Prevalence and incidence of low back pain among runners: a systematic review
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Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343
https://doi.org/10.1186/s12891-020-03357-4
RESEARCH ARTICLE Open Access
Prevalence and incidence of low back pain
among runners: a systematic review
Filippo Maselli1,2* , Lorenzo Storari1, Valerio Barbari1, Andrea Colombi1, Andrea Turolla3, Silvia Gianola4,
Giacomo Rossettini1 and Marco Testa1
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Systematic review registration: PROSPERO CRD42018102001.
Keywords: Low Back pain, incidence, Prevalence, Running
* Correspondence: masellifilippo76@gmail.com
1
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and
Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of
Savona, Savona, Italy
2
Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
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permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 2 of 25
Keypoints and requiring therapeutic assistance [20]. Currently a
definition of RRIs is not yet fully share [20], this is
Prevalence and incidence of LBP among runners reflected in the difficulty of analyzing the studies about
seem basically low if compared with general of RRIs [18]. RRIs therefore primarily affect joints of the
population and other popular sports activities; lower limb, pelvis and lumbar spine [18, 25, 26], causing
Running could, cautiously, be considered a painful muscles, tendons and joints, often resulting in
protective factor for the lumbar spine; low back pain (LBP) [14–26]. It is frequent in clinical
Risk factors for the onset of LBP are generally practice [27–33], that patients contact physical therapists
physical impairments or training methods-related for consultancy on LBP which represents a common
factors that could be partly modified and managed complaint of athletes [27–33]. In the 90% of the cases,
in clinical practice; LBP is defined as non-specific, because the patho-
Scarcity and methodological weakness of the anatomical musculoskeletal causes are not clearly identi-
available studies invite to conduct further research fiable [34]. LBP is one of the most common health prob-
about actual prevalence and incidence as well as risk lems in the world, that 80% of adults experience at some
factors for LBP among runners; point in their life [35, 36]. Despite many published stud-
LBP may be better defined as Running Related ies on the prevalence and incidence of LBP, there is not
Disorder instead of Running Related Injury. a clear consensus regarding its actual epidemiologic im-
pact [37–40]. Indeed, some evidence reported a point
Background prevalence estimate of LBP that ranged from 1 to 58%
Running is one of the most practiced sports in the adult (mean 18.1%) [39, 40]. One-year and lifetime’s preva-
population worldwide, due to the sustainable cost of lence of LBP in the general worldwide population,
technical materials and its great beneficial impacts on ranged between 0.8–82.5% (mean 38,1%) and 11–84%
health [1–11]. The benefits of running include weight (mean 47,1%), respectively [39, 40]. Similarly, regarding
control and prevention of chronic health disorders, such a population of athletes [41], the percentage values of
as the cardiovascular diseases, resulting in a general re- the prevalence of LBP remains wide, namely 1–94% in
duction of mortality risk [1–6]. The health benefits asso- the lifetime (highest prevalence in rowing and cross-
ciated with running are well-documented, nevertheless country skiing) [41], and 18–65% for the point preva-
the attention to lifestyle, diet, fitness and competitive lence (lowest prevalence in basketball and highest preva-
athletics promoted by media in the last decade, have led lence in rowing) [41].
to a drastic increase of the levels of physical activity and As seen in the general population, a big amount of
interest in both competitive and recreational running, athletes also experiences LBP [41–48]. Moreover, ath-
even in subjects without an appropriate knowledge on letes of particular sport disciplines such as ski, rowing,
training methodology [3–8]. Although evidence suggests golf, volleyball, track and fields, swimming or gymnastics
that running is one of the most effective ways to achieve are at greater risk of suffering from LBP than non-
a good state of health and fitness [9], recent studies indi- athletes population [33, 41, 43–48]. The incidence rates
cate that it also involves a relatively high risk of associ- of low back pain in athletes have been reported up to
ated injury [10, 11]. Several authors have reported that 30% depending on the specific sport they are involved in
11–85% of recreational runners have at least one Run- [49]. However different authors describe also a great
ning Related Injuries (RRIs) each year [10], resulting in a variability in prevalence rates, that have been reported in
reduction or interruption of training in 30–90% of run- a range from 66% [50, 51] to 88.5%, respectively in
ners [11–13]. Acute RRIs are rare, almost 80% of RRIs young athletes and in elite athletes [52]. The incidence
are due to overuse, resulting from an imbalance between rate constitutes the frequency of new events of a medical
the resistance capacity of connective tissue and the bio- disorder in the studied population considered at risk,
mechanical load of running [14, 15]. The prevalence rate calculated in a given period of time [53]. On the other
of RRIs among middle and long-distance runners has hand, the prevalence proportion is the part (in percent-
been reported to range between 19 and 92% [2, 16–20]. age) of a defined population affected by a particular
However, the discrepancies among studies limit the medical disorder at a given point in time, or over a spe-
comparison of data due to the divergences in the type of cified period of time [53].
runners analyzed, follow-up provided, study design, eti- Despite several studies about the prevalence and inci-
ology and definition of RRIs [1, 2, 14–25]. In 2015, dence of LBP in general population and sports are re-
Yamato et al. [20] defined the RRIs as musculoskeletal trievable [35–41], it seems that this topic has not been
pain or physical complaint of the lower limbs or of the clearly investigated in the runners. Researches are mainly
back/trunk due to running, causing a total restriction or focused on RRIs in general but there are not Systematic
interruption of running for at least seven or more days Reviews (SRs) specifically addressing prevalence,Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 3 of 25
incidence and risk factors for LBP in runners [11, 18]. gluteus/buttock) [56] and the pathoanatomical cause of
Moreover, earlier literature of LBP has been addressed the pain cannot be determined [57]. We selected studies
to a wide range of sports or athletes [31, 54] and no con- published in English or Italian language without limits of
clusive data were published peculiarly on the LBP among date of publication. Descriptive observational designs,
a specific population of runners. For this reason, the such as case report and case series, and any study, which
aims of this systematic review (SR) were to investigate did not meet the inclusion criteria, were excluded.
among runners: 1) the prevalence and the incidence of
LBP; and 2) specific risk factors for the onset of LBP. Study selection
The selection and data collection process were done by
Methods two reviewers (FM and AC) under the supervision of a
Study design and protocol third author (MT). The whole records were screened by
The Preferred Reporting Items for Systematic Reviews the management software for systematic reviews “Rayyan”
and Meta-Analyses (PRISMA) protocol was used to de- (https://rayyan.qcri.org), while references were managed
sign the present SR [55]. This SR has been registered in by the “Mendeley” software (https://www.mendeley.com).
PROSPERO database (number CRD42018102001). After the removal of the duplicates, titles and abstracts
were screened. Then, full-texts of the identified studies
Search strategy were obtained for further assessment and analyzed inde-
An electronic literature search was conducted in the fol- pendently according to the eligibility criteria by two re-
lowing databases from their inception to 31st of July viewers (FM and AC). Where appropriate, authors were
2019: PubMed, CINAHL (EBSCO), Google Scholar, contacted in order to obtain the full-text.
Ovid, PsycINFO, PSYNDEX, Embase, SPORTDiscus,
Scientific Electronic Library Online (SciELO), Cochrane
Data collection
Library and Web of Science. Research strategies were
For each article, the following data was extracted: study
conducted and designed depending on the specific set-
design; author, year of publication; the number and
tings of each database with the supervision of an expert
characteristics of participants/populations; international
librarian. The research strings were developed according
definition and/or any diagnostic criteria for LBP; analysis
to the PICO model of clinical question (participants, in-
of the variables and the outcome of the studies; study
terventions, comparison and outcomes). Free-terms or
settings/country (e.g., marathon, half-marathon, survey,
synonyms (e.g. runners; risk factors; running-related in-
lab analysis); prevalence and incidence rates; interven-
jury), and when possible MeSH (Medical Subject Head-
tion and results; follow-up or study duration; theoretical
ings) terms (e.g. low back pain; prevalence; incidence)
perspectives on potential risk factors on the onset of
were used and combined with Boolean operators (AND,
LBP: reported risk factors; outcomes and measurements
OR, NOT). Additionally, a manual research has been
to associate the risks associated with LBP (e.g., relative
conducted through the bibliographies of all the assessed
risk, odds ratio, etc.).
studies to obtain an integrative cross-references full-text
selection. A dedicated search strategy was prepared for
each database. We have reported the full search strategy Quality assessment
for PubMed in Additional file 1. The Risk of Bias (RoB) of the included studies is ana-
lyzed using the Joanna Briggs Institute Critical Appraisal
Eligibility criteria tools [58] according to the specific study design (e.g.,
All studies were conducted on runners without age limi- prevalence data, cross-sectional studies, case-control
tation. We included any type of study design aiming to studies, prospective studies). In addition, as prevalence
investigate prevalence, incidence or risk factors for LBP data may be sourced from several numbers of study de-
as RRIs (e.g., cross-sectional, case-control, prospective signs, a critical appraisal checklist specifically for preva-
and retrospective cohort studies). Moreover, single lence studies were used. Two independent researchers
cohort designs were also considered. Runners of any (FM, LS) evaluated the RoB. The score of RoB was not
kind of experience or mileage were included, whereas adopted as criteria to include/exclude studies in this
sprinters and track and field athletes were not consid- review.
ered. We defined as RRI any occurrence severe enough
to avoid or even restrict the running activity for at least Agreement
24 h. We selected studies reporting at least one anatom- Cohen’s Kappa (K) was used to assess the interrater
ical area included in LBP definition such as area located agreement between the two authors (FM, AC) for full-
below the margin of the 12th rib and above inferior glu- text selection (K = 0.78; 0.61–0.80 IC 95%). Cohens’ K
teal fold (included: pelvis/pelvis crest, sacrum and was interpreted according to Altman’s definition: k <Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 4 of 25
Fig. 1 PRISMA 2009 flow diagram
0.20 poor, 0.20 < k < 0.40 fair, 0.41 < k < 0.60 moderate, Results
0.61 < k < 0.80 good, 0.81 < k < 1.00 excellent [59]. Study selection process
Electronic database searches and the identification of
Data analysis additional references yielded 14,575 records, including
We reported the data related to the prevalence, inci- 3952 duplicates that were removed. After screening titles
dence and risk factors for LBP from each study. When and abstracts, 10,564 (including 2 full-text not available)
needed, we estimated data on prevalence, incidence and records were excluded. Then, 59 potentially relevant
risk factors using available data of the included studies. studies were considered eligible for full-text assessment,
We reported the prevalence and incidence percentage resulting in 19 included studies in this SR for quality as-
in table form. sessment, data extraction and analysis. The selectionMaselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 5 of 25
Table 1 Studies Exclusion
First Author, Year Journal, Title Reasons For Exclusion
Aggrawal ND, 1979 Br J Sports Med Data for prevalence, incidence or risk factors running related
A Study of changes in the spine in weight-lifters and other low back injuries are not reported
athletes This study evaluates the spine complaints in weight-lifters
and track and field athletes
Bertelsen ML, 2017 Scand J Med Sci Sports Study design is not included
[24] A framework for the etiology of running-related injuries
Brill PA, 1995 Sports Med Study design is not included
The influence of running patterns on running
injuries.
Buist I, 2010 Am J Sports Med Primary and secondary outcomes are not evaluated
Predictors of running-related injuries in novice runners en-
rolled in
a systematic training program: a prospective cohort study
Burrows M, 2003 Br J Sports Med Primary and secondary outcomes are not evaluated
Physiological factors associated with low bone mineral This study analyzes the BMD (bone mass index) of several
density in female endurance runners body segments after physical exercises
Cai C, 2015 J Orthop Sports Phys Ther Primary and secondary outcomes not evaluated
Low Back and Lower Limb Muscle Performance in Male and This study evaluates some physical test such as muscular
Female Recreational Runners with Chronic Low Back Pain strength and length
Cole AJ, 1995 J Back Musculoskelet Rehabil Data for prevalence, incidence or risk factors running related
Spine injuries in runners: A functional approach low back injuries are not reported
Study design is not relevant
Damsted C, 2019 J Orthop Sports Phys Ther Primary and secondary outcomes are not evaluated.
Preparing for half-marathon: The association between This study evaluates only running-related injuries localized in
changes in weekly running distance and running-related in- the lower limb
juries – does it matter how the running is scheduled?
Fokkema T, 2018 J Sci Med Sport Data for prevalence, incidence or risk factors running related
Prognosis and low back injuries are not reported
prognostic factors of running-related injuries in novice run-
ners: a
prospective cohort study
Franke TPC, 2019 [5] J Orthop Sports Phys Ther Data for prevalence, incidence or risk factors running related
Running Themselves Into the Ground? Incidence, Prevalence, low back injuries are not reported
and Impact of Injury and Illness in Runners Preparing for a This study grouped the data for head, spine and trunk
Half or Full Marathon
Fredericson M, 2007 Sports Med Study design is not included
Epidemiology and aetiology of marathon running injuries
Garbutt G, 1990 [60] Med Sci Sports Exerc Data for prevalence, incidence or risk factors running related
Running speed and spinal shrinkage in runners with and low back injuries are not reported
without low back pain This study analyzes the spinal shrinkage in runners. The
authors consider LBP as an independent of the shrinkage
induced by running
Hamill J, 2009 Res Sports Med Primary and secondary outcomes are not evaluated.
Lower extremity joint stiffness in runners with low back pain This study evaluates the joint stiffness of hip, knee and ankle
in runners with current LBP, resolved LBP and controls
Hespanhol Junior LC, Scand J Med Sci Sports Data for prevalence, incidence or risk factors running related
2016 Health and economic burden of running-related injuries in low back injuries are not reported
runners training for an event: a prospective cohort study
Jacobs S, 1986 Am J Sports Med Primary and secondary outcomes are not evaluated
Injuries to runners: a study of entrants to a
10,000-m race.
Kemler E, 2018 [12] Phys Sportsmed Data for prevalence, incidence or risk factors running related
The relationship between the use of running applications low back injuries are not reported
and running-related injuries
Kluitenberg B, 2013 BMC Public Health Study design is not included
The NLstart2run study: health effects of a running promotion
program in novice runners, design of a prospective cohort
study
Kluitenberg B, 2016 J Sci Med Sport Primary and secondary outcomes are not evaluated.Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 6 of 25
Table 1 Studies Exclusion (Continued)
First Author, Year Journal, Title Reasons For Exclusion
The NLstart2run study: training-related factors associated with This study analyzes the risk factors for running-related injury
running-related injuries in novice runners without referring to specific anatomical sites for each
participant
Lee SP, 2018 Phys Ther Sport Primary and secondary outcomes are not evaluated
Adaptations of lumbar biomechanics after four weeks of The authors report only that incorporating minimalist
running training with minimalist footwear and technique footwear and technique coaching into a
guidance: Implications for running-related lower back pain runners’ training may induce changes in lumbar
biomechanics associated with reduced risk of running related
LBP, without any statistical analysis
Lewis G, 2000 ISMJThe etiology and clinical features of low back pain in Study design is not relevant
distance runners: a review
Linton L, 2018 J Sci Med Sport Data for prevalence, incidence or risk factors running related
Running with injury: a study of UK novice and low back injuries are not reported
recreational runners and factors associated with running
related injury
Lopes AD, 2011 J Physiother Data for prevalence, incidence or risk factors running related
Musculoskeletal pain is low back injuries are not reported
prevalent among recreational runners who are about to This study evaluated the general spine complaints
compete: an observational study of 1049 runners
Nielsen RO, 2019 BMJ Open Study design is not included
The Garmin-RUNSAFE Running Health Study on the aetiology
of runningrelated injuries: rationale and design of an 18-
month prospective cohort study including runners worldwide
Nielsen RO, 2013 [61] Int J Phys Ther Study design is not included
Classifying running-related injuries based upon etiology,
with emphasis on volume and pace
Noormohammadpour Eur Spine J Data for prevalence, incidence or risk factors running related
P, 2015 Low back pain status of female university students in relation low back injuries are not reported
to different sport activities This study evaluates the LBP status in 9 sports, but not
among runner
Ogon M, 1999 Foot Ankle Int Primary and secondary outcomes are not evaluated
Does arch height affect impact loading at the lower back
level in running?
Oliveira RR, 2017 Int J Sports Phys Ther Primary and secondary outcomes are not evaluated
There are no biomechanical differences between runners This study evaluates the timing of TrA (transversus abdominis
classified by the functional movement screen muscle) activation and the sit and reach test such as possible
factors for LBP development
Preece SJ, 2016 Gait Posture Primary and secondary outcomes are not evaluated
How do elite endurance runners alter movements of the This study analyzes some cinematics parameters of the spine
spine and pelvis as running speed increases? and pelvis without any consideration for LBP
Sado N, 2017 Sports Biomech Primary and secondary outcomes are not evaluated
The three-dimensional kinetic behaviour of the pelvic rotation This study analyzes the lumbosacral cinematic to improve
in maximal sprint running the sprint performance in running
Schafer WE, 1985 Stress Health Data for prevalence, incidence or risk factors running related
Life changes, stress, injury and illness in adult runners low back injuries are not reported
Scheer BV, 2011 [62] Clin J Sport Med Data for prevalence, incidence or risk factors running related
Al Andalus Ultra Trail: an observation of medical interventions low back injuries are not reported
during a 219-km, 5-day ultramarathon stage race
Seay JF, 2014 Eur J Sport Sci Data for prevalence, incidence or risk factors running related
Trunk bend and twist coordination is affected by low back low back injuries are not reported
pain status during running This study analyzes the differences in trunk sagittal
kinematics between 3 groups of runners, with current LBP,
resolved LBP or controls
Smits DW, 2018 Res Sports Med Data for prevalence, incidence or risk factors running related
Validity of injury self-reports by novice runners: comparison low back injuries are not reported
with reports by sports medicine physicians This study examines the criterion validity of self-reported run-
ning related injuries, compared to an injury consultation by a
sport medicine physician
Sugisaki N, 2011 Int J Sport Health Sci Primary and secondary outcomes are not evaluatedMaselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 7 of 25
Table 1 Studies Exclusion (Continued)
First Author, Year Journal, Title Reasons For Exclusion
The Relationship between 30-m Sprint Running Time and
Muscle Cross-sectional Areas of the Psoas Major and Lower
Limb Muscles in Male College Short and Middle Distance
Runners
Tam N, 2018 J Sports Sci Primary and secondary outcomes are not evaluated
Bone health in elite Kenyan runners
Tauton JE, 2002 Br J Sports Med Data for prevalence, incidence or risk factors running related
A retrospective case-control analysis of 2002 running injuries low back injuries are not reported
This study evaluates the running-related injury in athletes of
different sports such as cycling, swimming, weight-lifting, etc.
who referred to had an injury during running activity
Villavicencio AT, 2006 Neurosurg Focus Data for prevalence, incidence or risk factors running related
Back and neck pain in triathletes low back injuries are not reported
The study population is triathlon athletes
Wen DY, 2007 Curr Sports Med Rep Study design is not included
Risk Factors for Overuse Injuries
in Runners
Winter SC, 2018 J Phy Fit Treatment & Sports Primary and secondary outcomes are not evaluated.
Centre of Mass Acceleration-Derived Variables Detects Differ- This study evaluates the differences in running movements
ences between Runners of Different Abilities and Fatigue- using a wireless accelerometers
Related Changes during a Long Distance Over ground Run
Winter SC, 2019 Res Sports Med Data for prevalence, incidence or risk factors running related
Overuse injuries in runners of different abilities-a one-year low back injuries are not reported
prospective study. This study provides the total amount of injuries for the
groups of running level. The single anatomical site of injury
for each runner was not included
process is described in Fig. 1 according to the PRISMA had low and, less commonly, unclear RoB [63–68]. How-
Statement [55]. Reasons for exclusions are reported in ever, among them, in the study of Marti et al. [68], the
Table 1. item related to the criteria for inclusion was rated as
high risk, likewise the item about the reliability of the
Characteristics of the included studies condition measurement in the study of Chang et al. [67].
The 19 included studies were: cross-sectional (n = 6) For retrospective studies [69–71] there was a low RoB
[63–68]; retrospective (n = 3) [69–71]; and prospective across all the studies, apart from comparability of
(n = 10) [72–81]. They were all published in English, groups, matching of cases and controls, adoption of the
starting from 1981 [69] to 2019 [66, 80]. Overall, follow- same criteria for identification of case and controls and
ups or time duration of these studies ranged from 6 methods to measure the exposure in 3 studies [69–71],
weeks [76] to 2 years [79], while sample sizes varied from which were all rated as not applicable. Finally, for pro-
a minimum of 4059 to a maximum of 4380 participants spective studies [72–81], in 6 studies [71, 73–76, 79]
[66]. The characteristics of included studies are reported items related to the similarity/recruitment of groups,
in Table 2. methods of exposure were rated as not applicable. Also
were judged as not applicable the items related to the
Risk of Bias of the included studies time of follow-up and loss to follow-up in the study of
Details of the RoB of the included studies are presented Back et al. [72]. Moreover, in 3 studies [72, 74, 78] the
in Tables 3, 4, 5 and 6. Most items of all RoB assessment item about strategies to address incomplete follow up
tools used for the quality assessment were rated as low was evaluated as not applicable, whereas the remaining
risk. For all the studies addressing prevalence data re- items were commonly judged as low RoB.
gardless of the study design [63–65, 67, 68, 70, 81], the
items rated as unclear RoB were related to the sampling Summary of findings
methods in 3 studies [63, 65, 70], while in one study the Results about prevalence and incidence are reported in
items rated as high risk [68]. More in depth in one study Table 7.
[68], another two items were rated as high risk, one re-
garding the reliability of the condition measurement and Prevalence of LBP
one regarding the validity of identification of the condi- Eight [63–68, 70, 81] of the 19 included studies ad-
tion. For cross-sectional studies, the majority of studies dressed prevalence of LBP among runners. Six wereTable 2 Characteristics of the included studies
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
Bach KD, A comparison To compare muscular N = 45 Age = 18–43 I = 22% (1- Injury severe enough to Runners was defined Low Back Pain Goniometric range of
1985 [72] of muscular tightness at the hip years M = 28 (19.4 year temporarily give up the according to the motion measurements
Prospective tightness in between runners and years) F = 17 (25.7 incidence) running activity. following criteria: of three hip
Cohort study runners and nonrunners, and to years) individuals who run 18 movements, abduction,
USA nonrunners and determine if there is a LBP = 10 (M = 7 F = or more miles per week, flexion with the knee
the relation of relation between muscular 3). Running who run on a regular extended, and
muscular tightness and low back pain experience > 1 years basis, and who have extension, were taken
tightness to low in runners. engaged in running for on two subject
back pain in a minimum of 1 year populations, runners,
Maselli et al. BMC Musculoskeletal Disorders
runners. and non-runners, in
(The Journal Of order to determine
Orthopaedic tightness of the hip ad-
And Sports ductor, extensor, and
Physical flexor muscles,
Therapy) respectively.
(2020) 21:343
Besomi M, Training volume To determine the N = 4380 P = 13.5% A running-related injury Participants was defined Lower Back
2019 [66] and previous relationship between Age = 36 (1-year was defined as “any in- as runners if have
Cross-sectional injury as weekly pre-competition 10 km = 1316 21 prevalence); jury to muscles, ten- competed in one of the
study associated running volume and the km = 2168 42 km = 0.7%(point dons, joints and/or three SM running
Chile factors for presence of running-related 896 prevalence) bones caused by run- distances (10–21-42 km)
Running- injuries (RRIs) by race LBP = 31 (point ning. The injury had to
Related Injuries distance. prevalence); 307 (1- be severe enough to
by race dis- year overall cause or be expected to
tance: A Cross- prevalence; 77 = 10 cause a reduction in dis-
Sectional Study. km; 163 = 21 km; tance, speed, duration,
(Journal of 67 = 42 km) or frequency of running
Human Sport & Running for at least 7 days. Con-
Exercise) experience = < 1 ditions such as muscle
year = 704; 1–4 soreness, blisters, and
years = 2226; > 4 muscle cramps were not
years = 1450. considered as injuries”.
Buist I, Incidence and The purpose of this study is N = 629 I = 4.8% (8 A running-related injury The participants had to Back
2008 [73] risk factors of to determine the incidence M = 207 F = 422 weeks) was defined as any mus- categorize themselves Lower Back
Prospective running-related of RRI and to identify sex- Age = 43.7 years culoskeletal pain of the as novice runners,
cohort study injuries during specific predictors of RRI Running lower limb or back caus- runners with previous
Netherlands preparation for among a group of novice experience = novice ing a restriction in run- experience who have
a 4-mile recre- and recreational runners runners, runners ning (mileage, pace or taken up running again
ational running training during an 8-week with previous duration) for at least 1 or runners who were
event. period for a 4-mile running experience who day. already engaged in
(British Journal event. have taken up regular running.
of Sports running again or . The training program
Medicine) runners who were for novice runners
already engaged in started with ten 1-min
regular running. repetitions of running
LBP = 31 alternated by 1 min of
Page 8 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
walking. The training
program for experi-
enced runners started
with 30 min of continu-
ous running. The expos-
ure time of running in
the training program for
novice and recreational
runners varied, respect-
Maselli et al. BMC Musculoskeletal Disorders
ively, between 10 and
40 and 20–60 min per
training.
Chang WL, Running injuries To investigate the N = 893 M = 714 P = 3.2% Questionnaire did not Regular running was Lower Back Pain
2012 [67] and associated distribution of lower (80%) F = 179 (20%) (lifetime specifically ask the defined as a minimum
Cross-sectional factors in extremity running injuries Age = 20–50 y prevalence) participants to identify if of 30 min running at
(2020) 21:343
study participants of and their associated factors. full marathon group they currently had any least twice a week.
Taiwan ing taipei (38.8 11.6 years) symptoms. We would
marathon. 10 km group not know how many of
(Physical (33.6 9.8 years) the runners only had
Therapy in Full marathon = 127 previous injuries or they
Sports) (14.3%); Half also suffered from
marathon = 337 current injuries. The
(37.7%);10 km = 429 severity of the running
(47.9%) symptoms was not
Running experience: defined in the
< 1 year = 179; 1-5 questionnaire.
years = 435; 5-10
years = 130; > 10
years = 146
LBP = 29; 8 (Full
marathon); 11 (Half
marathon); 10 (10
km)
Clement DB, A survey of To give an accurate N = 1650 I = 3.7% (2 Physician diagnosis of To be regarded as a Lower back
1981 [69] overuse running indication of age and sex M = 987 (59.8%) F = years) RRI runner, a patient had to injuries:
Retrospective injuries. distributions, training 663 (40.2%) Age = be running at least 2 Nonspecific
survey (The Physician mileage, etiological factors, 28 years miles (3 km) three days lower back pain;
Canada and and the incidence of Running a week at the time of Sciatica;
Sportsmedicine) specific disorders to experience = injury. Spondylolysis;
physicians in recreational runners Spondylolisthesis
sportsmedicine clinics. LBP = 68 (M = 36
F = 32);
Nonspecific lower
back pain = 54 M =
27 F = 27;
Page 9 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
Sciatica = 10 M = 10
F = 3;
Spondylolysis = 3
M = 2 F = 1;
Spondylolisthesis =
1 F = 1;
Dallinga J, Injury incidence To report (1) the injury N = 706 I = 1.9% Every physical complaint Participants was defined Lower Back OSTRC and
2019 [80] and risk factors: incidence in recreational M = 375 F = 331 (protocol- that caused at least 1 as runners if have questionnaire of
Maselli et al. BMC Musculoskeletal Disorders
Prospective a cohort study runners in preparation for a Age = 43.9 years event week of training loss. competed at least in running training and
cohort study of 706 8-km or 8-km or 16-km running Running incidence, one of the two injury related to running
Netherlands 16-km recre- event and (2) which factors experience = novice 12 weeks) distances of the run (8-
ational runners. were associated with an in- and recreational 16 km).
(BMJ Open creased injury risk. runners
Sport & Exercise LBP = 13
Medicine) 8 km =128
(2020) 21:343
16 km = 521 both
distances = 29
Ellapen TJ, Common To document the N = 200 *P = 14% A sensation of distress To be regarded as a Lower Back/Hip
2013 [70] running prevalence and nature of M = 120 F = 80 (overall 1- or agony, and which runners, participants
Retrospective musculoskeletal running-related musculo- Age = 43.6 years year prevented them from have to had run at least
descriptive injuries among skeletal injuries among rec- Running prevalence) physical activity for a an half marathon (21.1
study recreational reational half-marathon experience = cohort *P = 9% minimum of 24 h km)
Africa half-marathon runners over a 12-month regularly male
runners in period (1 July 2011–31 June participated in half- *P = 10%
kwazulu-natal. 2012). marathons (21.1 female
(The South km), with an aver- (* the data
African Journal age road-running of
of Sports history of 12.2 years. prevalence
Medicine) LBP = 28. are related
to lower
back/hip)
Kluitenberg B, The Nlstart2run The purposes of the study N = 1696 I = 0.3% RRI was defined as a Pelvis/Sacrum/
2015 [76] Study: Incidence were to assess the M = 364 F = 1332 musculoskeletal Buttock
Prospective and risk factors incidence of RRIs and to Age = 43.3 years complaint of the lower
cohort study of Running- identify risk factors for RRIs Running extremity or back that
Netherlands Related Injuries in a large group of novice experience = novice the participant
in novice runners. In total, runners attributed to running
runners. 1696runnersofa6- LBP = 6 and hampered running
(The weeksupervised“StarttoRun” ability for three
Scandinavian program were included in consecutive training
Journal of the NLstart2run study. sessions at the same
Medicine & body part. Muscle
Science in soreness and blisters
Sports) were not registered.
Page 10 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
Lysholm J, Injuries in To study injury-provoking N = 60 I = 5% Any injuries that The participants have a Low Back Pain
1987 [74] runners. factors in training and com- M = 39 F = 11 markedly hampered previous experience of
Prospective (The American petition, and to compare Age = Sprinters training or competition running training (7 h per
cohort study Journal of differences in injury pattern (20.6 ± 3.8), middle- for at least 1 week were week or more).
Sweden Sports between different groups distance runners noted.
Medicine) runners. (18.6 ± 2.4), and
long-distance/mara-
thon runners
(34.5 ± 7.4)
Maselli et al. BMC Musculoskeletal Disorders
Running
experience = 4 years
(sprinters) 3 years
(middle distance) 5
years (long
distance/marathon)
LBP = 3
(2020) 21:343
Marti B, On the - How frequent are jogging N = 4358 P = 0.7% Runners were asked to Lower Back
1988 [68] epidemiology injuries in a representative M = 4358 overall 1- classify jogging injuries Buttock
Cross-sectional of running population comparing all Age = 35.0 years years LBP - that had occurred Pelvic Crest
survey injuries, the participants in a popular LBP = 30 Grade III during the previous 12
Switzerland 1984 bern running event, and how injuries months according to
grand-prix often do such injuries lead (2.2% lower their effect on running.
study. to medical consultation back; 0.6% Grade I injuries involved
(The American and absence from work? pelvic crest; maintenance of full
Journal of - Is the incidence of 0.9% training activity in spite
Sports jogging injuries related to buttock) of symptoms; Grade II, a
Medicine) behavior and/or reduction of training
characteristics of runners activity, and Grade III,
(training mileage, type of full training interruption,
running shoes, age, defined as involuntary
number of years of complete interruption of
training, etc.)? running of at least two
- What are the site and weeks’ duration.
nature of the most
common injuries?
- Is there a relation
between specific runner
characteristics and specific
running injuries?
Malliaropoulos Prevalence of The purpose of the study N = 40 ultra-trail P = 20.2% If symptoms were According to the Lower Back
N, injury in ultra was to try to determine the runners (lifetime) severe enough to forgo International Trail Lower Back Pain
2015 [64] trail running. prevalence of lower M = 36 F = 4 training for at least 1 running Association, trail
Cross-sectional (Human extremity and lower back Age = 38.4 years day or causing them to running takes place on
study Movement) musculoskeletal injuries in (22–59) quit a race. various natural terrain
Greece ultra-trail runners by Running (mountain, desert, or
Page 11 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
considering injuries and re- experience = Level forest) while minimizing
lated symptoms. Addition- A = 13; Level B = 27; running on paved or
ally, the predicting factors < 6 years = 21; > 6 asphalt surfaces (no
associated with these injur- years = 19 more than 20% of the
ies were investigated in LBP = 17 total distance in
order to aid in the preven- competition). It can
tion and rehabilitation of involve uphill, downhill,
trail running injuries. and horizontal trails and
is similar in duration to
Maselli et al. BMC Musculoskeletal Disorders
an ultra-marathon,
which is considered any
race beyond the mara-
thon distance of 42.195
km.
Messier SP, A 2-year pro- To determine the risk N = 300 I = 6% (2 Overuse running injuries Participants was defined Back -Exercise Self-efficacy
(2020) 21:343
2018 [79] spective cohort factors that differentiate M = 172 F = 128 years) were graded with the as runners if they run a Scale (0, lowest self-
Prospective study of over- recreational runners who Age = 41.15 method defined by minimum of 5 miles per efficacy; 100, highest
cohort study use running in- remain uninjured from Running Marti et al.: grade 1, week. self-efficacy)—which as-
USA juries, the those diagnosed with an experience = 11.2% maintained full activity sesses beliefs in the
runners and in- overuse running injury LBP = 18 in spite of symptoms; ability to continue to
jury longitudinal during a 2-year observa- grade 2, reduced weekly run at one’s training
study (TRAILS). tional period. mileage; and grade 3, pace for periods of 1 to
(The American interrupted all training 8 weeks24.
Journal of for at least 2 weeks − 12-Item Short Form
Sports Health Survey (SF-12)
Medicine) healthrelated quality-of-
life survey (0, low; 100,
high)—which measures
perceived health (men-
tal subscale) and func-
tioning (physical
subscale).
-Satisfaction With Life
Scale (5, extremely
dissatisfied; 35, highly
satisfied)—which
assesses global
judgment of life
satisfaction.
-Positive and Negative
Affect Scale (PANAS)
(10, very slightly; 50,
extremely for each
scale).
-State-Trait Anxiety
Inventory–S Scale (20,
Page 12 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
not at all; 80, very
much)—which asks
participants to report
how they feel right
now.
-Visual analog scale for
pain (0, no pain; 10,
extreme pain).
Maselli et al. BMC Musculoskeletal Disorders
Rasmussen CH, Weekly running The purpose of this study N = 662 I = 0.5% The running-related in- Completion of the H.C. Lower Back
2013 [71] volume and risk was to investigate if the risk M = 535 F = 127 point jury definition was Andersen marathon
Retrospective of running- of injury declines with Age = 41.4 incidence modified based on the
cohort study related injuries increasing weekly running Running injury definition used by
Denmark among mara- volume before a marathon experience = Macera et al.; a running-
thon runners. race marathon runners: related injury was de-
(The < 2 years = 49; 2–5 fined as an injury to
(2020) 21:343
International years = 262; > 5 muscles, tendons, joints
Journal of years = 351; and/or bones caused by
Sports Physical LBP = 3 running; The injury had
Therapy) to be severe enough to
cause or be expected to
cause a reduction in dis-
tance, speed, duration,
or frequency of running
for at least 14 days. Con-
ditions like muscle sore-
ness, blisters, and
muscle cramps were not
considered as injuries.
Tauton JE, A prospective To determine the injury N = 840 I = 1.6% -The novice group is Low Back
2003 [75] study of pattern in a sample of the M = 205 F = 635 Low back = primarily sedentary and
Prospective running injuries: “In Training” clinics during Age = 30–56 years 7% (4 men), deconditioned people
cohort study the vancouver their 13 weeks program, Running =5% (10 interested in
Canada sun run “in and identify associated risk experience = novice women) establishing a running
training” clinics. factors for injury. runners -Hip/pelvis: program probably to
(British Journal LBP = 37 =7% (4 improve health and
of Sports men), =10% fitness. The program for
Medicine) (19 women) this group incorporates
run/walk repeats that
eventually lead to a
continuous running
session in the 12th
week.
-The intermediate
program is designed for
people who have
Page 13 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
completed the novice
walk/run program and
would like to increase
their running endurance
and intensity in a safe
and effective way. Hill
training, interval, and
fartlek sessions are
implemented.
Maselli et al. BMC Musculoskeletal Disorders
Teixeira RN, Prevalence of The purpose of this N = 199 P = 14% (1- Runners who compete Lumbar Spine VAS
2016 [65] musculoskeletal research was to assess the M = 164 F = 35 year at the elite level, Pelvic/Sacral/
Cross-sectional pain in prevalence, location and Age = 34 (30–39) prevalence) defined as those Gluteus
study marathon intensity of running related Running competing at
Brazil runners who musculoskeletal pain over experience = international and/or
compete at the the previous 12 months in marathon runners national level; Their
(2020) 21:343
elite level. marathon runners who at elite level, on training is characterized
(The compete at the elite level average of 11 years; by a high training
International and to verify whether LBP = 28 volume, with weekly
Journal of certain training (Lumbar Spine 20; training loads of up to
Sports Physical characteristics are Pelvic/Sacral/ 160 km/week.
Therapy) associated with Gluteus 8)
musculoskeletal pain.
van der Worp The 5- or 10-km To determine the incidence N = 373 (5 km = 189; I = 2.7% Defined as running- Adult women (aged Lower Back
MP, Marikenloop and characteristics (site and 10 km = 184) related pain of the ≥18 years) who had Buttock
2016 [77] run: a prospect- recurrence) of running- F = 373 lower signed up for the
Prospective ive study of the related injuries and to iden- Age = 37.55 back and/or the lower ‘Marikenloop 2013’
cohort study etiology of tify specific risk factors for Running extremity that restricted running event were
Netherlands running-related running-related injuries. experience = novice running for at least 1 eligible for inclusion.
injuries in runners day. The ‘Marikenloop’ is a
women. LBP = 10 (4 Lower run over 5- or 10 km in
(Journal of Back; 6 Buttock) Nijmegen, the
Orthopaedic & Netherlands, and is a
Sports Physical female-only event.
Therapy)
Von Rosen P, Etiology of The aims of this study were N = 189 I = 2.8% As any physical Low Back Pain OSTRC
2017 [78] running-related to describe the injury F = 189 complaint that affected Lower Back
Prospective injuries in prevalence/incidence, Age = range 18–24 participation in normal
cohort study women. severity grade, injury Running training or competition,
Sweden (The location, risk factors and the experience = elite led to reduced training
International prevalence of illness in athletes volume, experience of
Journal of running (RU), orienteering LBP = 5 pain or reduced
Sports Physical (OR) and cross-country ski- performance in sports; *
Therapy) ing athletes (CR). A substantial injury was
defined as an injury
leading to moderate or
Page 14 of 25Table 2 Characteristics of the included studies (Continued)
General Title of the Aims of the study Population Incidence or RRI definition RUNNER definition LBP Outcomes and outcome
informations study Prevalence (definition, measures
(Author, years, (Journal) characteristics,
study design, anatomical area)
country)
severe reductions in
training volume, or
moderate or severe
reduction in
performance, or
complete inability to
participate in sports; * A
new injury was
categorized as a
Maselli et al. BMC Musculoskeletal Disorders
recurrent or a non-
recurrent injury, based
on if the injury occurred
in the same body site as
the previous injury
within the last year.
(2020) 21:343
Walter SD, The Ontario The purpose of this study N = 1288 I = 1.8% All registered entrants Back
1989 [81] Cohort Study of was to investigate the M = 985 F = 303 (point to these events: 16-km Back Injuries
Prospective Running- incidence and causes of Age = 41.4 incidence) (10-mile) race, 4-km (2.5-
cohort study Related Injuries. running injuries. Running P = 4.3% (1- mile) fun run in St Cath-
USA (Archives of experience= year arines. 22.4-km (14mile)
Internal LBP = 23 new prevalence) run and a four-member
Medicine) injuries; 56 old 5.6-km (3.5-mile) team
injuries relay in Burling ton were
included.
Woolf SK, The Cooper The purpose of this study N = 436 P = 13.6% Low Back Pain
2002 [63] River Bridge was to investigate the M = 227 F = 209 (point LBP
Cross-sectional Run of low back incidence, prevalence, and Age = 36.45 years prevalence)
survey pain in runners possible risk factors for LBP Running
USA and walkers. among a group of runners experience = any
(Journal of the and walkers. kind of runner from
Southern novice to athletes
Orthopaedic LBP = 59
Association)
Page 15 of 25Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 16 of 25
Table 3 Case Control Critical Appraisal
Clement DB. 1981 [69] Ellapen TJ. 2013 [70] Rasmussen CH. 2013 [71]
Were the groups comparable other than the presence of disease in cases Not applicable Not applicable Not applicable
or the absence of disease in controls?
Were cases and controls matched appropriately? Not applicable Not applicable Not applicable
Were the same criteria used for identification of cases and controls? Not applicable Not applicable Not applicable
Was exposure measured in a standard, valid and reliable way? Unclear Yes Yes
Was exposure measured in the same way for cases and controls? Not applicable Not applicable Not applicable
Were confounding factors identified? Yes Yes Yes
Were strategies to deal with confounding factors stated? Yes Yes Yes
Were outcomes assessed in a standard, valid and reliable way for cases Yes Yes Yes
and controls?
Was the exposure period of interest long enough to be meaningful? Yes Yes Yes
Was appropriate statistical analysis used? Unclear Yes Yes
Table 4 Cohort Critical appraisal
Dallinga Bach DK. Buist I. Lysholm Tauton JE. Van der Messier Kluitenberg Von Walter
J. 2019 1985 [72] 2008 [73] J. 1987 2003 [75] Worp MP. SP. B. 2015 [76] Rosen P. SD. 1989
[80] [74] 2016 [77] 2018 2017 [78] [81]
[79]
Were the two groups similar Yes Yes Not Yes Not Not Yes Not Not Not
and recruited from the same applicable applicable applicable applicable applicable applicable
population?
Were the exposures measured Yes Yes Not Yes Not Not Yes Not Not Not
similarly to assign people to applicable applicable applicable applicable applicable applicable
both exposed and unexposed
groups?
Was the exposure measured in Yes Yes Yes Yes Unclear Unclear Yes Unclear Unclear Unclear
a valid and reliable way?
Were confounding factors Yes Unclear Yes Unclear Yes Yes Yes Yes Yes Yes
identified?
Were strategies to deal with Unclear Unclear Yes Unclear Yes Yes Yes Yes Yes Yes
confounding factors stated?
Were the groups/participants Unclear Yes Unclear Yes Unclear Unclear Yes Yes Unclear Unclear
free of the outcome at the
start of the study (or at the
moment of exposure)?
Were the outcomes measured Yes Yes Yes Unclear Yes Yes Yes Yes Yes Yes
in a valid and reliable way?
Was the follow up time Yes Not Unclear Yes Yes Yes Yes Unclear Yes Yes
reported and sufficient to be applicable
long enough for outcomes to
occur?
Was follow up complete, and if Yes Not Yes Yes Yes Yes Yes Yes Yes Yes
not, were the reasons to loss to applicable
follow up described and
explored?
Were strategies to address Yes Not Yes Not Unclear No Yes Yes Not Yes
incomplete follow up utilized? applicable applicable applicable
Was appropriate statistical Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
analysis used?Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 17 of 25
Table 5 Cross Sectional Critical Appraisal
Chang WL. Malliaropoulos N. Marti B. Woolf S. Teixeira RN. Besomi M.,
2012 [67] 2015 [64] 1988 [68] 2002 [63] 2016 [65] 2019 [66]
Were the criteria for inclusion in the sample clearly Yes Yes No No Yes Yes
defined?
Were the study subjects and the setting described Yes Yes Yes Yes Yes Yes
in detail?
Was the exposure measured in a valid and reliable Yes Yes Yes Yes Yes Yes
way?
Were objective, standard criteria used for No Yes Yes Yes Yes Yes
measurement of the condition?
Were confounding factors identified? Unclear Yes Yes Yes Yes Yes
Were strategies to deal with confounding factors Unclear Yes Yes Unclear Yes Yes
stated?
Were the outcomes measured in a valid and Unclear Yes Yes Unclear Yes Yes
reliable way?
Was appropriate statistical analysis used? Yes Yes Yes Yes Yes Yes
cross-sectional studies [63–68], one was a retrospective LBP in runners was reported, and it was equal to 13.6%.
study [70] and one was a prospective study [81]. The The study of Marti et al. [68] reported a 1-year preva-
range of point prevalence ranged from a minimum of 0, lence of LBP of 0.7%, but this value was calculated in a
7% [66] at a maximum of 13.6% [63] and lifetime preva- sample of all male runners, and it was referred only to
lence ranged from a minimum of 3.2% [67] a maximum the Grade III injuries (defined as full training involuntary
of 20.2% [64]. Point prevalence values, 13.6 and 0.7% re- interruption of running for at least 2 weeks duration). In
spectively, were reported in two studies [58, 64]. Five the cross-sectional study of Teixeira et al. [65] 1-year
studies reported values of 1-year prevalence [65, 66, 68, prevalence of LBP (including pain in the lumbar spine
70, 81], ranged from 14% [65, 70] to 0.7% [68], and those and pain in pelvic/sacral/gluteus regions) among elite
about lifetime prevalence were two [63, 64], 3.2 and marathon runners was 14%. In the retrospective descrip-
20.2% respectively. Only 1 study [66] addressed data for tive study of Ellapen et al. [70] the 1-year prevalence of
point and 1-year prevalence, with values of 0.7 and lower back (including hip) among recreational half-
13.5% respectively [66]. Also in the cross-sectional sur- marathon runners was 14% (mean value; 13% for men,
vey study of Woolf et al. [63], the point prevalence of 15% for women). In the only prospective cohort study,
Table 6 Prevalence Studies Critical Appraisal
Chang WL. Marti B. Ellapen Malliaropoulos Walter Teixeira Woolf Besomi
2012 [67] 1988 [68] TJ. N. SD. RN. S. M.
2013 2015 [64] 1989 2016 2002 2019
[70] [81] [65] [63] [66]
Was the sample frame appropriate to address the target Yes Yes Yes Unclear Yes Yes Yes Yes
population?
Were study participants sampled in an appropriate way? Yes No Unclear Yes Yes Unclear Unclear Yes
Was the sample size adequate? Yes Yes Yes Unclear Yes Yes Yes Yes
Were the study subjects and the setting described in Yes Yes Yes Yes Yes Yes Yes Yes
detail?
Was the data analysis conducted with sufficient coverage Yes Yes Yes Yes Yes Yes Yes Yes
of the identified sample?
Were valid methods used for the identification of the Yes No Yes Yes Yes Yes Unclear Yes
condition?
Was the condition measured in a standard, reliable way Yes No Yes Yes Yes Yes Yes Yes
for all participants?
Was there appropriate statistical analysis? Yes Yes Yes Yes Yes Yes Yes Yes
Was the response rate adequate, and if not, was the low Yes Yes Yes Yes Yes Yes Unclear Yes
response rate managed appropriately?Maselli et al. BMC Musculoskeletal Disorders (2020) 21:343 Page 18 of 25
Table 7 Results about prevalence and incidence of LBP
Author, year Study design Incidence Prevalence
Lifetime 1 year Point Other Lifetime 1 year Point Other
Bach DK, 1985 [72] Prospective Cohort 22%
Besomi M, 2019 [66] Cross Sectional Survey 13.5% 0.7%
Buist I, 2008 [73] Prospective Cohort 4.8% (protocol event: 8 weeks)
Chang WL, 2012 [67] Cross Sectional Survey 3.2%
Clement DB, 1981 [69] Retrospective Survey 3.7% (2 years)
Dallinga J, 2019 [80] Prospective Cohort 1.9% (protocol event: 12 weeks)
Ellapen TJ, 2013 [70] Retrospective Descriptive 14%
Kluitenberg B, 2015 [76] Prospective Cohort 0.3% (protocol event: 6 weeks)
Lysholm J, 1987 [74] Prospective Cohort 5%
Marti B, 1988 [68] Cross Sectional Survey 0.7%
Malliaropoulos N, 2015 [64] Cross Sectional 20.2%
Messier SP, 2018 [79] Prospective Cohort 6% (2 years)
Rasmussen CH, 2013 [71] Retrospective Cohort 0.5%
Tauton JE, 2003 [75] Prospective Cohort 1.6% (protocol event: 13 weeks)
Teixeira RN, 2016 [65] Cross Sectional 14%
Van der Worp MP, 2016 [77] Prospective Cohort 2.7% (12 weeks)
Von Rosen P, 2017 [78] Prospective Cohort 2.8%
Walter SD, 1989 [81] Prospective Cohort 1.8% 4.3%
Woolf SK, 2002 [63] Cross Sectional Survey 13.6%
Walter et al. [81], the 1-year prevalence of LBP among 3.2% [67], in a sample of 893 subjects of which 80% of
1288 runners was 4.3%. The highest lifetime prevalence male runners [67].
rate of LBP was reported to be 20.2% in the cross-
sectional study of Malliaropoulos et al. [64] in a sample Incidence of LBP
of 40 ultra-trail runners. Furthermore, in another cross Twelve [69, 71–81] of the 19 included studies addressed
sectional study [67], the LBP lifetime prevalence was incidence of LBP among runners. Ten were prospective
Table 8 Risk Factors for the onset LBP
Author Risk Factors For LBP P -Value Odds Ratio
Clement DB, 1981 [69] - Leg-length discrepancy /
- Reduced hamstrings flexibility /
- Reduced back flexibility /
Ellapen TJ, 2013 [70] - Hip flexion angles (female) -(Thomas Test + goniometer) p < 0.01 †3.0488
Malliaropoulos N, 2015 - > than 6 years of experience in running P= †5.4857
[64] 0.012
Woolf SK, 2002 [63] - Not equal wear of heels1 p= ‡1.263 (female
- BMI ≥ 241 0.034 ^BMI)
- Not performing Weekly aerobics activity1 p < 0.01 ‡1.122 (male ^BMI)
- Not Play in contact sports regularly1 (i.e. football, soccer, basketball, wrestling, boxing, p < 0.05
rugby p < 0.04
- Not using orthotics + not equal wear of heels1 p=
- Outside pattern of weara,1 0.011
- Running without Inside pattern of wear2 p=
- Higher Physical height; 0.013
- Flexibility exercises routine for a longer time before working out2 p ≤ 0.02
- Not doing Traditional aerobics activity2 p ≤ 0.02
p ≤ 0.05
p < 0.05
* higher credits as a sum of sex and age of the runner, difficulty level of previous races – positive height difference, the vertical climb index, and the distance in
km – and performance.1 Previous LBP; a Subgroup of runners without insert; 2 Current LBP; †value calculated by authors using data from the full-text;‡ value
reported directly from the full-textYou can also read
