Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 17, Issue 9, pp 1125–1134 | Cite as

Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study

  • Adad BarantoEmail author
  • Mikael Hellström
  • C.-G. Cederlund
  • Rickard Nyman
  • Leif Swärd
Sports Medicine


A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly selected, for a baseline MRI study. After 15 years all the participants at baseline were invited to take part in a follow-up examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes had disc height reduction at one or several disc levels. Disc degeneration was found in more than 90% of the athletes and deterioration had occurred in 88% of the athletes, with the highest frequency in weight lifters and ice-hockey players. 78% of the athletes and 38% of the non-athletes reported previous or present history of back pain at baseline and 71 and 75%, respectively at follow-up. There was no statistically significant correlation between back pain and MRI changes. In conclusion, athletes in sports with severe or moderate demands on the back run a high risk of developing disc degeneration and other abnormalities of the spine on MRI and they report high frequency of back pain. The study confirmed our hypothesis, i.e. that most of the spinal abnormalities in athletes seem to occur during the growth spurt, since the majority of the abnormalities demonstrated at follow-up MRI after the sports career were present already at baseline. The abnormalities found at young age deteriorated to a varying degree during the 15-year follow-up, probably due to a combination of continued high load sporting activities and normal ageing. Preventive measures should be considered to avoid the development of these injuries in young athletes.


Adolescence Athletes Back pain Disc degeneration MRI Spine 



The authors acknowledge the financial support of The Medical Society of Göteborg, Sweden, Trygg-Hansa insurance company, The Research Council of the Swedish Sports Confederation (Centrum för idrottsforskning), Swedish Society of Spinal Surgeons/4S and Government grants under the LUA/ALF agreement. The authors acknowledge the assistance of the statistical advisor Anders Odén, PhD, Romelanda, Sweden. The authors thank radiology nurse P-A Svensson, Department of Radiology at Queen Silvia’s Children’s Hospital, Sahlgrenska University Hospital, Göteborg. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden. The experiments comply with the current laws in Sweden.


  1. 1.
    Alexander J (1976) Effect of growth rate on the strength of the growth plate-shaft function. Skeletal Radiol 1:67–76. doi: 10.1007/BF00347732 CrossRefGoogle Scholar
  2. 2.
    Bahr R, Andersen SO, Loken S et al (2004) Low back pain among endurance athletes with and without specific back loading—a cross-sectional survey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine 29:449–454. doi: 10.1097/01.BRS.0000096176.92881.37 PubMedCrossRefGoogle Scholar
  3. 3.
    Baranto A, Hellström M, Nyman R et al (2006) Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc 14:907–914. doi: 10.1007/s00167-005-0032-3 PubMedCrossRefGoogle Scholar
  4. 4.
    Caine D, Lindner K (1985) Overuse injuries of growing bones: the young female gymnast at risk? Physician Sports Med 13:51–64Google Scholar
  5. 5.
    Eriksson K, Nemeth G, Eriksson E (1996) Low back pain in elite cross-country skiers. A retrospective epidemiological study. Scand J Med Sci Sports 6:31–35PubMedCrossRefGoogle Scholar
  6. 6.
    Fairbank JC, Couper J, Davies JB et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  7. 7.
    Goldstein JD, Berger PE, Windler GE et al (1991) Spine injuries in gymnasts and swimmers. An epidemiologic investigation. Am J Sports Med 19:463–468. doi: 10.1177/036354659101900507 PubMedCrossRefGoogle Scholar
  8. 8.
    Granhed H, Morelli B (1988) Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med 16:530–533. doi: 10.1177/036354658801600517 PubMedCrossRefGoogle Scholar
  9. 9.
    Group E (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208. doi: 10.1016/0168-8510(90)90421-9 CrossRefGoogle Scholar
  10. 10.
    Harvey J, Tanner S (1991) Low back pain in young athletes. A practical approach. Sports Med 12:394–406. doi: 10.2165/00007256-199112060-00005 PubMedCrossRefGoogle Scholar
  11. 11.
    Hellström M, Jacobsson B, Swärd L et al (1990) Radiologic abnormalities of the thoraco-lumbar spine in athletes. Acta Radiol 31:127–132PubMedCrossRefGoogle Scholar
  12. 12.
    Jackson DW (1979) Low back pain in young athletes: evaluation of stress reaction and discogenic problems. Am J Sports Med 7:364–366. doi: 10.1177/036354657900700614 PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson DW, Wiltse LL, Cirincoine RJ (1976) Spondylolysis in the female gymnast. Clin Orthop Relat Res (117):68–73Google Scholar
  14. 14.
    Kjaer P, Leboeuf-Yde C, Korsholm L et al (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180. doi: 10.1097/01.brs.0000162396.97739.76 PubMedCrossRefGoogle Scholar
  15. 15.
    Kozar B, Lord R (1983) Overuse injury in the young athlete: reasons for concern. Phys Sportsmed 11:116–122Google Scholar
  16. 16.
    Kujala UM, Kinnunen J, Helenius P et al (1999) Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis. Eur Spine J 8:480–484. doi: 10.1007/s005860050209 PubMedCrossRefGoogle Scholar
  17. 17.
    Kujala UM, Taimela S, Erkintalo M et al (1996) Low-back pain in adolescent athletes. Med Sci Sports Exerc 28:165–170. doi: 10.1097/00005768-199602000-00002 PubMedGoogle Scholar
  18. 18.
    Lundin O, Hellström M, Nilsson I et al (2001) Back pain and radiological changes in the thoraco-lumbar spine of athletes. A long-term follow-up. Scand J Med Sci Sports 11:103–109. doi: 10.1034/j.1600-0838.2001.011002103.x PubMedCrossRefGoogle Scholar
  19. 19.
    Modic M, Masaryk T, Ross J et al (1988) Imaging of degenerative disc disease. Radiology 168:177–186PubMedGoogle Scholar
  20. 20.
    Mooney V, Cairns D, Robertson J (1976) A system for evaluating and treating chronic back disability. West J Med 124:370–376PubMedGoogle Scholar
  21. 21.
    Sassmannshausen G, Smith BG (2002) Back pain in the young athlete. Clin Sports Med 21:121–132. doi: 10.1016/S0278-5919(03)00061-9 PubMedCrossRefGoogle Scholar
  22. 22.
    Schmorl G, Junghanns H (1971) The human spine in health and disease. Editor Grune and Stratton, New YorkGoogle Scholar
  23. 23.
    Swärd L, Hellström M, Jacobsson B et al (1990) Acute injury of the vertebral ring apophysis and intervertebral disc in adolescent gymnasts. Spine 15:144–148. doi: 10.1097/00007632-199002000-00021 PubMedCrossRefGoogle Scholar
  24. 24.
    Swärd L, Hellström M, Jacobsson B et al (1991) Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine 16:437–443. doi: 10.1097/00007632-199104000-00009 PubMedCrossRefGoogle Scholar
  25. 25.
    Swärd L, Hellström M, Jacobsson B et al (1990) Back pain and radiologic changes in the thoraco-lumbar spine of athletes. Spine 15:124–129. doi: 10.1097/00007632-199002000-00015 PubMedCrossRefGoogle Scholar
  26. 26.
    Tertti M, Paajanen H, Kujala UM et al (1990) Disc degeneration in young gymnasts. A magnetic resonance imaging study. Am J Sports Med 18:206–208. doi: 10.1177/036354659001800216 PubMedCrossRefGoogle Scholar
  27. 27.
    Videman T, Sarna S, Battie MC et al (1995) The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine 20:699–709PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Adad Baranto
    • 1
    Email author
  • Mikael Hellström
    • 2
  • C.-G. Cederlund
    • 3
  • Rickard Nyman
    • 4
  • Leif Swärd
    • 1
  1. 1.Department of OrthopaedicsUniversity of Gothenburg and Sahlgrenska University HospitalGöteborgSweden
  2. 2.Department of RadiologyUniversity of Gothenburg and Sahlgrenska University HospitalGöteborgSweden
  3. 3.Department of RadiologyHalmstad HospitalHalmstadSweden
  4. 4.Department of RadiologyUppsala UniversityUppsalaSweden

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