High Rates of Overuse-Related Structural Abnormalities in the Lumbar Spine of Youth Competitive Alpine Skiers: A Cross-sectional MRI Study in 108 Athletes

Abstract

Background: Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes. Purpose: To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination. Results: Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions ( P = .018; R2 = 0.116) and end plate changes ( P = .024; R2 = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age ( P = .034; R2 = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes ( P < .05 for all). Conclusion: As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.

Lower Back Complaints in Adolescent Competitive Alpine Skiers: A Cross-Sectional Study

“…Despite these plausible sports-related adverse loading patterns, only a few studies, however, have investigated the occurrence of lower back complaints in competitive alpine skiers. Moreover, due to focusing on a different age group and reporting other time prevalence measures or absolute injury rates, most of them are not directly comparable to the results of the current study [3,4,6,8,11]. The only study directly comparable to our investigation reported similar magnitudes of current low back pain (67.0%) in ski high school athletes aged 15-19 years [30].…”

“…Specifically, degenerative disc changes were observed to be more prevalent in adolescent competitive alpine skiers than in age-matched controls [10]. Moreover, a recent study found such disc degenerations (particularly disc dehydration and disc protrusion) to be significantly more prevalent in symptomatic than in asymptomatic athletes [11]. However, little is known about the prevalence of lower back complaints in adolescent skiers with respect to severity (i.e., intensity and disability).…”

“…According to this association, athletes may be considered a high-risk population, mainly due to the training and competition loads they are subjected to. Moreover, as a result of their musculoskeletal and spinal immaturity and excessive height growth, adolescent athletes are especially vulnerable [11,13].…”

Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions

“…In particular, the ACSA of multifidus muscle [ 108 – 111 ] and the ratio between the ACSAs of the multifidus and quadratus lumborum muscles [ 111 ] were related to the occurrence of lower extremities injury both in the pre-season and playing season. In a recent study conducted in young competitive alpine skiers, a smaller lumbar multifidus ACSA (assessed by MRI) was related to a higher occurrence of disc protrusions and end plate alterations [ 112 ]. Moreover, bilateral muscle differences in rectus femoris and VL ACSAs may be associated with games missed because of lower extremity injury in professional basketball players [ 38 ].…”

Thigh muscle activation patterns and dynamic knee valgus at peak ground reaction force during drop jump landings: Reliability, youth competitive alpine skiing-specific reference values and relation to knee overuse complaints

“…[9][10][11] A major concern pertains to youth skiers around the growth spurt, whose bodies are still maturing and, therefore, are especially sensitive to unfavourable loads. 11,12 Moreover, in under 16 years old (U16) skiers, overuse injuries revealed to be more frequent in females than in males. 9 In skiing, up to 1.75 times the body weight can act on each leg, 13 and the knee joint is inevitably subjected to extreme kinematics, including high degrees of flexion and valgus.…”