F-MARC data “strongly depict” increased prevalence of low back pain in retired footballers


FootballThis year’s Spineweek meeting (Singapore; 16–20 May) featured a number of presentations from F-MARC, the Fédération Internationale de Football Association (FIFA) Medical Assessment and Research Centre. Among the data presented at the meeting, one first-of-its-kind study found a significantly higher rate of low back pain amongst retired male footballers, when compared with an age band-matched general population control group, even after adjusting for known risk factors.

The researchers from Nottingham University (Nottingham, UK) used a self-reported questionnaire design to gather prevalence data from 4,089 men in the general population (mean age 62.8 years, standard deviation ±10.4) and 1,237 retired professional footballers (mean age 59.9 years, standard deviation ±11.7). Current widespread pain, knee pain, upper back and head pain, and lower body pain, were illustrated with a body pain manikin included in the questionnaire. The definition of current pain was any that had been experienced for most days of the past month. A logistical regression analysis was used to determine and compare prevalence rates between the groups, and to identify risk factors such as body mass index and age.

Statistically significant differences were found for low back pain in ex-football players, of whom 28.8% reported current low back pain, compared with the control group, where crude prevalence was observed at 23.9% (p=0.001). These results bore an unadjusted odds ratio of 1.28 (95% confidence interval 1.11–1.48), which was maintained at 1.25 (95% confidence interval, 1.08–1.47) when adjusted for confounding risk factors.

Not only did the data show a significant increase in prevalence of low back pain amongst ex-footballers, but it also revealed a significant overlap between low back and knee pain. Gwen Fernandes, who presented the data, told Spinal News International that this overlap could be due “to other biomechanical factors, [such as] knee malalignment, which was incidentally statistically more prevalent in former players.”

The study was limited by its lack of clinical or radiographic analysis, and by its exclusion of certain known confounding factors, such as psychological status. Co-author Mark Batt concludes that “body pain in general in this group of retired athletes is simply more likely, due to the combined years of high intensity training and match play…with significant injuries to the lower limb.”

The F-MARC session at Spineweek also focused on the FIFA 11+ training programme, developed and assessed by the organisation to prevent injuries associated with football. The 20-minute programme is comprised of running, followed by plank exercises, followed by running. A number of randomised controlled trials have evaluated the success of the programme in a diverse range of large populations. A new longitudinal study from Germany was presented at the meeting, assessing for the first time the physical changes associated with implementation of the programme.

The research team measured the isometric force and functional balance patterns of the trunk in 203 players (aged 12–29, mean age 15±2.01; 164 male, 39 female) over a 12-week training programme. The players—from all 16 youth football clubs in Bavaria, Germany—were divided into an intervention group and a control group. The intervention group performed the FIFA 11+ programme bi-weekly.

The research team found that both groups experienced significant change in isometric trunk force (p<0.05). The intervention group, however, also experienced improvements in trunk endurance and functional stability (p<0.01). Given the link between trunk stability outcomes and the evolution of back pain, these results suggest that the FIFA 11+ programme can cause positive physical changes. “This effect is not related to football itself,” lead author Christian Schneider told SNI, “It is a training effect and an ageing effect. “Considering the promising results of current studies regarding to sensory motor approaches for the treatment of back pain in adults,” the authors conclude, “further investigations should focus on the possible effects of additive exercises aiming on neuronal adaptation in adolescents to the FIFA 11+ programme.” Schneider told SNI, “We will continue with follow-up and compare with other sports. The main research focus will be on sensometry exercises and spondylolysis.”