Knee Surg Sports Traumatol Arthrosc
DOI 10.1007/s00167-014-3069-3
SPORTS MEDICINE
Low back pain in female elite football and handball players
compared with an active control group
Paula Tunås • Agnethe Nilstad • Grethe Myklebust
Received: 2 July 2013 / Accepted: 6 May 2014
Springer-Verlag Berlin Heidelberg 2014
Abstract
Purpose The purpose of this cross-sectional study was to
compare the prevalence of low back pain (LBP) among
female elite football and handball players to a matched
non-professional active control group.
Methods The participants were requested to answer a
questionnaire based on standardized Nordic questionnaires
for musculoskeletal symptoms to assess the prevalence of
LBP. Included participants were elite female football
(n = 277) and handball players (n = 190), and a randomly
selected control group from the Norwegian population
(n = 167).
Results Fifty-seven percentage of the football players,
59 % of the handball players and 60 % of the control group
had experienced LBP the previous year. There were no
significant group differences in the prevalence of LBP ever
(p = 0.62), the previous year (p = 0.85) or the previous
7 days (p = 0.63). For both sports, there was a significant
increase in prevalence of LBP from the resting period to
the competitive periods of the season (p B 0.001). Seventy
percent of the goalkeepers in both football and handball
had experienced LBP the previous year.
Conclusion There were no difference in LBP among
female elite football and handball players compared with
the control group. However, female elite athletes in football and handball reported a high prevalence of LBP
compared to previous studies. The variations in LBP and
playing positions indicate that specific field positions,
P. Tunås (&) A. Nilstad G. Myklebust
Department of Sports Medicine, Oslo Sports Trauma Research
Centre, Norwegian School of Sports Sciences, PB 4014,
Ullevål Stadion, 0806 Oslo, Norway
e-mail: [email protected]
in football and handball, is a risk factor for developing
LBP.
Level of evidence III.
Keywords Low back pain Prevalence Female Elite
athletes Football Handball
Introduction
Top-level sports require monotonous and repetitive
demanding physical exercises and training with high loads
on the spine, often from an early age [6]. Several studies
have reported a high prevalence of LBP among elite athletes [4, 6, 15, 16, 18, 35, 36]. Existing literature has
focused on sports with specific demands to the lower back,
such as rowing [4, 33], gymnastics [7, 12, 21, 24, 35, 36],
wrestling [6, 13, 24, 36], weight lifting [6, 13, 24, 29] and
cross-country skiing [4, 10, 28]. There are also studies that
have investigated the prevalence of LBP in team sports.
Hoskins et al. [18] showed that elite rugby players were
twice as likely to report daily or weekly LBP as a nonathletic group, and the prevalence of LBP increased with
athletic level. Keene et al. [21] reported the incidence of
back injuries in American football college players to be 17
per 100 participants. In a retrospective study on beach
volleyball players, LBP was reported as the most common
overuse injury [5]. Hangai et al. [16] also demonstrated a
high rate of LBP in volleyball players (78 %), compared to
control subjects (50 %). Baseball, basketball [16], ice
hockey [6], tennis [16, 36] and male football [15, 16, 24,
26, 29, 30, 36] are other team sports that have reported a
high prevalence of LBP.
The origin of LBP can be a result of a traumatic as well
as an overuse injury [30]. A traumatic injury refers to a
123
Knee Surg Sports Traumatol Arthrosc
specific traumatic event leading to immediate interruption
of training and competition or matches [8, 11]. An overuse
injury is caused by micro-trauma over a long period of time
without a single identifiable event of trauma and do not
necessarily cause absence from training and competition
[3, 8, 11, 30]. It is thereby possible that overuse injuries are
underestimated in several sports, as many studies have used
the ‘‘time loss’’ definition (an injury that results in a player
being unable to take full part in future training or match
play) or the ‘‘medical attention’’ definition (an injury that
results in a player receiving medical attention) to report
injuries [8, 11]. The effect of this may have contributed to
inaccurate reports of prevalence of LBP in many sports.
Traumatic injuries in the lower extremities, especially in
knee and ankle have reported to be high in both football
[20, 32, 37] and handball [23, 25, 31], while the prevalence
of LBP has been given less attention and is poorly investigated. On the other hand, retrospective epidemiological
studies reporting overuse injuries in football [20, 30, 32]
and handball [31] have found LBP to be one of the most
prevalent overuse injuries [20, 30–32]. Ristolainen et al.
[30] presented LBP to be the most prevalent previous
overuse injury (28 %) among football players. Few studies
have compared the prevalence of LBP among football
players with a control group [15, 16, 24, 38]. Two longterm follow-up studies found no differences in LBP in
former male football players compared to non-athletes [24,
38]. In contrast, two cross-sectional studies, which included athletes from various sports, indicated a higher rate of
LBP in football players than in a normal population [15,
16]. To our knowledge, no previous studies have examined
the prevalence of LBP among elite handball players or
among female elite football players, and little is known of
what consequences football and handball play has on the
lower back. Evaluating the prevalence of LBP among elite
football and handball players is essential for developing
prevention strategies. Increased knowledge on the prevalence of LBP will improve the development of prevention
exercises and programs in the clinic. Thus, the purpose of
the present study was to investigate the prevalence of LBP
among female elite football and handball players, and to
compare the result with a matched non-professional active
group of women.
Materials and methods
This cross-sectional study is based on a survey among
female elite football players (2009–2011; 3 years), female
elite handball players (2007–2011; 5 years) and a female
control group (2012) (Fig. 1). The survey was conducted as
a part of a prospective cohort study aimed at investigating
risk factors for ACL injuries in female elite football and
123
handball players. The players participated in pre-season
screening tests where they also completed a questionnaire
regarding LBP. All players who completed the questionnaire and were 18–32 years of age the year they were
tested, were included in this study. A gender-matched
control group (females aged 18–32) of 400 people was
randomly selected from the Norwegian population by the
National Register and included in the study. A similar
questionnaire (without sports-specific questions) was sent
by post to the control group. Subjects who did not return
the questionnaire within 4 weeks were contacted by telephone and were asked to complete the questionnaire
directly, or to return it by e-mail or post. To compare the
elite-level athletes with a less athletic group, we excluded
subjects from the control group who reported being competitive athletes training more than 5 times per week.
We also excluded samples unable to speak or read
Norwegian.
The questionnaire
The questionnaire was based on standardized Nordic
questionnaires, which have been found valid, to study and
compare the prevalence of occupational musculoskeletal
symptoms in different groups and populations in the
Nordic countries [1, 22]. The reliability of the questionnaire has been shown to be acceptable [22]. The Nordic
questionnaire about LBP uses the following definition;
‘‘pain, ache or discomfort in the lower back with or
without radiation to one or both legs’’. The participants
were requested to answer the questionnaire whether they
had pain or not in the lower back, by marking the option
closest to the true situation. Special information was
given to exclude pain caused by the menstrual period. We
included the following standard questions from the Nordic
questionnaire:
•
•
•
•
•
•
•
Have you ever experienced LBP?
Have you experienced LBP during the previous 7 days?
How many days during the past 12 months have you
had LBP?
Have you been examined or treated for LBP by a
physician, physical therapist, chiropractor or other
health personnel as an outpatient during the previous
12 months?
Have you ever had to change your occupation or
working assignments because of LBP?
Have you ever had surgery because of LBP?
Have you ever experienced radiating LBP?
In addition to the standard questions, specific questions
were elaborated. Most of these were based on sport-specific
questions (thoroughly pilot tested) used in the study by
Bahr et al. [4]. These questions are listed above:
Knee Surg Sports Traumatol Arthrosc
•
•
•
•
•
•
•
•
What is your playing position on the court?
How many seasons have you been playing at the elite
level?
How many hours have you trained during the past year
(4 categories: \400 h/400–549 h/550–699 h/ [700 h)?
How many days of training have you missed because of
LBP during the past 12 months?
How many matches have you missed because of LBP
during the past 12 months?
Have you experienced LBP during the following parts
of the season: the resting period, the transitional period
or the competitive season (4 categories: no/sometimes/
weekly/daily?
Has the LBP been caused by contact with another
player?
In what involvement have you experienced LBP (3
categories: acute pain as a result of injury/pain over
time as a result of overuse/both)?
The control group answered the last specific question
only. In addition, the control group answered questions
about their training habits (number of weekly training
sessions and eventual competitive sport). Questions
regarding age, height and weight were also included for all
three groups.
Ethical approval
The study was approved by the Regional Committee for
Medical Research Ethics; South-Eastern Norway Regional
Health Authority (ID number 2011/1999) and by the
Norwegian Social Science Data Services (ID number
28757), Norway. All players signed a written informed
consent form.
covariates. We also used Binary logistic regression to
assess whether seasons and playing positions on the court
were potential predictive factors for developing LBP, with
adjustments for age, height and weight. Low back pain in
the previous 12 months (yes/no) was the dependent variable, and as independent variables we used seasons and
playing positions. Odds ratios (OR) with 95 % confidence
intervals (CI) are reported. p values equal to or below 0.05
were considered statistical significant.
Results
Participants
Sample characteristics
There were no differences in age between the football
(22.4 ± 4) and the handball players (22.3 ± 3) (p = 0.92),
but the control group (25.6 ± 4) was older compared to
both the football (p = 0.001) and the handball players
(p = 0.001; Table 1). The handball players were higher
than the two other groups (p = 0.001), but there was no
difference between the football players and the control
group (p = 0.94). There were differences in weight
between handball players and the control group (p = 0.01),
between football players and the control group
Table 1 Subject characteristics (n = 634) by group
Football
(n = 277)
The questionnaires were analysed using SPSS (v. 18.0 for
Windows, SPSS, Evanston, Illinois). Subject characteristics are reported as means ± standard deviations, and differences were assessed using a one-way between-group
analysis of variance (ANOVA). We compared LBP prevalence between groups with Chi-square tests (Pearson’s
chi-square or Fishers exact test, as appropriate). Wilcoxon
signed rank test was used to test for changes in LBP
prevalence across the season. Binary logistic regression
analyses were used to test for interaction of the training
volume in the two sports with regard to prevalence of LBP,
adjusted for the parameters age, weight and height. The
dependent variable was the prevalence of LBP the previous
12 months (yes/no), while yearly training volume was the
independent variable and age, weight and height were
Control group
(n = 167)
Age (years)
22.4 ± 4
22.3 ± 3
25.6 ± 4
Height (cm)
167.7 ± 5
173.1 ± 6
167.9 ± 7
Weight (kg)
62.6 ± 7
69.0 ± 7
3.1 ± 4
3.2 ± 4
Elite level (years)
Statistics
Handball
(n = 190)
66.1 ± 14
–
Results are shown as mean ± SD. Elite level: number of seasons
(years) playing at the elite level in their sport
Fotball players
n = 311
Handball players
n = 206
Control group
n = 400
Answers
n = 305
Answers
n = 203
Answers
n = 170
Excluded
n = 28
Included
n = 277
Excluded
n = 13
Included
n = 190
Excluded
n=3
Included
n = 167
Total participants n = 634
Fig. 1 Flowchart of included participants in the study
123
Knee Surg Sports Traumatol Arthrosc
(p = 0.001), and between the football and handball players
(p = 0.001).
30
Football
Prevalence of LBP
Table 2 summarizes the responses to the LBP questionnaire. There were no differences in the prevalence of LBP
among the groups. More than 60 % of the groups had
experienced LBP ever. More than half of the participants
had experienced LBP during the previous 12 months and
24–31 % reported having experienced LBP the previous
week. Figure 2 illustrates the prevalence of days of LBP
the previous 12 months by group. Football and handball
players reported having received significantly more outpatient medical assistance than the control group.
Only 3.2 % (n = 6) of the handball players, 3.6 %
(n = 10) of the football players and 4.9 % (n = 8) of the
participants in the control group who reported having
experienced LBP ever did not experience LBP the previous
12 months. More than 70 % of the football and handball
players, who reported having experienced LBP ever,
described the source of the LBP to be a result of overuse
injury. Less than 10 % of the football and handball players
Table 2 Responses (%) to the various LBP questions by group
(n = 634)
Football
(n = 190)
Handball
(n = 277)
Control
group
(n = 167)
p value
LBP ever (n = 634)
60.6
62.6
65.3
(n.s)
LBP previous
12 month
(n = 629)
56.9
59.3
59.8
(n.s)
LBP previous 7 days
(n = 629)
24.0
25.9
30.9
(n.s)
Sleeping problems
(n = 627)
14.8
17.6
15.4
(n.s)
Medical assistance
(n = 628)
34.1
40.0
24.4
0.002
Surgery (n = 627)
0.7
0.5
1.8
(n.s)
15.2
18.0
16.7
(n.s)
Occupational change
(n = 628)
10.9
18.2
11.5
(n.s)
Thigh
9.1
8.6
7.9
(n.s)
Knee
0.4
1.1
3.0
(n.s)
Lower leg or foot
Missed training
(n = 467)
Missed competition
(n = 467)
123
Handball
Control group
20
15
10
5
0
0 days
1-7 days
8-30 days
>30 days
Daily
Fig. 2 Prevalence of days of LBP (%) during the previous 12 months
by group (n = 629)
reported a traumatic injury as the source of the pain. When
looking at the different playing positions on the court
among football players, the highest prevalence was found
for goalkeepers (71 %) and midfielders (67 %). For handball players, goalkeepers (70 %) and line players (63 %)
had the highest prevalence. Low back pain related to
playing situations was reported in 39 % of the football
players and 41 % of the handball players. Football players
experienced most LBP during landing, followed by
shooting and turning/cutting. For handball players, the
corresponding figures were shooting, followed by tackling
and landing. Only 4.7 % (n = 13) of the football players
and 6.3 % (n = 12) of the handball players reported that
LBP was caused by a contact situation with another player.
Midfielders (OR 2.5, CI 1.1–5.7; p = 0.03) and goalkeepers (OR 3.04, CI 1.0–9.3; p = 0.05) in football were
more likely to experience LBP compared to strikers
(Table 3). Number of years playing at elite level did not
affect the risk of LBP.
Training volume
Radiating LBP
(n = 628)
Gluteal region
Prevalence of LBP (%)
25
5.1
3.2
7.3
(n.s)
27.7
39.0
–
(n.s)
8.4
11.8
–
(n.s)
The total training volume during the previous 12 months
for football and handball players is presented in Table 4.
The training volume in the control group was reported;
never 8.4 % (n = 14), once a week or less 19.2 %
(n = 32), 1–2 times a week 31.1 % (n = 52), 3–4 times a
week 29.3 % (n = 49), 5 times a week 8.4 % (n = 14)
and 7 times a week 0.6 % (n = 1). The most common
activity reported by the control group was fitness studio
training.
Training volume exceeding 700 h per year was related
to less amount of LBP, but the relationship was not significant (OR 0.5; CI 0.2–1.6; p = 0.28) (Table 5).
Knee Surg Sports Traumatol Arthrosc
Table 3 Analysis of risk factors for LBP during the previous
12 months (yes/no) by sport group (n = 449)
Variables
Regressions
coefficient
Seasons (years) (n = 438)
-0.04
95 % confidence limits
of odds ratio
p value
OR
LB
UB
(n.s)
1.0
1.0
1.1
Football (n = 239)
Prevalence of LBP
Striker
Ref.
Defender
0.37
(n.s)
1.4
0.7
3.2
Midfielder
0.92
0.03
2.5
1.1
5.7
Forward
0.41
(n.s)
1.5
0.6
4.1
Goalkeeper
1.11
0.05
3.0
1.0
9.3
Handball (n = 185)
Line player
Ref.
Back
-0.03
(n.s)
1.0
0.9
1.1
Wing
0.003
(n.s)
1.0
0.9
1.2
Goalkeeper
0.08
(n.s)
1.1
0.9
1.3
OR odds ratio, LB lower bound, UB upper bound, Ref. reference group
Table 4 Training volume during the previous 12 months by sport
(n = 440)
Football
(n = 267) (%)
Handball
(n = 173) (%)
Training volume (h)
\400
400–549
550–699
[700
14 (5.2)
10 (5.8)
98 (36.7)
101 (37.8)
46 (26.6)
81 (46.8)
54 (20.2)
36 (20.8)
Table 5 Logistic regression analysis of LBP in the previous
12 months (yes/no) and yearly training volume among the two sports
groups (n = 438)
Variables
among female elite football and handball players. Furthermore, nearly three-quarters of the goalkeepers among
both football and handball players reported to have had
LBP the previous 12 months. The players also reported a
noticeably higher amount of LBP during the competitive
season.
Regression
coefficient
p value
OR
LB
UB
2.2
Training volume
\400
Ref.
400–549
-0.22
(n.s)
0.8
0.3
550–699
0.46
(n.s)
1.1
0.4
2.8
[700
-0.62
(n.s)
0.5
0.2
1.6
OR odds ratio, LB lower bound, UB upper bound, Ref. reference group
Discussion
The main findings of the current study were that there were
no differences in the prevalence of LBP among female elite
football players, female elite handball players and the
control group. Nevertheless, according to results reported
in previous studies, there is a high frequency of LBP
Our findings conclude small differences when comparing
the prevalence of LBP among the three groups. In spite
of this, there was a relatively high cumulative and period
prevalence of LBP in the two athletic groups compared
to other studies. In our study, we found that 57 % of the
football players and 59 % of the handball players had
experienced LBP the previous 12 months. In the study by
Bahr et al. [4], the prevalence of LBP the previous
12 months was reported to be 63 % among cross-country
skiers, 55 % among rowers and 50 % among orienteers.
Sward et al. [36] reported back pain among wrestlers,
gymnasts, football players and tennis players at a frequency between 50 and 85 %. Of these 58 % of the
football players reported LBP, which is consistent with
our findings. A higher prevalence was reported by Hangai et al. [15, 16], where the lifetime prevalence of LBP
was 62 and 77 %, respectively. However, the high
prevalence of LBP in the control group in our study is
not in accordance with previous findings [4, 15, 16, 18,
35]. Noteworthy, many out of previous studies have not
used a randomly selected control group [15, 16, 18, 35],
and the result can therefore not be generalized to the
total population. Another explanation of the high prevalence of LBP in the control group could be related to the
fact that the athletic level of our controls was relatively
high.
Direct comparisons between elite athletes and a less
athletic population regarding LBP may be difficult, as
highly motivated top athletes may ignore pain with the
purpose of maintaining or progressing physical performance [35]. Reasons could be strictly competitiveness,
economical or keeping their position in the team. Granhed
& Morelli [13] stated that that tolerance of pain seemed to
be higher among athletes than non-athletes. They investigated wrestlers, who are athletes used to body contact
during combats probably leading to painful moments. Bahr
et al. [4] also mentioned that athletes may have a higher
threshold for reporting symptoms, as LBP may interfere
more with sport performance than other daily activities.
Alternatively, even low amounts of pain may impede athletic performance and thus affect the athlete to a greater
extent than a non-athlete [35]. Experience of pain is subjective and will likely differ within groups and not only
between groups.
123
Knee Surg Sports Traumatol Arthrosc
The low back pain questionnaire
Notable is the significant larger proportion of football and
handball players who sought medical attention in cause of
LBP than the control group. The same finding was reported
by Bahr et al. [4], who suggested that the finding could be
explained by severity of the injury in sports groups compared to the less athletic group or that an elite athletic
population has easier access to professional care. It could
also mirror the fact that elite athletes strive hard to get back
to full participation in training sessions and competitions as
soon as possible.
Only a few football and handball players in this study
reported contact with another player to be the cause of their
LBP. These findings are similar to the study by Greene
et al. [14], where a majority of the reported sports-related
back injuries were caused by self-initiated actions. Most
participants reporting LBP ever did also report LBP the
previous 12 months. A previous history of LBP is documented to be a strong risk factor for future episodes of LBP
[27, 34]. Furthermore, current LBP and a history of LBP
during the previous 5 years may be a predictor for sustaining LBP in the following athletic season [14]. The
majority within all three groups in our study reported the
cause of the LBP to be a result of overuse injury. This
finding is in accordance with previous studies, showing that
LBP among football [20, 30, 32] and handball players [31]
more often is a result of overuse rather than a traumatic
injury [20, 30–32]. The frequent overuse estimation gives
us an indication of the importance of reporting all types of
injuries, and not only the time-loss injuries, which is
commonly used in epidemiological studies [3]. In our
study, we would have ended up with a lower prevalence of
LBP if we had used the time-loss definition, since only
30–40 % of the football and handball players reported
missed training due to LBP. For match absence, the corresponding numbers would have been approximately 10 %
in both groups. It is important to keep in mind that these
results are self-reported and not fully reliable, as we do not
have information from clinical examinations.
Our results demonstrated that being a goalkeeper
increased the likelihood for LBP. A total of 70 % of the
goalkeepers in both football and handball had experienced
LBP the previous 12 months. Ozturk et al. [26] found a
significantly higher prevalence of osteophytes in the spine
in former football players among goalkeepers and forward
players compared to the other playing positions. The high
prevalence of LBP among goalkeepers in our results may
indicate a high physical load of the lumbar spine in this
playing position. The goalkeeper’s role in both football and
handball involves quick reflexive actions to prevent scoring, as well as landings with unequal weight distribution
with a great range of motions in the spine. It is possible that
123
these elements affect the lower back in a negative way.
Ozturk et al. [26] suggest that goalkeepers in football
conduct movements involving hyperextension and rotation
of the spine more frequently than other players, and these
actions have been suggested as an aetiological factor to
develop spondylolysis [9, 17, 19]. There is also evidence
supporting rotational movements in occupational settings
to be a risk factor for developing LBP [17, 39], which
could theoretically also be applied to sport exercises.
Many years of competing at a high level have been
found to increase the prevalence of LBP [16], but our
findings did not indicate any interaction between prevalence of LBP the previous year and number of seasons
played at the elite level. Instead, we found a higher prevalence of LBP in the intense training and competitive
season, which is in line with the observation by Bahr et al.
[4], assuming that periods with higher amounts of football
and handball play is stressing the lower back. When
investigating the relationship between LBP the previous
year and annual training volume for the football and the
handball players, we did not find any significant correlation. Conversely, the interaction was rather a reduction in
LBP with increased training volume. During the active
resting period, we assume that players have less footballand handball-specific training sessions, since there are
fewer matches at this time. Contrary, the players do more
basic physiological training with focus on strength, coordination and condition. Related to this reflection, it can be
assumed that there are movements and actions in the two
sports contributing to LBP, such as twisting and high load,
rather than the training volume.
Methodological considerations
There are some limitations to consider when interpreting the
results from the current study. The main limitation is the
low response rate among the control group (46 %). This
might be explained by the fact that subjects without
symptoms of LBP did not answer to the questionnaire to the
same extent, even though the invitation letter clearly stated
that we wanted the participant to complete the questionnaire
whether they have had pain or not in their lower back. With
this in mind, the prevalence of LBP in the control group
may be overestimated. Another potential limitation is the
relatively high activity level in the control group, which
may mask potential differences between the groups.
We used a retrospective registration design to collect
information about LBP, and one challenge with studies
employing a retrospective model is the threat of recall bias.
The fact that the results are dependent on the memories of
the participants may lead to underreporting of the prevalence of LBP. However, this problem is likely to affect all
three groups in a similar manner. The information regarding
Knee Surg Sports Traumatol Arthrosc
symptoms of LBP in the present study was collected with
the Nordic questionnaires, which have been thoroughly
assessed for reliability, validity and practical use [1, 22].
Nevertheless, as Bahr et al. [4] stated when they investigated endurance athletes, it should be noted that the Nordic
questionnaires are developed to investigate the prevalence
of musculoskeletal symptoms in occupational settings in
different populations and not in a sporting context. In order
to better correspond to athletes, we therefore applied sportspecific questions, as previously used by Bahr et al. [4].
Another factor to consider is the threat of sampling bias.
In this case, the data collection was conducted in connection with pre-season screening tests of female elite football
and handball players in Norway. An inclusion criteria for
the screening tests was that the players needed to be free of
injury and able to fully participate in training and matches
with their team. Therefore, some players did not participate
due to other injuries, and we do not know whether these
had experienced LBP or not. Despite this, as we have been
able to include a high number of football and handball
players in the study, we assume that these players are a
representative sample of female football and handball
players at the top level in Norway.
The analysis controlled for age, height, weight, seasons
playing at the elite level, training volume and playing
position on court. There may be other confounders which
we were unable to control for, such as playing surface.
Football players have shown a higher incidence of LBP
when playing at artificial turfs compared to natural grass
[2]. There are no data about playing surface, but with this
study design, it is not possible to establish such a causeand-effect relationship. Moreover, there are no information
about the athletes’ occupational work, even though most of
these players have a full-time job in addition to playing
football or handball. This may be an influencing factor, as
frequent lifting [17, 40] and twisting [17, 39] in occupational setting are elements that have shown to increase
tendency to develop LBP.
The high prevalence of LBP among female elite football
and handball players indicate the need for preventive core
exercises and programs. This is important to keep in mind
in the daily clinical work, and hopefully, this will lead to a
reduction of the prevalence of LBP in these athletes. Further research should focus on investigating why some
playing positions have a higher propensity of developing
LBP. Increased knowledge on risk factors for LBP will
improve the development of preventive strategies.
Conclusion
The main findings of this study was that there was no
difference in LBP among female elite football and handball
players compared with a non-professional active group of
women. However, female elite athletes in football and
handball have a high frequency of LBP according to results
reported in previous studies. There was also found a higher
amount of LBP in the competitive season. The variations in
LBP related to playing positions on the court indicate that
specific field positions in football and handball is a risk
factor for developing LBP.
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