Prevalence and Incidence of Lumbar Bone Stress Injuries in Adolescent Athletes: A Systematic Review.

Abstract

Background: Low back pain is prevalent among both the general population and physically active adolescents. A substantial proportion of cases can be attributed to lumbar bone stress injuries (LBSI), particularly among adolescents engaged in competitive sports, likely due to high physical demands. This study aims to evaluate the prevalence and incidence of LBSI in adolescent athletes, with a focus on sport- and location-specific as well as age- or sex-related differences.

Methods: A systematic review was conducted using the PubMed and Web of Science databases to identify studies reporting on LBSI in adolescent athletes aged 11 to 19 years. Inclusion criteria focused on MRI-confirmed LBSI. Data synthesis included descriptive statistics, correlation and regression analysis to assess the influence of sport type, age, sex, and injury location on the prevalence and incidence of LBSI.

Results: From 188 initially identified articles, nine studies were included in the final analysis, comprising a total of 572 athletes across various sports. The review revealed LBSI prevalence rates ranging from 10.5% to 54% and incidence rates between 21% and 27%. The highest prevalence was observed in "cricket fast bowlers". A strong correlation (r=0.80) was identified between older adolescent age and increased LBSI prevalence, particularly in cricket players. However, the influence of sex could not be adequately analysed due to the limited representation of female athletes. The most frequently reported location of LBSI was the L5 level (24%-86%), followed by L4 (17%-50%), L3 (5%-33%) and L2 (10%-18%), respectively.

Conclusion: LBSI is a significant overuse injury among adolescent athletes, particularly in sports that involve repetitive lumbar loading in hyperextension combined with rotation. The findings highlight the need for targeted preventive strategies, focusing on age-related risk and sport-specific demands. Future research should focus on diverse athlete populations, including balanced sex representation, and employ longitudinal designs to better understand the long-term implications of LBSI.