PREVALENCE OF LOW BACK PAIN IN ATHELETS

INTRODUCTION:
Low back pain (LBP) is a common health problem among adults of working
age population, and its prevalence or incidence increases with increasing in age.
Low back pain is one of the common health problems that 50–80% of adults
experience at some point in their life. It is believed that adults of working age are
the most vulnerable group of LBP, which is ranked as the highest cause of
disability than any other condition.(Fatoye et al., 2019).
The prevalence of back pain in athletes has been investigated in several studies,
but there are still under- or uninvestigated sports discipline like sports exposed to
repetitive overhead activity. Athletes spend much time in training and competition
and, because of the nature of their disciplines, subject their bodies to a great deal of
mechanical strain, which puts a high level of stress on their musculoskeletal
systems. From this it is hypothesized that elite athletes who engage in repetitive
overhead motions experience a higher strain on their spine and thus possibly a
higher prevalence of back pain compared with an active control group. BP is not
only a medical problem, but also a socioeconomic burden. It may lead to limited
functioning in everyday life, impairs quality of work, and is the leading cause of
activity limitation and work absence. Pain in the cervical, thoracic, and lumbar
spine is also a common complaint among elite athletes.
Acute injury or pain can be caused by falling, being tackled in team sports, fighting
in combat sports, or while lifting heavy weights. However, much more common
than acute incidents are chronic back problems. In many sports, the back and spinal
column undergoes elevated stress for a long time. This may result in inflammation
around the vertebrae and back muscles, which sometimes causes injuries to the
discs but much more often leads to upper or lower back pain. Sciatica, for instance,
is back pain that also affects the back of the legs or even the feet. It can occur in
cyclists who are in a flexed forward posture or athletes of water and swing sports
who perform a great deal of trunk rotation. Particularly in sports with repetitive
asymmetric loading, the sacroiliac joint dysfunction is a frequent cause of low back
pain in athletes. In most of these sports, asymmetric loading causes side-to-side
dysbalances that may greatly enhance susceptibility to back pain. A clear example
is an association between repeated golf swings and golf-related low back injuries.
(Zemková et al., 2020)

The first steps to evaluate an athlete who presents with low back pain (Fett et al.,
2019) involve a thorough history and physical examination in order to elicit the
injury mechanism, identify any neurologic deficits or signs of more serious injury,
and to direct the physician to the appropriate workup. Pain due to spondylolysis
and facet (posterior element) injuries is reproducible with extension, whereas
discogenic pain is reproduced with flexion. A thorough neurological examination
is mandatory, including motor, reflex, and sensory testing in addition to
provocative tests such as the Spurling’s test and straight leg raise (Lasegue’s) test.
When radicular pain or neurological deficits are present, MRI is necessary to detect
spinal cord and nerve involvement(Ball et al., 2019)
Pain, disability, quality of life and fear-avoidance similarly improve by walking or
exercise in chronic low back pain. Walking may be considered as an alternative to
other physical activity. Implications for Rehabilitation Walking is commonly
recommended as an activity in chronic low back pain. Pain, disability, and fear-
avoidance similarly improve by walking or exercise. Adding walking to exercise
does not induce greater improvement in the short-term. Walking may be a less-
expensive alternative to physical exercise in chronic low back pain.(!!! INVALID
CITATION !!! (Vanti et al., 2019))
People with chronic low back pain (CLBP) suffer from weaknesses in their core
muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was
recently developed to treat this condition. IMT can improve respiratory function,
increase core muscle activity, and, consequently, reduce pain intensity in athletes
with CLBP. (Ahmadnezhad et al., 2020)
Aquatic exercise can statistically significantly reduce pain and increase physical
function in patients with low back pain. Further high-quality investigations on a
larger scale are required to confirm the results.(Shi et al., 2018)
Physical therapists may use exercise training interventions, including trunk muscle
strengthening and endurance and specific trunk muscle activation, to reduce pain
and disability for patients with acute LBP with leg pain. Physical therapists use
exercise training interventions, including trunk muscle strengthening and
endurance, multimodal exercise interventions, specific trunk muscle activation
exercise, aerobic exercise, aquatic exercise, and general exercise, for patients with
chronic LBP. Physical therapists may provide movement control exercise or trunk
mobility exercise for patients with chronic LBP. Physical therapists may use
exercise training interventions, including specific trunk muscle activation and
movement control, for patients with chronic LBP with leg pain.(George et al.,
2021)
REVIEW OF LITERATURE:
Fares M Y, Fares J, Salhab H A, et al. (July 11, 2020) conducted a study on Low
Back Pain Among Weightlifting Adolescents and Young Adults. They concluded
that Weightlifting is a common type of sports training that develops the strength
and size of skeletal muscles. Low back pain (LBP) is one of its most common
complaints. This sport has become prevalent among adolescents and young adults
as they work to enhance their physique and body image. The aim of our study is to
explore the nature and cause of LBP in weightlifting adolescents and young adults
in an aim of extrapolating proper preventive measures.Participants were patients
who engaged in weightlifting sports and had presented to our clinic with
nonspecific LBP. They were examined and asked to rate and localize their pain.
Back positioning during weightlifting techniques along with other exercise habits
was explored. Patients with congenital or systemic diseases and fractures were
excluded from our study. A total of 93 patients presented with LBP (age range: 16-
26 years), all of whom partook in weightlifting (N=93). Localized pain was found
in 43 patients (46%). Pain radiating to the left side was found in 31 patients (33%),
while pain radiating to the right was found in 19 patients (21%). LBP localized at
the level of L4-L5 was found in 44 cases (47%), while that localized at L5-S1 was
found in 43 cases (46%). Only six cases localized pain at the level of L3-L4 (7%).
A total of 23 cases required surgery (25%), while others were managed
conservatively. All the participants (100%) reported their pain to be initiated
during or after weightlifting maneuvers. Psychological symptoms were found in 13
cases (19%). Factors that helped relieve the pain included surgery, swimming, and
wearing a back brace. Weightlifting is a sport that utilizes heavy weights to engage
the muscles in the body, and consequently, predisposes athletes to LBP. Using
excessive weights and performing improper techniques puts the back in a
compromising position that may lead to injury. Medical and sports personnel
should raise awareness on the biomechanical properties of the lumbar spine and the
correct spine-protective posture during training to help prevent these injuries in the
future. (Fares et al., 2020)
 Farahbakhsh, Farzin et al. In 2018 made a systematic review on ‘Prevalence of
Low Back Pain Among Athletes" and concluded The prevalence of low back pain
(LBP) in athletes across a variety of time frames and sports is not known.
OBJECTIVES: To systematically collate and appraise studies on the prevalence of
LBP in athletes and stratify by point, one year and life-time prevalence. A
comprehensive search was conducted in February 2016. The following sources
were individually searched: PubMed (1950 to present), Ovid SP Medline (1950 to
present), ISI (1982 to present) and Google Scholar; Surveys were included if they
aimed to report the prevalence of LBP amongst the athletes. Two reviewers
independently evaluated the methodological quality of the studies.The literature
search generated 4379 records. Title and/or abstracts were reviewed by two
investigators and full-texts of 201 relevant articles were selected for further
evaluation. Studies were included if they reported the prevalence of LBP in an
athletic population (any level of participation in sports and any age range) and
were written in English. Furthermore, to adequately assess the prevalence rate,
studies had to report the number of athletes with LBP as a percentage of the total
number of athletes. Studies that did not contain necessary data to calculate
prevalence rate including case reports and non-original studies were excluded and
41 studies entered the bias assessment step. A bias assessment was applied to the
methodology of 41 studies, and 36 with low to moderate risk for bias were
included in this review. LBP in athletes was shown to have a point prevalence
ranging from 10% to 67%, a one-year prevalence ranging from 17% to 94%, and a
life-time prevalence ranging from 33% to 84%. The highest prevalence of LBP
was found among skiers, floorball players and rowers and the lowest were found in
shooters, golfers and triathletes.Like general population, LBP is quite prevalent
among athletes. There is a lack of sound data on the prevalence and mechanism of
LBP in some popular sports such as volleyball, swimming and track and field. The
lack of standardization of research methods and outcome measurement tools are
significant problems in literature. Researchers need to use standard and
internationally acceptable definitions for LBP and related functional disability.
Investigators are encouraged to conduct epidemiologic studies, along with search
for possible mechanism of LBP, by recruitment of large sample population of the
athletes who are selected through randomization of the national population and
adopt recent recommendations for a standard definition of LBP.(Farahbakhsh et
al., 2018)
 Wilson F, Ardern CL, et al conducted a study on Prevalence and risk factors for
back pain in sports in 2021 aimed to determine the prevalence of low back pain
(LBP) in sport, and what risk factors were associated with LBP in athletes.Design
Systematic review with meta-analysis. Data sources Literature searches from
database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing
and Allied Health Literature (CINAHL), Web of Science and Scopus,
supplemented by grey literature searching.Eligibility criteria Studies evaluating
prevalence of LBP in adult athletes across all sports. Results are Eighty-six studies
were included (30 732, range 20–5958, participants), of which 45 were of ‘high’
quality. Definitions of LBP varied widely, and in 17 studies, no definition was
provided. High-quality studies were pooled and the mean point prevalence across
six studies was 42%; range 18%–80% (95% CI 27% to 58%, I2=97%). Lifetime
prevalence across 13 studies was 63%; range 36%–88% (95% CI 51% to 74%,
I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%–
94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by
participant numbers, study quality and methodologies, and varying LBP
definitions. Risk factors for LBP included history of a previous episode with a
pooled OR of 3.5; range 1.6–4.0 (95% CI 1.9 to 6.4). Statistically significant
associations were reported for high training volume, periods of load increase and
years of exposure to the sport. Conclusion is LBP in sport is common but estimates
vary. Current evidence is insufficient to identify which sports are at highest risk. A
previous episode of LBP, high training volume, periods of load increase and years
of exposure are common risk factors.(Wilson et al., 2021)
Maselli, F., Storari, L., Barbari, V. et al. Prevalence and incidence of low back
pain among runners. Running is one of the most popular sports worldwide. Despite
low back pain (LBP) represents the most common musculoskeletal disorder in
population and in sports, there is currently sparse evidence about prevalence,
incidence and risk factors for LBP among runners. The aims of this systematic
review were to investigate among runners: prevalence and incidence of LBP and
specific risk factors for the onset of LBP.A systematic review has been conducted
according to the guidelines of the PRISMA statement. The research was conducted
in the following databases from their inception to 31st of July 2019: PubMed;
CINAHL; Google Scholar; Ovid; PsycINFO; PSYNDEX; Embase; SPORTDiscus;
Scientific Electronic Library Online; Cochrane Library and Web of Science. The
checklists of The Joanna Briggs Institute Critical Appraisal tools were used to
investigate the risk of bias of the included studies. Nineteen studies were included
and the interrater agreement for full-text selection was good (K = 0.78; 0.61–0.80
IC 95%). Overall, low values of prevalence (0.7–20.2%) and incidence (0.3–22%)
of LBP among runners were reported. Most reported risk factors were: running for
more than 6 years; body mass index > 24; higher physical height; not performing
traditional aerobics activity weekly; restricted range of motion of hip flexion;
difference between leg-length; poor hamstrings and back flexibility. Prevalence
and incidence of LBP among runners are low compared to the others running
related injuries and to general, or specific population of athletes. View the low
level of incidence and prevalence of LBP, running could be interpreted as a
protective factor against the onset of LBP.(Maselli et al., 2020)
M. K. Rossi et Al, in 2018 conducted a study on "Incidence and risk factors
for back pain in young floorball and basketball players and concluded that The aim
of this study was to investigate the incidence of back pain in young basketball and
floorball players under 21 years of age. The secondary aim was to examine risk
factors especially for low back pain (LBP). Nine basketball and nine floorball
teams (n = 396) participated in this prospective follow-up study (2011-2014).
Young athletes (mean age 15.8 ± 1.9) performed physical tests and completed a
questionnaire at baseline. The follow-up lasted 1-3 years per player. During the
follow-up, back pain reported by the players was registered on a weekly basis and
verified by a study physician. The exposure time (AE) on team practices and
games was recorded by the coach. Altogether back pain was reported 61 times by
51 players. The incidence of back pain was 87 per 1000 athlete-years and 0.4 per
1000 hours of AE. Hamstrings, quadriceps and iliopsoas extensibility and general
joint hypermobility were not associated with LBP. Furthermore, no association
between LBP and leg extension strength or isometric hip abduction strength
asymmetry was found in these young basketball and floorball players. In
conclusion, back pain can lead to a considerable time-loss from training and
competition among young basketball and floorball players and the pain tends to
reoccur. Lower extremity muscle extensibility, general joint hypermobility or
investigated lower extremity strength measures were not associated with the risk of
LBP.(Rossi et al., 2018)
Jane S Thornton et Al, conducted a research on "Treating low back pain in
athletes" to summarise the evidence for non-pharmacological management of low
back pain (LBP) in athletes, a common problem in sport that can negatively impact
performance and contribute to early retirement. Five databases (EMBASE,
Medline, CINAHL, Web of Science, Scopus) were searched from inception to
September 2020. The main outcomes of interest were pain, disability and return to
sport (RTS). Among 1629 references, 14 randomised controlled trials (RCTs)
involving 541 athletes were included. The trials had biases across multiple
domains including performance, attrition and reporting. Treatments included
exercise, biomechanical modifications and manual therapy. There were no trials
evaluating the efficacy of surgery or injections. Exercise was the most frequently
investigated treatment; no RTS data were reported for any exercise intervention.
There was a reduction in pain and disability reported after all
treatments.Conclusions is While several treatments for LBP in athletes improved
pain and function, it was unclear what the most effective treatments were, and for
whom. Exercise approaches generally reduced pain and improved function in
athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the
value of manual therapy (massage, spinal manipulation) or biomechanical
modifications alone could be drawn because of insufficient evidence. High-quality
RCTs are urgently needed to determine the effect of commonly used interventions
in treating LBP in athletes.(Thornton et al., 2021)
Fett D, Trompeter K, (2019) studied Prevalence of back pain in a group of
elite athletes exposed to repetitive overhead activity. The prevalence of back pain
in athletes has been investigated in several studies, but there are still under- or
uninvestigated sports discipline like sports exposed to repetitive overhead activity.
Elite athletes spend much time in training and competition and, because of the
nature of their disciplines, subject their bodies to a great deal of mechanical strain,
which puts a high level of stress on their musculoskeletal systems. From this it is
hypothesized that elite athletes who engage in repetitive overhead motions
experience a higher strain on their spine and thus possibly a higher prevalence of
back pain compared with an active control group. To examine the prevalence of
back pain and the exact location of pain in a cohort of elite athletes with repetitive
overhead activity and in a control group of physically active sport students.
Additionally, to examine different characteristics of pain, and to evaluate the
influence of confounders on back pain. A standardized and validated online back
pain questionnaire was sent by the German Olympic Sports Confederation to
German national and international elite athletes, and a control group of physically
active but non-elite sports students.The final sample comprised 181 elite athletes of
the sports disciplines badminton, beach volleyball, handball, tennis and volleyball
and 166 physically active controls. In elite athletes, lifetime prevalence of back
pain was 85%, 12-month prevalence was 75%, 3-month prevalence was 58% and
point prevalence was 38%; for the physically active control group, these
prevalences were 81%, 70%, 59% and 43%, respectively. There was no significant
group difference in prevalence over all time periods. The lower back was the main
location of back pain in elite athletes across all disciplines and in controls;
additionally a distinct problem of upper back pain was found among volleyball
players. Despite the high mechanical load inherent in the sport disciplines included
in this study, the elite athletes who engaged in repetitive overhead activities did not
suffer more from back pain than the physically active controls. This suggests that
other mechanisms may be influencing back pain prevalences in a positive way in
these athletes. Furthermore, these disciplines may practice preventive factors for
back pain that outweigh their detrimental factors. Therefore, we posit that
extensive prevention work is already being implemented in these sports and that
there are additional individual protection factors in play. More research is required
to explore these suppositions, and should include investigations into which
preventive training programs are being used. Nevertheless, in volleyball
particularly, a focus on stabilization/preventive training should be applied to the
upper back and neck.(Fett et al., 2019)
Ball, J.R., et al. In 2019 studied "Lumbar Spine Injuries in Sports" and
concluded Low back pain is one of the most prevalent complaints of athletes at all
levels of competition. The purpose of this literature review is to provide an
overview of sport-specific injuries and treatment outcomes that can be used by
healthcare providers to better recognize injury patterns and treatment options for
different groups of athletes. To our knowledge, no prior comprehensive review of
lumbar spine injuries in sports is currently available in the literature, and it is
essential that healthcare providers understand the sport-specific injury patterns and
treatment guidelines for athletes presenting with low back pain following an
athletic injury. Injury mechanisms were found to vary significantly by sport,
although some broad recommendations can be made with regards to optimal
treatment for these injuries and return to play. Additionally, it was found that
certain treatments were more beneficial and resulted in higher rates of return to
play depending on the specific sport of the injured athlete. Healthcare providers
need to be aware of the different injury patterns seen in specific sports in order to
properly evaluate and treat these injuries. Furthermore, an individualized treatment
plan needs to be selected in a sport-specific context in order to meet the needs of
the athlete in the short and long term.(Ball et al., 2019)
 Ramdas, Jella, et Al, studied Prevalence and risk factors of low back pain.
Detailed demographic picture was taken from all the patients which included the
age, gender, smoking and alcoholic status, socio economic status, travelling, type
of work, hours at work. Type and duration of sport, history of previous LBP, the
intensity of pain, way it is relieved, duration of pain, i.e. the frequency of pain in a
day are also taken into account. The most common age group to be affected among
the males was 31-40 years of age, where 38.6% were affected, while amongst the
female the most common age group to be affected was 41-50 years with 38.1%.
Most of the patients has strenuous physical exercise on daily basis for long period
of time (70.9%). 58.3% patients were under stress and anxiety, while 56.3% lifted
heavy weights regularly. 44.7% persons were either overweight or obese and had
LBP due to the excess weight, while 28.6% had LBP due to sitting for long
periods. This study shows that lower back pain is prevalent among all the age
groups, especially among the younger adults. Identification of predisposing factors
among the individuals which cause LBP can lead to diagnosing the condition at the
earliest and preventing chronic pain, thereby improving the quality of life.
Amr Chaabeni, Amine Kalai, et Al conducted a cross sectional study on
Prevalence and Associated Factors of Low Back Pain among Adolescent Athletes
from an Athletics Club. Low back pain (LBP) in adolescent athletes may lead to a
significant lost playing time and thus reduce their performance and compromise
their career. The aim of our study was to determine the one-year prevalence of
LBP and its associated factors in adolescent athletes. Methods: A cross-sectional
study including adolescent athletes from a Tunisian athletics club. LBP prevalence
and circumstances were noticed. Training characteristics and flexibility of the
lumbar spine and lower extremities were studied. Results: We included 141 young
athletes with a mean age of 16.42 ± 1.76 years. The sex ratio was 1.23. Athletes
practiced 3 types of sports: running (n = 67), throwing (n = 42) and jumping (n =
32). The average length of sport practice was 4 ± 2 years. The one-year prevalence
of LBP was 60.2%. Athletes with LBP history were older (p = 0.004) and had a
higher BMI (p = 0.003) and poorer spinal flexibility (p = 0.008) than athletes with
no LBP. The practice duration was not significantly different between the two
groups. Athletes practicing throwing sports had higher prevalence of LBP (73.8%)
than those practicing running (56.7%) and jumping (50%) without statistical
significance (p = 0.083). The main circumstance of LBP onset was “an intense
training session”. Quadriceps tightness was an associated factor with LBP only for
adolescents practicing jumping (p = 0.026). In conclusion, prevalence of LBP in
adolescent athletes remains high. Older age, high BMI, high practicing years and
poor spine flexibility seem to be associated with the onset of LBP. Further high-
quality studies assessing more epidemiological, anatomical and sports
characteristics are still needed.
Sumbul Ansari et Al (2022) studied Prevalence and risk factors of chronic
low back pain in university athletes to establish the prevalence of chronic low back
pain (CLBP) in university-level athletes and to examine the influence of age, sex,
body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP.
The secondary purpose was to check the association of certain variables in athletes
having CLBP with the sports discipline and chronicity of LBP. A total of 340
players (100% response rate) from different sports, aged 18–30 years with at least
1 year of participation in sports at the university level were screened for the present
study. The subjects completed a detailed, semi-structured questionnaire that
gathered data regarding their demographic variables, personal and pain-related
factors. The study was registered on the clinical trials registry, India
(CTRI/2021/09/036675).The results revealed the sport-wise point prevalence as
follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%),
badminton (7.7%) and tennis (7.7%). A higher number of years at university-level
participation (>4 years), smoking, anxiety and BMI (>25 kg/m2) are risk factors
for CLBP. The type of LBP, the intensity of the pain (current and last week),
variation of the pain intensity, disability, intake of oral medications, physiotherapy
for CLBP, number of missed days of training and number of missed matches are
not significantly related to the chronicity of LBP or the sports discipline. Only the
number of missed days of training had a significant association with the chronicity
of LBP.CLBP is a common complaint in Indian university athletes, and our
findings indicate the necessity for a specific prevention program.
Abdulrahman Omar Albasseet et Al conducted a study on Prevalence of
Low Back Pain Among athletes in Riyadh, Saudi Arabia. The purpose of this
qualitative research was to understand the ubiquity and prevalence of low back
pain among athletes in Riyadh, Saudi Arabia.The study involved 371 participants
enrolled from three units; gyms, sports centers, and public places. The study took
place between May 2022 and August 2022. Self-administered questionnaires with
questions on demographics and a standardized scale (Standardized Nordic
questionnaires for the analysis of musculoskeletal symptoms) were used. Data
collection was exercised by trained research assistants pre-trained by the research
team. All the questions administered were standardized to enable respondents to
receive duplicate questions with identical wording. The participants had a mean
age of 26.9 years ± 7.69. Demographic: Gender (M, 193; 52%. F, 178; 48%). BMI
(Under, 15; 4.1%, Normal, 184; 184; 49.69%, Overweight, 128; 34.7% and Obese
42; 11.4%). smoking, (yes 114; 30.71%, No 234; 63.1%, ex 23; 6.2%). Nationality,
(Saudi, 288; 77.6%, Non-Saudi; 88; 22.4%). Prevalence of back pain: Once in a
lifetime, (305; 82.2%, never, 66; 17.8 %,) last twelve months (158; 42.6%, no pain,
213; 57.4%) past seven days (yes 106; 28.6%, no pain in 265; 71.4 %.) p = 0.028),
Associated factors: feeling sad (0.002) uncomfortable furniture (p = 0.005), and
gender (p < 0.001). Exercise duration and frequency exercising (p < 0.017) (p <
0.052) and Weightlifting (p < 0.065). Back pain is a relatively common complaint
experienced by people and is more common among athletes. Besides exercising, it
is evident that uncomfortable sleeping conditions, mental well-being, and gender
play a big role in spawning back pain.
Shahbandi A, Farahbakhsh F, et Al conducted a research on Spinal Pain
Prevalence and Characteristics Among Male Athletes with Disabilities. Chronic
pain is a serious secondary problem for many individuals with disabilities. 231
disabled athletes invited to compete in a multi-sport national sports tournament for
para-athletes in Ahvaz, Iran, participated in the study to be investigated whether
spinal pain (SP) prevalence and characteristics are different among different sports
and disabilities. Athletes’ demographic information, SP prevalence and
characteristics, and disability using Athlete Disability Index (ADI) Questionnaire
were obtained. SP prevalence, characteristics, and factors affecting SP intensity
and disability caused by low back pain (LBP) were determined as primary outcome
measures before data collection. The mean disability percentage and LBP intensity
score were 22.2% (19.2-25.3) and 2.14 (1.84-2.47) of 10, respectively. The highest
LBP intensity was among physical fitness participants and patients with spinal
lesions. Weight lifting athletes and athletes with arm movement limitation had the
highest disability. The mean neck pain intensity score was 2.16 (1.80-2.54). A high
prevalence of SP was observed among most disabilities and sports. Although its
intensity is rarely severe among a population of any disability or sports, it is
undeniably disabling among the vulnerable population of para-athletes.(Müller et
al., 2016)
Kinshi Kato, et Al in 2022 did a research on the prevalence and clinical
characteristics of sacroiliac joint dysfunction in adolescent baseball players. This
study aimed to investigate the prevalence and clinical characteristics of SIJ
dysfunction among high school baseball players.Participants comprised 891 high
school baseball players who had undergone annual medical evaluations (a self-
completed questionnaire and physical examination). The prevalence of SIJ
dysfunction and associations with the measurements of the flexibility of the spine
and lower extremities such as finger-floor-distance, straight-leg-raising angle,
heel–buttock-distance, Thomas test, and passive range of motion of the hip were
investigated Twenty-two of 891 subjects (2.5%) met our criteria for SIJ
dysfunction. Twelve subjects (55%) exhibited throwing arm side symptoms more
commonly than in the non-throwing arm side (n = 3, 15%) or bilateral side (n = 7,
32%). Previous episodes of LBP were experienced significantly more frequently
among subjects with SIJ dysfunction (n = 19, 86.4%) than among those without (n
= 501, 57.7%; P = 0.015). The prevalence of present LBP that interfered with play
was significantly higher among subjects with SIJ dysfunction (n = 9, 42.9%) than
among those without (n = 118, 21.2%; P = 0.038). The prevalence of SIJ
dysfunction as a source of LBP was estimated at 7.1% (9 of 127 subjects). After
adjustment for associated factors using a logistic regression model, we observed a
significant association between a limitation in hip internal rotation on the throwing
arm side and SIJ dysfunction (odds ratio 3.11 [1.30–7.71]; P = 0.0109).According
to our criteria, the estimated prevalence of SIJ dysfunction among high school
baseball players is 2.5%. There was a significant association between a limitation
in hip internal rotation on the throwing arm side and SIJ dysfunction.(Kato et al.,
2022)
. (!!! INVALID CITATION !!! (Vanti et al., 2019)).

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