Low back pain in athletes: prevalence, assessment and exercise

A systematic review with meta-analysis included 86 studies with a total of about 30,700 participants. The point prevalence was about 42 percent, with a range from 18 to 80 percent, in six high-quality studies. The prevalence over the past 12 months was about 51 percent, and the lifetime prevalence about 63 percent [1].

The figures must be interpreted with caution. The definitions of back pain varied widely between the studies, the estimates differed considerably, and the authors considered that the knowledge is not good enough to point out which sports carry the highest risk [1].

A previous episode of back pain was the clearest factor, with a pooled odds ratio of 3.5. High training volume, periods of increased load and many years of exposure to the sport were also linked to back pain. These are associations and not proven causes [1].

In young athletes, structural injuries such as spondylolysis are described as the most common cause of low back pain. Muscle imbalance, stiffness, growth spurts, poor technique and too much training are mentioned as risk factors [5].

NHI describes that the doctor asks about the intensity, type and radiation of the pain, what eases or worsens it, its duration and previous problems. In persistent problems or suspected nerve compression, the examination covers gait, spinal mobility and the legs with strength, sensation and reflexes [3].

Additional investigations are usually not necessary when there are no red flags [4]. Routine X-ray usually gives no benefit, and MRI or CT is used only in exceptional cases, for example when a disc prolapse is suspected [2]. Imaging is considered for severe pain lasting more than four to six weeks, or for nerve damage without improvement after four to six weeks [3].

In young athletes with suspected spondylolysis, pain on extension is described, and the work-up is done with imaging [5].

NHI recommends staying active as early as possible, even when it still hurts, and avoiding bed rest. When the acute symptoms have settled, endurance training and strength training for the abdominal and back muscles are recommended, and regular exercise can prevent new episodes [2]. For long-lasting low back pain, the Norwegian Electronic Medical Handbook describes the main principle as maintaining normal activity despite the pain [4]. What is the right loading in a particular sport must be assessed individually.

A network meta-analysis from 2019 with 89 studies and 5,578 participants with chronic low back pain found that exercise worked better than passive treatments, and that Pilates gave the most pain relief. Strength training and core training gave the best improvement in physical function. The quality of the studies was generally low, and the authors considered it unlikely that one form of exercise is best for everyone [7].

NHI writes that chiropractic or other manual treatment can help in some situations, but that it is less relevant in chronic problems [2]. A review in the BMJ from 2019 found that spinal manipulation for long-lasting low back pain gave about the same effect on pain as recommended treatments, and that the effect was modest on average [6].

The studies behind these recommendations mainly concern low back pain in general, and not athletes specifically.

Acute pain lasts less than four weeks, subacute less than twelve weeks and chronic more than twelve weeks. The vast majority recover on their own within the first weeks, and uncomplicated acute pain usually improves within one to two weeks without treatment [3].

Athletes who have had back pain before report new episodes more often [1]. For young athletes, it is described that return to sport should be adapted to diagnosis, sport, age and maturity, and is recommended when the athlete has pain-free movement and normal strength [5].

NHI mentions the following as especially important in low back pain: pain at rest, constant or steadily worsening pain, chest pain, fever, unexplained weight loss, known cancer or injury, severe loss of muscle strength or loss of sensation, and morning stiffness for more than an hour. Age under 20 or over 55 is also mentioned [3].

You should also see a doctor for severe back pain, one-sided pain radiating below the knee, and long-lasting problems that do not improve with self-care [3].

A naprapath can examine where the pain is and what triggers it, go through your training load and set up a plan with exercises, advice and possibly manual techniques. If imaging is needed, you are referred on. You can read more about low back pain and about naprapathy at Dr.Dropin.

Why do athletes get low back pain?

The cause varies. In the review, previous back pain, high training volume, periods of increased load and many years in the sport were linked to low back pain, but these are associations and not proven causes [1]. In young athletes, structural injuries such as spondylolysis are described as the most common cause [5].

Should I rest when my lower back hurts?

NHI recommends staying active as early as possible and avoiding bed rest. For the most severe pain, at most one to two days in bed may be relevant [2].

Do I need an MRI or X-ray?

Usually not. Routine X-ray rarely helps, and MRI or CT is used only in exceptional cases, for example when a disc prolapse is suspected [2]. Imaging is considered for severe pain lasting more than four to six weeks, and when serious disease or a fracture is suspected [3].

How long does low back pain last?

The vast majority recover on their own within the first weeks. Acute pain lasts less than four weeks, subacute less than twelve weeks and chronic more than twelve weeks [3].

The page about low back pain gives a general introduction to the problems, and the page about disc prolapse describes another relevant condition. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Wilson F, Ardern CL, Hartvigsen J, et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis. British Journal of Sports Medicine. 2021;55(11). First published online 19 October 2020. Link

2. Korsryggsmerter, vedvarende: behandling (Persistent low back pain: treatment). NHI.no. Last updated 20 January 2023. Link

3. Korsryggsmerter, lave ryggsmerter: veiviser (Low back pain: symptom guide). NHI.no. Last updated 5 October 2020. Link

4. Løge I (revised by). Korsryggsmerte, langvarig (Long-lasting low back pain). Norsk Elektronisk Legehåndbok, legehandboka.no. Revised 13 March 2024. Link

5. Purcell L. Causes and prevention of low back pain in young athletes. Paediatrics & Child Health. 2009;14(8):533-535. Link

6. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. Link

7. Kvam M. Den mest effektive treningen mot korsryggsmerter (The most effective exercise for low back pain). NHI.no, 17 March 2020. Reports the network meta-analysis by Owen et al., British Journal of Sports Medicine, 2019. Link