; methodology: KA, PK; formal analysis: KA, MG, TJ; data collection: EMM; resources: JM, MFM; data analysis: KA, MG, TJ; writing – orginal draft preperation: KA, MG, TJ; review and editing: KA, PK; supervision: PK. Data Availability The datasets generated and analysed in the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research received no specific grant and any funding agency in the public, commercial, or not-for-profit sectors. All authors contributed to the article and approved the submitted version. References Keener, M. M. & Tumlin, K. I. Self-reported acute injury and chronic pain in American equestrian athletes. 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Adamczewska","email":"data:image/png;base64,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","orcid":"","institution":"Poznan University of Physical Education","correspondingAuthor":true,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Adamczewska","suffix":""},{"id":634275018,"identity":"52ea732e-a1c7-42d5-a1b2-9032940a0b49","order_by":1,"name":"Mateusz Grajek","email":"","orcid":"","institution":"Medical University of Silesia","correspondingAuthor":false,"prefix":"","firstName":"Mateusz","middleName":"","lastName":"Grajek","suffix":""},{"id":634275019,"identity":"e8603efd-8946-4c24-8324-9d0f1f94135b","order_by":2,"name":"Tomasz Jurys","email":"","orcid":"","institution":"Medical University of Silesia","correspondingAuthor":false,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Jurys","suffix":""},{"id":634275020,"identity":"e3d1d506-d634-4f46-8445-2db771abb798","order_by":3,"name":"Ewa Malchrowicz-Mośko","email":"","orcid":"","institution":"Józef Piłsudski University of Physical Education in Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Ewa","middleName":"","lastName":"Malchrowicz-Mośko","suffix":""},{"id":634275021,"identity":"c2e511a9-171b-4dc0-bbda-3415dcb080bf","order_by":4,"name":"Joanna Małecka","email":"","orcid":"","institution":"Poznan University of Physical Education","correspondingAuthor":false,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Małecka","suffix":""},{"id":634275022,"identity":"c7f16dd9-db87-49dc-a167-faa409dddb80","order_by":5,"name":"Marta Flis- Maslowska","email":"","orcid":"","institution":"Poznan University of Physical Education","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"Flis-","lastName":"Maslowska","suffix":""},{"id":634275023,"identity":"a73b5c87-2bf2-4fef-98ae-43e1f4ea254b","order_by":6,"name":"Piotr Kocur","email":"","orcid":"","institution":"Poznan University of Physical Education","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Kocur","suffix":""}],"badges":[],"createdAt":"2026-02-18 10:23:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8908241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8908241/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108970210,"identity":"251cf52a-8897-4d4a-9d76-a126092d2a58","added_by":"auto","created_at":"2026-05-11 10:14:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169860,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study selection process.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8908241/v1/4415d292794bb2c9c257dc88.png"},{"id":108970337,"identity":"74de887d-43cf-43cb-9ff3-a8c996993d1a","added_by":"auto","created_at":"2026-05-11 10:15:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94815,"visible":true,"origin":"","legend":"\u003cp\u003eMean (± SD) Neck Disability Index (NDI) and Oswestry Disability Index (ODI) scores in professional and amateur equestrian athletes.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8908241/v1/eb720f6f3d73e8608428689a.png"},{"id":108970349,"identity":"9122657f-55c3-4007-b73e-f61460c89344","added_by":"auto","created_at":"2026-05-11 10:15:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":551765,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8908241/v1/d93abc8e-0d2c-494a-bea6-204af05eba7f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of neck and low back disability using the Neck Disability Index and Oswestry Disability Index in female show jumping riders: a cross-sectional study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe influence of horseback riding on episodes of acute or chronic back pain has been only rarely evaluated. Show jumping is an equestrian discipline that combines physical and mental skills [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to specificity of the discipline, back pain can be caused by training overloads, repetitive biomechanical loading associated with horse movement, injuries, falls and unpredictable situations during horseback riding.\u003c/p\u003e \u003cp\u003eOne of the causes of horse riders back pain episodes may also be the forced position in the saddle while riding. In show jumping discipline shortened stirrups are used to decrease the angle of hip, knee and ankle joint. Lower limb position in the saddle improves and facilitates the riding position to follow the movement of the horse over the jumps. During horseback riding, the show jumper\u0026rsquo;s upper body typically bends forward, the setup of the head is upwards, looking the direction of movement. It can cause muscle stiffness and disturb the balance of the rider and horse. Lower limb and upper body position in flexion can cause shortening of the muscles and fascia structures. Due to the riding position significant tension in hamstrings and iliopsoas muscles was found [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In competitive show jumping, repeated take-off and landing phases generate substantial axial and shear forces that are transmitted from the horse to the rider\u0026rsquo;s spine. Higher training volumes and longer training experience characteristic of professional athletes may further amplify cumulative mechanical loading of the lumbar region, potentially increasing the risk of functional disability over time. The major muscle groups used by showjumpers include the hip adductors, erector spinae and rectus abdominis. The erector spinae and rectus abdominis are responsible for maintaining the posture into the saddle, while hip adductors allow to contact and guide the horse [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Weeks et al. confirmed that core stabilization and hip straightening exercises may be an effective method to reduce LBP in equestrians [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHorse riding transfers repetitive, compressive and torsional loads onto the rider [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Younger equestrians appear to be at greater risk of developing BP due to having more intense during training sessions, or less advanced riding technique than older riders [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Cejudo et al. confirmed in their investigation that almost half of the child equestrian athletes (12\u0026ndash;17 years old) suffered one episode of LBP within the last 12 months [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The results showed that the strongest predictor of low back pain was high body fat greater than 23%.\u003c/p\u003e \u003cp\u003eNeck Disability Index and Oswestry Disability Index are commonly used to measure the neck\u0026rsquo;s and lumbar\u0026rsquo;s functional disorders [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite the widespread use of these instruments, comparative data examining spinal disability across different age groups and competitive levels in female show jumping athletes remain scarce.\u003c/p\u003e \u003cp\u003eMost of the published studies focused on lumbar disabilities. However, the showjumping position during horseback riding may also cause significant strain in the cervical spine. Therefore, the objective of this cross-sectional observational study was to assess the prevalence and severity of lumbar and cervical spine\u0026ndash;related disability in female show jumping athletes and to examine the association between competitive level, training exposure, and spinal disability across two age groups.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis cross-sectional observational study assessed lumbar and cervical spine\u0026ndash;related disability in female show jumping athletes. Data were collected during major indoor equestrian competitions in Poland, including the Cavaliada Tour and the FEI Jumping World Cup Central European League (CSI4*-W LR Grand Prix, obstacle height 155 cm). Surveys were distributed electronically in two ways: directly to horseback riders on-site during the competition, and online to amateur riders and spectators who had access to the survey via the official Cavaliada website. The survey was accessible over a period of one month, ensuring standardized data collection across all participants.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThe study population consisted exclusively of female riders actively practising horse riding. Participants were divided into two age groups: athletes younger than 18 years (12\u0026ndash;17) and athletes aged 18\u0026ndash;25 years. Participants were stratified into two age groups (12\u0026ndash;17 years and 18\u0026ndash;25 years) to account for developmental and biomechanical differences between adolescent and young adult athletes. Adolescents may be more susceptible to overload-related spinal symptoms due to ongoing musculoskeletal maturation and developing neuromuscular control. In contrast, athletes aged 18\u0026ndash;25 years typically present completed skeletal maturity while remaining relatively unaffected by age-related degenerative changes. This stratification allowed for a more accurate evaluation of the association between competitive level, training exposure, and spinal disability across developmentally distinct populations exposed to comparable equestrian demands [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Of the 400 surveys distributed, 353 complete responses were received and included in the analysis. Forty-seven responses were excluded due to missing key variables (e.g., age, training volume, or incomplete ODI/NDI questionnaires), representing a 12% non-response rate. No systematic differences in age or competitive level were observed between responders and non-responders, minimizing potential selection bias. Eligibility criteria included female sex, active participation in show jumping competitions, and age below 25 years. No exclusion criteria were applied regarding current pain, prior injuries, or weekly training volume to ensure a representative sample of competitive athletes. Participation was anonymous and voluntary.\u003c/p\u003e \u003cp\u003eThe final sample included 174 amateur and 179 professional athletes across both age groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eParticipants were classified as \u003cem\u003eprofessional\u003c/em\u003e or \u003cem\u003eamateur\u003c/em\u003e show jumping athletes based on their competitive level and regularity of participation in official competitions. Professional riders were defined as athletes who regularly competed in national and international show jumping events, including FEI-sanctioned competitions, and who participated in classes with obstacle heights exceeding 130 cm. This level of competition reflects a higher technical demand, greater training intensity, and increased mechanical loading during riding and jumping activities.\u003c/p\u003e \u003cp\u003eAmateur riders were defined as athletes competing primarily in lower-level regional or national events, with obstacle heights up to 120 cm, and without regular participation in high-level national or international competitions. This classification was chosen to distinguish riders with substantially different training volumes, technical demands, and cumulative exposure to sport-specific mechanical loads.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment Tools\u003c/h3\u003e\n\u003cp\u003eAn anonymous online survey was used to assess spinal disability in female show jumpers. This method was selected to reduce time demands, minimize costs, and limit potential transcription errors associated with paper-based questionnaires, in accordance with recommendations for online research methodologies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe survey was divided into three sections and required approximately five minutes to complete.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eDemographics and sport-specific variables\u003c/em\u003e: age, height, body mass, weekly training volume, and training experience (years of participation in show jumping).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eOutcomes\u003c/em\u003e: Lumbar spine\u0026ndash;related disability assessed with the Oswestry Disability Index (ODI) and cervical spine\u0026ndash;related disability assessed with the Neck Disability Index (NDI). ODI evaluates limitations across domains including pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, and traveling, with total scores ranging from 0 to 50 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. NDI consists of 10 items, each with six response options, reflecting increasing functional limitation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe same instruments and procedures were applied to all participants to ensure comparability between groups.\u003c/p\u003e\n\u003ch3\u003eBias and confounding\u003c/h3\u003e\n\u003cp\u003eEfforts to reduce bias included using standardized, validated questionnaires (ODI and NDI) and applying the same online format to all participants. Body mass was analyzed as a potential confounder and was compared across age groups, training experience, and disability categories. No matching was performed, as this was a cross-sectional study.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and received a formal confirmation from the \u003cb\u003eBioethics Committee at Poznan University of Medical Sciences (Confirmation No. KB-208/26)\u003c/b\u003e. The Committee confirmed that the research is a non-experimental, questionnaire-based study and, according to Polish law and Good Clinical Practice (GCP) regulations, does not require formal approval. Informed consent was obtained electronically from all participants, and parental consent was obtained for those under 18 years.\u003c/p\u003e\n\u003ch3\u003eReliability assessment\u003c/h3\u003e\n\u003cp\u003eAll statistical analyses were performed using Statistica software (version 13; TIBCO Software Inc., Palo Alto, CA, USA) and Microsoft Excel (Microsoft Corp., Redmond, WA, USA).\u003c/p\u003e \u003cp\u003eNormality of continuous variables was assessed using the Shapiro\u0026ndash;Wilk test. The characteristics of the subjects were presented using counts and percentage frequencies for qualitative variables. Between-group comparisons were performed using the Mann\u0026ndash;Whitney U test for continuous variables and chi-square or Fisher\u0026rsquo;s exact test for categorical variables. Subgroup analyses were conducted separately for each age group. Sensitivity analyses were performed by including incomplete surveys with imputed values for missing ODI or NDI items using mean substitution; results were consistent with the primary analyses. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric characteristics, training volume, and riding experience\u003c/h2\u003e \u003cp\u003eThe analysis included 179 riders younger than 18 years (70 professionals and 104 amateurs) and 174 riders aged 18\u0026ndash;25 years (78 professionals and 101 amateurs).\u003c/p\u003e \u003cp\u003eIn both age groups, body mass did not differ significantly between professional and amateur athletes. Among riders younger than 18 years, mean body mass was 55.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.85 kg in professionals and 57.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73 kg in amateurs (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.532). Similarly, in the 18\u0026ndash;25-year age group, body mass values were comparable between professionals (61.19\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86 kg) and amateurs (60.61\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64 kg; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.897).\u003c/p\u003e \u003cp\u003eWeekly time devoted to horse riding differed significantly between competitive levels in both age groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In riders younger than 18 years, amateur athletes most frequently reported training durations below 4 hours per week (72%), whereas professional athletes predominantly reported 4\u0026ndash;10 hours per week (69%). Training volumes exceeding 10 hours per week were reported by 16% of professionals and only 2% of amateurs. A similar pattern was observed in the 18\u0026ndash;25-year age group, where 65% of amateurs trained less than 4 hours per week, while 65% of professionals reported 4\u0026ndash;10 hours of weekly riding. Training durations above 10 hours per week were reported by 23% of professionals compared with 2% of amateurs.\u003c/p\u003e \u003cp\u003eRiding experience did not differ significantly between professional and amateur athletes in the younger age group (p\u0026thinsp;=\u0026thinsp;0.0756). In contrast, among athletes aged 18\u0026ndash;25 years, riding experience differed significantly between competitive levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), with a higher proportion of professional athletes reporting more than 12 years of riding experience.\u003c/p\u003e \u003cp\u003eThe distribution of NDI disability categories was comparable between professional and amateur athletes in both age groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In each group, mild disability was the most frequently reported category, whereas severe disability occurred rarely.\u003c/p\u003e \u003cp\u003eFor ODI, the distribution of disability categories differed between competitive levels in athletes younger than 18 years, with professional riders showing a higher prevalence of moderate and severe disability compared with amateurs. In the 18\u0026ndash;25 age group, the prevalence of minimal disability in ODI was identical for both professional and amateur riders (69%), with no statistically significant differences in the distribution of disability categories (p\u0026thinsp;=\u0026thinsp;0.5164).\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\u003eAnthropometric characteristics, weekly training volume, and riding experience\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmateur\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest result\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / % (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnder 18 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.62ᵃ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly riding time (h/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e59.58ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 or less\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72% (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4\u0026ndash;10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69% (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26% (27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emore than 10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRiding experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e8.48ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.0756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 or less\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16% (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4\u0026ndash;7\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53% (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55% (57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e8\u0026ndash;11\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26% (27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e12\u0026ndash;15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3% (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emore than 15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0% (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2.86ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.4139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNo disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27% (19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35% (36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMild disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54% (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51% (53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eModerate disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14% (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSevere disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0% (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e5.86ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.0534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMinimal disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66% (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82% (85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eModerate disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29% (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17% (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSevere disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e18\u0026ndash;25 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.19\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.61\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13ᵃ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8970\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly riding time (h/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e64.58ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 or less\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65% (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4\u0026ndash;10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65% (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33% (33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emore than 10\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23% (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2% (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRiding experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e10.56ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.0320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 or less\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6% (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4\u0026ndash;7\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29% (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e8\u0026ndash;11\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36% (28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42% (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e12\u0026ndash;15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17% (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emore than 15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7% (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2.86ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.4133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNo disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33% (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27% (27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMild disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54% (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62% (63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eModerate disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10% (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSevere disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1% (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e1.32ᵇ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.5164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMinimal disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69% (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69% (70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eModerate disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23% (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27% (27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSevere disability\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4% (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: \u003csup\u003ea\u003c/sup\u003e \u0026minus; Mann-Whitney U test, \u003csup\u003eb\u003c/sup\u003e \u0026minus; Likelihood-ratio chi-square test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDisability outcomes\u003c/h3\u003e\n\u003cp\u003eIn athletes younger than 18 years, no significant differences were observed between professional and amateur riders in NDI scores (9.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30 vs. 8.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66 points, respectively; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.223). In contrast, professional athletes demonstrated significantly higher ODI values compared with amateurs (16.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.61% vs. 12.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0534).\u003c/p\u003e \u003cp\u003eAmong athletes aged 18\u0026ndash;25 years, neither NDI nor ODI scores differed significantly between professional and amateur athletes. Mean NDI values were 7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21 points in professionals and 7.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98 points in amateurs (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.509), while mean ODI values were 17.56\u0026thinsp;\u0026plusmn;\u0026thinsp;14.64% and 15.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74%, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.464).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of disability categories\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLow back pain represents one of the most prevalent musculoskeletal complaints among equestrian athletes and constitutes a major factor limiting performance and long-term participation in the sport. The specific biomechanical demands of horseback riding, particularly in show jumping, expose riders to repetitive axial loading, impact forces, and complex trunk\u0026ndash;pelvis interactions that may contribute to the development of spinal symptoms. Competitive participation is typically associated with higher training volumes and longer riding experience, which may contribute to cumulative mechanical loading of the lumbar spine. In contrast, the influence of competitive riding on cervical spine\u0026ndash;related disability remains less clearly defined. Therefore, the present study aimed to investigate the association between competitive level, training exposure, and lumbar and cervical spine\u0026ndash;related disability in female show jumping athletes across two age groups. The more pronounced differences in lumbar spine\u0026ndash;related disability observed in younger athletes may be partly explained by age-related developmental factors. Adolescence is characterized by ongoing musculoskeletal maturation and evolving neuromuscular control, which may increase susceptibility to cumulative mechanical loading during intensive training. These results may imply that intensive competitive exposure during this critical developmental period could potentially be linked to increased lumbar spine symptoms in young female show jumpers.\u003c/p\u003e \u003cp\u003eThe main finding of this study suggests that professional competitive status is associated with higher lumbar spine\u0026ndash;related disability scores, as assessed by the Oswestry Disability Index, particularly among younger athletes.\u003c/p\u003e \u003cp\u003e. Although a similar trend was observed among athletes aged 18\u0026ndash;25 years, this difference did not reach statistical significance. In contrast, no significant differences were found between competitive levels with respect to cervical spine\u0026ndash;related disability, as measured by the Neck Disability Index. Importantly, body mass did not differ between groups and was not identified as a confounding factor, while professional riders reported substantially greater weekly training volume and longer training experience, suggesting a potential role of cumulative mechanical loading in the development of lumbar symptoms.\u003c/p\u003e \u003cp\u003eOur findings are consistent with previous reports indicating a high prevalence of low back pain among equestrian athletes. Kraft et al. confirmed in their study that the prevalence of low back pain in equestrian population is more than 50% higher than the prevalence of LBP in general population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Horseback riding is a unique discipline which combines relationship between human and animal. There are many factors beyond the gait and horse\u0026rsquo;s carrying capacity that contribute LBP in horseback riders. There is need to better understand some predictors increasing loads in the low back while riding including poor equestrian technique, incorrect riding posture, dimorphic setup. Recent biomechanical studies suggest that peak acceleration and shock attenuation might play role in chronic low back pain in equestrian athletes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Negative shock attenuation from pelvis to sternum in sitting trot indicates that the shock in the torso is increased. This also could be the predictor to the occurrence of chronic low back pain. The increase in shock could potentially be explained by a rotational component in the pelvis, highlighting the importance of core stability for horseback riders. These biomechanical demands may be associated with altered functional movement patterns in equestrian athletes.\u003c/p\u003e \u003cp\u003eFunctional movement adaptations specific to equestrian disciplines have also been reported. Lewis et al. identified discipline-specific differences in postural control and trunk stability among female riders, suggesting that these adaptations may influence loading patterns in both the lumbar and cervical spine [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, despite theoretical concerns regarding cervical spine strain due to prolonged head extension and forward trunk inclination in show jumping, our results indicate that cervical spine\u0026ndash;related disability is less influenced by competitive level, suggesting either adaptive mechanisms or lower cumulative load compared with the lumbar region.\u003c/p\u003e \u003cp\u003eWeeks et al. reported that a structured 8-week exercise programme focusing on trunk stability and postural control was associated with a reduction in chronic low back pain in equestrian athletes, suggesting that targeted training may decrease discipline-specific spinal loading [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This study highlights that it is important for equestrian athletes experiencing low back pain to undertake regular exercises.\u003c/p\u003e \u003cp\u003eEquestrian sports are associated with a high risk of traumatic injury due to the elevated riding position, high speeds, and unpredictable behavior of the horse. Jumping disciplines are particularly associated with spinal injuries [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Large epidemiological studies indicate that lumbar and thoracic spine injuries account for a substantial proportion of equestrian-related trauma, with cervical injuries also occurring in a notable minority of cases [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Although traumatic mechanisms such as falls and collisions represent an important source of spinal injury, it remains difficult to disentangle the contribution of acute trauma from cumulative, non-traumatic loading in the development of chronic back pain in equestrian athletes.\u003c/p\u003e \u003cp\u003eNaef et al. reported that young female riders constitute a large proportion of equestrian-related emergency department visits, with falls from horses accounting for over 80% of injuries [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These outcomes show the multifactorial nature of spinal complaints in equestrian sports, involving both repetitive mechanical loading and high-energy traumatic events.\u003c/p\u003e \u003cp\u003eIn conclusion, our findings underscore the importance of incorporating lumbar-specific conditioning and core stability programs early in the training of young competitive riders to mitigate the apparent risk of functional disability. Evidence from functional movement assessments and epidemiological studies indicates that discipline-specific adaptations in postural control and trunk stability can influence spinal loading, potentially increase low back pain and cervical discomfort. Trunk stability and neuromuscular control excercises have been shown to reduce low back pain in equestrian athletes, highlighting the importance of structured training programs as part of injury prevention and management. Despite the use of protective equipment, the high risk of falls and impact forces inherent to equestrian activities underscores the need for comprehensive preventive strategies, including rider education and appropriate technique. Future research should aim to integrate biomechanical, clinical, and epidemiological data to better understand injury mechanisms and optimize training and rehabilitation protocols for riders of different ages and skill levels.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the use of an online survey may introduce selection bias, as participation was voluntary and based on self-reported responses. As highlighted in previous methodological analyses, online surveys may be subject to sampling limitations and potential self-selection bias among respondents [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, spinal pain reported by participants may reflect not only cumulative riding-related loading but also the consequences of prior traumatic events related to horse riding or horse handling. Furthermore, the cross-sectional design of the study does not allow causal inferences regarding the directionality of the observed associations between training exposure and spinal disability.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study benefits from a relatively large sample size, inclusion of both amateur and professional athletes, and assessment across two age groups during major national and international competitions. These characteristics may enhance the relevance of the findings for competitive female show jumping athletes. Future longitudinal studies integrating biomechanical assessments, clinical examination, and injury history are warranted to better elucidate causal mechanisms and inform targeted preventive and rehabilitation strategies.\u003c/p\u003e \u003cp\u003eBecause of the cross-sectional design and the use of self-reported questionnaire data, the results should be interpreted with caution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that competitive-level equestrian athletes exhibit a higher degree of lumbar spine\u0026ndash;related disability compared with amateur riders, particularly in the younger age group, as reflected by higher ODI values. Although a similar trend was observed in older athletes, the differences did not reach statistical significance, likely due to greater variability within this group. Body mass did not differ between amateur and professional athletes across age categories, allowing for reliable comparisons between groups. Professional athletes in both age groups reported substantially greater weekly training exposure and longer training experience, indicating prolonged and more intensive mechanical loading of the musculoskeletal system. In contrast to lumbar spine outcomes, no significant differences were observed between groups in terms of cervical spine\u0026ndash;related disability, as assessed by NDI. Overall, the results suggest a potential association between competitive show jumping participation and increased symptoms related to lumbar spine dysfunction, particularly in younger athletes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Maciej Młodzik for the opportunity to conduct research during Cavaliada Horse Show. Special thanks to respondents who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: KA, PK; methodology: KA, PK; formal analysis: KA, MG, TJ; data collection: EMM; resources: JM, MFM; data analysis: KA, MG, TJ; writing \u0026ndash; orginal draft preperation: KA, MG, TJ; review and editing: KA, PK; supervision: PK.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed in the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant and any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the article and approved the submitted version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKeener, M. 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Med.\u003c/em\u003e \u003cb\u003e42\u003c/b\u003e (6), 575\u0026ndash;576 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"equestrian, cervical pain, low back pain, Neck Disability Index, Oswestry Disability Index","lastPublishedDoi":"10.21203/rs.3.rs-8908241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8908241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of the study was to assess the prevalence and severity of lumbar and cervical spine\u0026ndash;related disability and the association between competitive level, training exposure, and spinal disability using the Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) in female show jumping riders. This cross-sectional observational study included 353 female show jumping athletes aged 10\u0026ndash;25 years. Data were collected using an anonymous online survey distributed during major international equestrian competitions in Poland. Participants were stratified by age (\u0026lt;\u0026thinsp;18 and 18\u0026ndash;25 years) and competitive level (amateur vs. professional) to examine differences in lumbar and cervical spine\u0026ndash;related disability. Comparisons between amateur and professional athletes were conducted separately for each age group using non-parametric statistical tests.\u003c/p\u003e \u003cp\u003eProfessional athletes demonstrated significantly higher lumbar spine\u0026ndash;related disability, as assessed by ODI, compared with amateurs, particularly in the younger age group. Although a similar trend was observed in older athletes, the differences were not statistically significant. No significant differences were found between amateur and professional athletes in cervical spine\u0026ndash;related disability measured by NDI in either age group. Professional athletes in both age groups reported significantly greater weekly training volume and longer training experience. Body mass did not differ between groups and did not act as a confounding factor.\u003c/p\u003e \u003cp\u003eCompetitive participation in show jumping may be associated with increased lumbar spine\u0026ndash;related disability, particularly among younger female athletes, while cervical spine disability appears less influenced by competitive level. Higher training volume and longer training experience among professional riders may contribute to cumulative mechanical loading of the lumbar spine. These findings highlight the need for targeted preventive and conditioning strategies focusing on lumbar spine health in competitive female show jumpers.\u003c/p\u003e","manuscriptTitle":"Assessment of neck and low back disability using the Neck Disability Index and Oswestry Disability Index in female show jumping riders: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 10:11:34","doi":"10.21203/rs.3.rs-8908241/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T21:54:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T22:10:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120278061262930445999281676700494531311","date":"2026-04-30T15:26:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202571380322731279402485957886783651142","date":"2026-04-30T14:53:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178721600851338936996015005836710983356","date":"2026-04-30T14:50:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-30T14:37:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T10:23:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T09:10:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-18T23:18:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-16T09:58:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e08a9d07-dec5-42f7-a980-b9c84d4bae02","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T21:54:41+00:00","index":110,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T22:10:47+00:00","index":109,"fulltext":""},{"type":"reviewerAgreed","content":"120278061262930445999281676700494531311","date":"2026-04-30T15:26:09+00:00","index":103,"fulltext":""},{"type":"reviewerAgreed","content":"202571380322731279402485957886783651142","date":"2026-04-30T14:53:55+00:00","index":102,"fulltext":""},{"type":"reviewerAgreed","content":"178721600851338936996015005836710983356","date":"2026-04-30T14:50:38+00:00","index":101,"fulltext":""},{"type":"reviewersInvited","content":"13","date":"2026-04-30T14:37:25+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":67919178,"name":"Health sciences/Health care"},{"id":67919179,"name":"Health sciences/Medical research"},{"id":67919180,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-11T10:11:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 10:11:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8908241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8908241","identity":"rs-8908241","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}