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134 BrJ Sports Med 1996;30:134-139

Low back pain and other overuse injuries in a
group of Japanese triathletes

Jyri Seppo Olavi Manninen, Mauri Kallinen

Abstract their first sport, that these long term effects can
Objective-To document the incidence of be monitored and investigated more accu-
low back pain and other overuse injuries rately. Data on triathlete injuries are sparse,
in a group of triathletes, and to investigate and the most recent studies were performed
any associations with various physical and some five years ago'`7 This, along with the
triathlon related factors. above mentioned rapid development of the
Methods-By means of a questionnaire, the sport - especially in recent years - indicates the
physical characteristics, training habits, strong need for further more comprehensive
and the incidences of overuse injuries of 92 investigation into triathlon related injuries.
Japanese triathletes (70 males, 22 females) It has been argued that triathlon, as a
were documented. Student's t and x2 tests multisport event, causes less overuse injuries
were used to determine the significance of than single sports, because of the more even
any associations with injury incidence, as distribution of loads over the body's musculo-
well as differences between subjects experi- skeletal structures. Despite this, triathletes still
encing or not experiencing low back pain in suffer from a high degree of overuse injuries.
the previous year. These overuse injuries also account for as
Results-Low back pain was experienced much as 85% of all injuries suffered.3' One
by 32% of subjects in the previous year. The commonly injured site is the low back. 15
majority (54%) of low back pain episodes The main purposes of this study were to
lasted under seven days, suggesting mainly document the incidence of low back pain and
soft tissue involvement, and 19% lasted other overuse injuries in a group of triathletes,
over three months, suggesting involvement and to investigate the associations between
of the intervertebral discs. Weekly trunk certain physical and triathlon related factors
flexor muscle training frequency was signi- and the incidence of low back pain.
ficantly greater (P = 0.035) for the low back
pain subjects. Close to significant differ- Methods
ences for average weekly cycling time, A pilot study was conducted to design a
trunk flexor muscle training time, and low triathlon injury questionnaire to obtain data on
intensity aerobic rining, as well near the physical characteristics oftriathletes (that is,
significant associations for weight training age, height, weight, body mass index), their
and average weekly triathlon taining load, training habits (that is, weekly training times
were also found. No other factors were and distances, type of training performed and
significantly associated with low back pain. at what intensities, etc), as well as on their
Low back injuries accounted for 28% of all triathlon related injuries (their incidences and
injuries. Only the knee was a more possible causes), in particular low back pain. In
common single site of injury (33%/o). addition, test-retest reliability of the question-
Conclusions-The three most common naire was determined. It was found to be highly
injuries suffered by the triathletes were of repeatable (Manninen J: Triathlon and lower
the knee, back and shoulder. The low back back pain: a pilot study. Unpublished paper for
pain suffered by many triathletes could be physiotherapy masters programme. University
of a potentially serious nature. It is of Jyviskyla, Finland, 1994). The questionnaire
suggested that cycling is a major risk was then employed in this present study for
factor for low back pain in triathletes. obtaining the same type of data from the
(BrJ Sports Med 1996;30:134-139) Japanese triathlete subjects.
Representatives of various triathlon clubs
Department of Health Key terms: low back pain; triathlon; injury; cycling around Japan were contacted about the present
Sciences, University of' study, and were told that it involved triathlon
JyvdskylA, Finland Triathlon is an endurance sport involving training methods and injuries. Once informed
J S 0 Manninen
M Kallinen swimming, cycling, and running. It has of- consent had been obtained from the represen-
The study was carried out ficially existed only for about 20 years, and tatives, questionnaires were mailed out. The
at the Institute of Sports during this time has developed very rapidly numbers allotted to each club were based on
Medicine and Science, with regard to training strategies and cycling estimates of club member numbers. The club
Agui, Japan technology. Because of the short history of the representatives were asked to distribute the
Correspondence to: sport, it has been very difficult to evaluate, or questionnaires to those club members willing
Jyri Seppo Manninen,
1046 NW 9th Street, even predict, its long term physical effects (that to take part, and to then return both completed
Corvallis Oregon 97330, is, sports related factors) on the participants. It as well as unused questionnaires.
Accepted for publication is really only in the new or younger generation During March 1994, 185 questionnaires
8June 1995 of triathletes, for many of whom triathlon was were mailed out to the representatives of 10

27% of subjects participated Weights 1-4 (1-4) 0-6 (1 1) 1-2 (1-3) 0-012 in running.between the aerobic and anaerobic [10 to 300] [30 to 200] [10 to 300] thresholds. biking. Most were located in Results the Kinki._ 201 *a 15 E 23 z 10 [ 8 51 0 4 2 31-35 3640 41-45 48-50 . they 35 (figure).05. There were no signifi- ant gender differences except for weight train- Table 1 Physical characteristics of triathlete subjects. Therefore. A regular stretching programme was [O to 5-0] [O to 2 5] [O to 50] followed by 94% of subjects. test and x2 analyses was set at P = 0. [range] ing. and x2. accounted for 12% of total Weight (kg) 63-8 (7 5) 51-4 (4-6) 61-0 (8 7) < 0 01 [46-0 to 85 0] [40 0 to 64-0] [40 0 to 85 0] training time.51 Age group (years) The age distribution of the Japanese triathlete subjects.Low back pain in Japanese triathletes 135 35 n =92 31 30 'M~~ Female U) 0 25 8 8BO Male a 7C0 . in which females trained significantly less. The level of three smoked an average of 10 cigarettes per statistical significance for both the Student's t day. this Total 14-7 (64) 14-4 (5-1) 14-6 (61) 0-87 [2-2 to 30 0] [5-0 to 24 5] [2-2 to 30-0] Distances (kin) Swim 6-4 (3 7) 6-8 (3 3) 6-5 (3 6) 0-66 a Training intensity levels: [0 3 to 20] [2 to 13] [3 to 20] Bike 123-6 (67 5) 99-8 (52 0) 118-0 (64 7) 0 09 Low intensity . [range] bars" (special handlebars) on their bicycles. 86% of subjects used triathlon "aero- (SD). The remainder (43%) trained for [0-5 to 12-0] [1-0 to 100-] [05 to 12-0] Olympic distance and sprint events. and only 4% in [O to 50] [0 to 4 0] [O to 50] [P < 0 05] Circuits 005 (1 0) 0-5 (0 8) 0 5 (10) 0-98 cycling. 3-3 for females). than actual response rate was calculated. business. 38%. [19 to 52] [20 to 56] [19 to 56] Height (m) 170-7 (65) 158-0 (52) 167-7 (8-2) < 0 01 Supplementary training (circuit and weight [154 to 185] [143 to 165] [143 to 185] training combined). 109 were returned The physical characteristics of the triathletes completed. Values are mean (SD). and running Body mass index (kgm2) 218 (0 2) 20-8 (0 3) 21-6 (0 2) < 0 01 accounted for 29%. - . and medical). office work. cigarettes regularly. Chubu. Three of these subjects Statistical analyses included descriptive smoked one or less per day. Student's t tests.5 Over Swim 3-6 (2 0) 3 9 (1 9) 3-7 (1-9) 0-52 half (57%) trained for half and full distance [0 3 to 10-] [10 to 90] [0 3 to 10-0] Bike 5-0 (2 7) 4-8 (2 5) 5 0 (2 6) 0 73 events. Before Run 4-3 (2 0) 4-6 (2 3) 4-3 (2 0) 0-58 [0-3 to 90] [1-0 to 13-0] [0-3 to 13-0] triathlon training. The The subjects had been training regularly for Excel 4 0 and SPSS 6-0 computer software triathlon on average for 4-1 years (4 3 for packages were employed to carry out these males. not including supplementary training). Only age did not differ subjects were excluded on the basis that they significantly between male and female subjects. GENERAL Of these questionnaires. and Kanto regions of Japan. Most of the training was performed at medium Male (n = 70) Female (n = 22) Total (h = 92) P (41%) and low intensities (38%). Swimming. - [1 to 150] [5 to 120] [1 to 150] High intensity at or above the anaerobic threshold. 12% in swimming. training times and distances of the triathletes are described in table 2. The research. and most (96%) were in occu- were not triathletes. Male (n = 70) Femnale (n = 22) Total (n = 92) P Seventy three per cent of subjects performed weight training. study. while the other methods. Run 42-0 (24-3) 43-0 (22 5) 42-2 (23 8) 0-87 Medium intensity at or below the aerobic threshold. by definition. the completion rate rather (for example. and 33% respect- [17-3 to 30-1] [19-0 to 23 9] [17-3 to 30-1] ively. Values are means Further. of total triathlon training time (that is. did not indicate that they were training all the Most (63%) of the triathletes were aged 26 to three sports. The average weekly analyses. On average. Due to the distribution pations involving sedentary or light activities method employed. Only 29% included circuit Age (years) 31-6 (7 4) 30-1 (7 3) 31-3 (7 4) 0-39 training in their overall training programme. The questionnaires returned by 17 are described in table 1. Table 2 Average weekly training times and distances of triathletes. the remain- Times (hours) der being performed at high intensity. Six subjects smoked was 550/o (92/168). selected triathlon clubs. Only one subject was true completion rate for the triathlete subjects a professional triathlete.

and 14% had seven days. inadequate stretching. Twenty two per cent stated that Seventy two per cent of subjects had sustained their initial pain episode had begun suddenly. in Thirty two per cent of subjects had experi. Also. Table 5 frequency was significantly greater in those classifies the injuries according to anatomical subjects who had experienced low back pain in region. The subject's usual cycling position. cervical region 4%). and inadequate absence of low back pain. pain symptoms decreased in 45% of affected and inadequate warm up. Swim- or training for some time during the previous ming related factors were stated as the causes year. (58%). job minutes each time. performance of weight training (P = 0054). flexibility. A in that year. although the males had a notably nor was the presence or number of lower limb higher life time incidence rate (P = 0052). faulty running tech- experienced lower limb symptoms in the nique. at least one musculoskeletal injury related to but was due to some definite incident. or associations (X2 tests) homogeneous group by race.150 km. Specific reasons in either one or both legs. majority of pain episodes (54%) lasted under 30% had sustained two injuries. There were triathlon "aerobars" was associated with the no significant differences between males and incidence of low back pain in the previous year. experienced lower limb symptoms as a cause of lower limb injury. other training methods. Initial for circuit training (19%). and prior participation in other sports were not LOW BACK PAIN significant. they were with the incidence of low back pain in the previous 12 month period. Only the knee was a more Average weekly trunk flexor muscle training common single site of injury (33%). females. The subjects in this study comprised a totally back-pain subjects. An injury involving subjects over their period of triathlon training. Seventy four per cent of the low high proportion (23%) also occurred during back pain subjects associated pain with cycling.136 Manninen. nor the use of incidence rates are given in table 3. Pain had of which the knee was the most common site mainly been felt in the lower and upper back of injury (54% of all lower limb injuries). & .40 km Heel 1 1 1st Metatarsophalangeal joint 1 I per week (n = 19). over half (56%) had stopped work upper limb. all involving the shoulder. Kallinen Table 3 Low back pain incidence rates (%) of triathlete Table 4 Injury rates of triathlete subjects subjects Number of Male (n = 70) Female (n = 22) Total (n = 92) Male (n = 70) Female (n = 22) Total (n = 92) injuries n % n % n % n % n % n % 0 18 26 8 36 26 28 Lifetime 45 64 9 41 54 59 1 29 41 8 36 37 40 Yearly 23 33 6 27 29 32 2 15 21 5 23 20 22 Monthly 15 21 3 14 18 20 >=3 8 11 1 5 9 10 Point 9 13 2 9 11 12 was performed 6&8 times per week for 13-4 symptom-free subjects for gender. in addition to their low Running was the most common activity stated back pain. in 51% OTHER INJURIES of subjects. Thigh 2 19 Group 1: Swim . 23-0 for females). with the remainder Most injuries involved the lower limb (61%). Four per cent had been unable to train of all shoulder injuries. Total 105 100 . The remainder had included overtraining. week to three months. low back pain episodes began for no particular reason. The triathlon in the previous year. Because of their low stretching. Twenty seven per cent lasted one sustained three or more injuries (see table 4). Of this group. and average weekly Knee Low back 35 29 33-3 27-6 triathlon training loada (P = 0095) (X2 tests).6 km. These were: average Table 5 Anatomical distribution (%0) of injuries (n = 105) weekly trunk flexor muscle training time in triathlete subjects (n = 66) (P = 0 055). Only 8% of injuries were of the back pain. & bike . (19%) lasting over three months. the previous year (P = 0035). the competition season. but 32% had. The average age that 45% with weight training. a hard running surface. Low back swimming technique. age. Group 2: All other subjects (n = 73). They included poor at all for extended periods of time. that is. proportion of low intensity aerobic n % training (P = 0-09) (t tests).a Shoulder 9 8-6 The differences between low back pain and Ankle 8 7-6 Calf 5 4-8 Plantar arch 4 3-8 Neck/cervical region 4 3-8 Tibia 4 3-8 a Dichotomised groups based on average weekly Achilles tendon 3 2-9 triathlon training load. The least likely association stated was years (23-8 for males. Other results also indicated close to significant differences (t Discussion tests) between the low back pain and non-low. neither biking position. activity level. average weekly cycling time Anatomical site ofinjury Frequency (P = 0 065). the spinal region had been sustained by 32% Twenty nine per cent had not noted any overall of subjects (lower back injuries 28%.terms of the degree of trunk flexion in a enced low back pain in the previous year. either suddenly or little by little. neck/ changes. and 43% with low back pain was first experienced was 23-7 running. The injuries suffered during the previous year greatest incidence of low back pain occurred associated with the incidence of low back pain during the mid-season training phase (44%).

the proportion of long involvement in the sport. as reflected by their manding. Of concern was that LOW BACK PAIN almost 20% of all the pain episodes had lasted The subjects in this study could be considered over three months. not statistically significant. emphasising the latter. as the subjects were not selected almost 28% of all overuse injuries suffered in through participation in a particular competition the previous year. all other persons not problem may have existed. According to the same to be much fitter and stronger than the general classification. often very physically de- goal oriented people. on average. injury of the intervertebral disc. non. full distance triathlon). low back complaints accounted for studies. We attempted to minimise this possible matches the life time low back pain incidence selection bias by promoting the study as looking rate (59%) of the triathlete subjects in this at both triathlon training methods and triathlon study. but this was most probably due This gender difference may be related to to the inclusion of a wider range of triathletes differences in training methods or volumes. injuries due to secondary reflex activity. training. However. that is. the males in and shorter. tioned studies. and was lack of common low back pain risk factors. the pain-spasm cycle. the of all the overuse injuries sustainedlA 7 which results were perhaps more descriptive of general is comparable to the figures for other sports. injuries. training season. would be minimal in a group of subjects in epidemiological studies involving of trained athletes.Low back pain in Japanese tniathletes 137 all Japanese. triathlon. According to Mooney's classification of low petitions. namely a possible involved in regular and very physically de. as opposed to after com. While the been given for the general population. In triathlon populations than those in previous this study.'4 1' In not allow generalisation about the entire popu. their training would have pain in this group of triathletes could be been of a more typical nature than that done attributed to soft tissue or myofascial structure during the competition season. the a clear danger sign of potential future and incidence of low back pain of the subjects was possibly severe long term disability. that is.3 5 6 the subjects to 60 years. Almost all subjects followed a regular training between males and females were either stretching programme. Further. have suffered from it at some time. trends. the lifetime incid. factors. low back injuries account for 4l17% lation of Japanese triathletes. especially when work practices were and Micheli. although their age was similar been found. the for approximately 5-10% of all athletic majority being primarily involved in employ. duration would be expected for triathletes and were most probably very determined and involved in regular. There are very few data on the somewhat exaggerated due to a possible non. Involvement of the zygapophyseal typical phenomena. differences for cycling and weight level. This closely set. but on the an astonishing 72% of subjects had com- basis of varying geographical location. a more serious pathology or population. the question. pations related to sport or triathlon. close (P = 0 052) to the set level of significance. While rela- manding athletic activities. such as normal post-race joints was also likely.'o It point incidence (12%) was at the lower limit of would be expected that many of these risk the general population values. O'Toole et al5 reported that (for example. injuries. would have also represent a continuance of acute soft tissue been excluded. These figures show that low back pain overuse injuries generally. and competition example. Second. and if traumatic low back injuries are excluded. but was in fact very what less than those in the previously men. This study revealed that ." In contrast. training. '0 as might be expected. though a portion of recovery "pain" and fatigue.'7 the majority of low back two reasons. with the age distribution well as smoking. Despite the relative duration pain episodes was quite high. In comparison with other studies the general population ranging mainly from 30 involving triathlete subjects. as subjects was 31-3 years. either no gender differences had to seven years). naires were completed during the mid-season then the prevalence would be even higher. The subjects trained some. This such as poor trunk muscle strength and endur- is interesting as the average age of the triathlete ance. including both overuse and traumatic ment of a non-physical nature. However. The plained of low back pain or sciatica in the incidence rates for all injuries may have been previous year.2 Also. The difference was year age groups. The majority of triathletes in this this study experienced a greater incidence of low study were distributed in the 26-30 and 31-35 back pain than the females. The overwhelming tively frequent soft tissue injuries of short majority did not smoke. participation by uninjured triathletes. which could have suspected zygapophyseal joint problems could been falsely interpreted as an injury. or the incidence had been greater to that of the subjects in the study by Ireland for females. 2 13 Sports such as gymnastics show The methodological approach employed did the highest low back injury rates. injuries. cardiovascular fitness and flexibility. very few subjects had occu. Lumbar spine injuries account. were not overweight. For in terms of skill. This could be expected to improve the back pain based on the potential for spon- reliability and generalisability of the results for taneous recovery. not less than that reported for the general General risk factors for low back pain have population. especially the physical risk indicators ence rate (59%) was in the middle range. incidence rates of low back pain for cyclists.'0 In previous studies on the general were generally younger (by approximately five population. First. but Mellion'6 stated that up to 60% of cyclists we were aware of this problem from the out. they were generally lighter taken into account. rather than in triathletes is as prevalent as in other sports. compared to the figure statistically significant or showed very strong of 65% reported by Ireland and Micheli. Interestingly.

to the "on" load of running. 2 With an inability to dissipate forces at place greater overall cumulative physical stress one joint. low back pain. It is passive elements makes the spine susceptible to reasonable to assume that those training more injury.138 Manninen. that is. Possibly the lengthens with an increase in the length of the training exercises for the trunk flexors were biking phase. to knee problems. Cycling.3 However. However. reported a greater average weekly cycling time. especially in a flexed position longation of the acute phase symptoms. 1 2 4 Migliorini4 for 61% of all injuries in this study. Also. Injuries of the lower back (28%) also eccentric muscle work during running. It subjects with low back pain in this study were would have been beyond the scope of this study flexor overpowered because they exercised to examine the relation in greater detail. or contribute to. as well as an tate themselves in the belief that greater appropriate degree of hip flexion for optimal abdominal muscle training may decrease their force generation during the pedalling cycle. may in fact be the key mately 60% of triathletes having suffered at component predisposing to low back pain.'13 this does not necess. the anatomical sites of injury bearing begins.' 5 OTHER INJURIES While running may cause most overuse In our study. the knee plaints. The triathlete is perhaps more susceptible to quency. In order to maintain may have been done in an attempt to rehabili. This may have resulted low back pain in the previous 12 months in inappropriate stresses on the lumbar spine. this may have actually lumbar spine is often held in a relatively flexed contributed further to a deterioration or pro. Further. This to Migliorini's suggestion. those experiencing performed incorrectly. Low back pain subjects ing to low back pain. there is a resultant overload at the on their bodies than those who train less.24 25 Should there be some kind of lower triathletes there is an upper "safe training limit limb disorder. The having been reported. but perhaps certain generalisations has been seen in triathlete injury patterns. future research should carried out to look extensor muscles.' 0 Thus it is very important have been seen to be flexor overpowered. Lower limb injuries accounted of overuse injuries in triathletes.which is indispensable for proper or ankle. Muscle activity changes from being was the single most common site of injury mostly concentric during cycling to include (30-50°/0).19 Perhaps the triathlete with no significant associations being found. before neuromuscular and elastic common site (4-17%) after the shoulder. then abnormal forces could be or zone" beyond which an increase in training incident on the lumbar spine. a risk factor cannot be ruled out. with can be made. were closely matched.' 2 4 with approxi- pain. Sitting. an aerodynamic cycling position. has been postulated that a time lag exists after though in other studies they were the third most cycling. associated with an increased incidence of low Migliorini suggested that this transition period back pain in the previous year. injuries related to triathlon was very similar to arily mean it is the primary cause of low back those reported previously.2' This individuals. This is further literature. While it is very difficult the possible detrimental effects of vibration as to draw definite conclusions about the causes. Kallinen increased trunk flexor muscle training fre. as weight Micheli. back pain occurring frequently in combination with lower limb injuries. It were the second most common in this study. the incidence of musculoskeletal injuries in triathletes. it is quite Other possible causes of low back pain in possible that the initial cause of the low back athletes have been suggested previously in the pain originated from cycling.5 It has been load would produce a non-proportional and suggested that malalignment in the foot leads greater increase in the risk of injury. and this theoretical upper limit would vary between subsequently to lumbar spine problems. to other foot problems.can reach its optimal level. while clearly how the muscles are trained is just as running may have been the final factor produc- important as how often and how much. In our study. Of course.' 4 5 21 22 Excessive or repetitive supported by the majority of subjects them- loading of the spine is a major cause of back selves implicating cycling as the main cause of injury in endurance athletes. has been shown to Another possibility is the presence of trunk increase intradisc pressure. it is not clear at how (inappropriate) cycling position may whether an imbalance is a causal factor or a cause. So. In all studies. efficiency . position." to examine cycling position and its association ratios of 1I0 to 0*8 (trunk extensors to flexors) with the incidence of low back pain. This next joint as forces ascend upwards towards the could indicate that even among top level Skull. This result provides some support after they had experienced low back pain. and for long periods. was the cause of most com. although very generally. in the study by Collins running technique . the symptoms.'9 20 Normal values are in present study did that. thereby predispos- muscle imbalances. et al. There was some indication (P = 0 095) that elastic passive elements of the spinal structures. compared found that the change from the "off' load of to the figure of 85% reported by Ireland and cycling.' the back was the most commonly injured . when this transition is occurring.2 foot. it is possible that subjects began to train though this was not statistically significant their trunk flexor muscles more frequently only (P = 0 065). the order of 1 3. average weekly triathlon training load was asso- The loss of ability to protect these weakened ciated with low back pain incidence. loading results in a weakening of the visco.2 Also. the number of times they were lower back injury during the initial stages of the trained weekly on average. ing marked symptoms or injury.23 Repetitive their low back pain. was significantly run. How- their abdominal muscles more than their back ever. least one soft tissue overuse injury in the even though it is responsible for only 12-29% previous year. However. result of low back pain.

postural.5:529-38. statistically significant associations in our study. Epidemiology and the impact of low back pain. 8 Heliovaara M. Ann Sports Med 1987. Despite the 13 Lachmann S. appreciation is extended to Tommi Salmela 25 Voloshin A. In this study. Lower extremity overuse injuries. both organisational and financial. factors. Wosk J. muscular. Overuse injuries in triathletes: a study of the 1986 Seafair injuries occurred frequently in combination Triathlon.711:171-7. 1989. low back pain of a serious nature. and shoulder. as well as related more accurately. NZJ Sports Med 199 1.Low back pain in Japanese triathletes 139 site. Armstrong M. 14 Goldstein J. and their effects minimised. . and comprised 5 O'Toole M. common sites of injury in the present study 18 Pope M. Spine injuries ence was found between low back pain and in gymnasts and swimmers: an epidemiological investi- gation. to this study. Descriptive epidemiology and public health aspects of low back pain. Medical CONCLUSION considerations in triathletes: the 1984 Hawaiian Ironman Triathlon.3:117-120. non-low-back-pain subjects. Schultz A. injuries to the shoulder in Italian national triathletes in the period 1987-1990. 11 Magora A. Hiller W. cyclists. Overuse injuries in all upper limb injuries. Sievers K. Wosk J. in relation Biomech 1982. Injuries by triathletes. Finland: Kuopio University. a rela. London: Blackwell Scientific Publications. Maatela J. Sisk T. Kuukkanen for her all her great organisational support. Smith R. Work history. and injury patterns. Brull M. there were several 15 Meeusen R. Ind Med Surg injury of the intervertebral disc. The relationship were of the knee. 12 Harvey J.13:982-92. Acta Med Scand (suppl) 1986. An in vivo study of low back pain and Medicine and Science in Japan. A indicates that triathletes are at risk of suffering practical approach. Sports Med 1991. Spine 1988. Ann Med tively high proportion are of longer duration. 103:48-50. Frankel V. and the majority of 19 Beenbon D. were the third most common. While most pain episodes are of short 9 Kelsey J. extension and lateral bending in healthy subjects and patients with low-back cycling is suggested as a major contributing disorders. training. though strengths in attempted flexion.13:655-60. Windler G. Common cycling injuries. 3 Massimino F. Peterson K. between anthropometric. Volvo award in biomechanics. Morrisey M. Ann Sports Med 1987. 6 O'Toole M. duration and involve the soft tissues. Soft tissue injuries in sport. Wilder D.13:197-206. Kahanovitz N.12:394-406. Tanner S. This clearly 1970. Spine 1988.3:121-3.21:327-33. 1988:3. and mobility characteristics of males ages 18-55. 1988 clearly identified. Ann Sports Med 1988. II. as well as to Tiina the human locomotor system.39:504-10. although there were no 2 Ireland M. Low back pain in young athletes. Warwick D. Jf Sports TraumatolRelRes 1991. Black R. The three most 17 Mooney V. Also.17:675-80. Kuopio. with lower limb injuries. fact that only one statistically significant differ.5:133-42. 1992. caused by running. Ann Med general population or other athletes such as 1989. 10 Pope M. so on the motor output and movement patterns. but the incidence has been quite 4 Migliorini S. Hawley J. low back. Laird R. Wagner M. Force transmission through for his assistance with statistical analysis. Hiller D. Low back pain is a common problem suffered 7 Williams M. O'Toole M. Spine 1980. Spine 1985. Trunk clear cause of injury to the lower back.21:387-92. Knekt P. A review of the literature related to trunk muscle performance. Gymnastic injuries.13:337-56. the incidence of low back pain.21:321-5.19:463-8. The classification of low back pain. and the Daiko Foundation. 17:514-8. Bevins T. J all their assistance. Nordin M. triathletes still suffer from it as much as the MAkeld M. White A. AmJ Sports Med 1991. Anderson G. Ann Med 1989. J Biomech Eng 1981. that these factors and their associations with 23 Mahlamaki S. ciations of certain training related factors with 11:52-70. Impivaara 0.15:21-7. Berger P. 16 Mellion M. O'Toole et al5 revealed that low back 1 Collins K.16:2-6. An epidemiological study of overuse injuries varied. Triathletes: biographic data. Investigation of the relation between low back These most probably implicate involvement or pain and occupation. there is no one 20 McNeill T. The triaxial coupling of torque generation of trunk muscles during isometric The results of this study give direction for the exertions and the effect of fatiguing isoinertial movements design of controlled interventional studies. Massimino M. Risk indicators in low back pain. ultraendurance triathletes. Am_J Sports Med 1989. We would like to thank the staff at the Institute of Sports 24 Voloshin A. Laird R. Simms K. Borms J. The sports related factors likely to 21 Micheli L. Spine 1980. While most knee injuries in triathlon are 10:644-8. shoulder injuries by swimming. of 10-16 year skiers and controls living in the North-Savo area. NZ J Sports Med 1988. Low back symptoms and signs in young low back pain in triathletes can be investigated cross-country skiers: a cross-sectional and follow-up study on the low back symptoms and signs. for shock absorption in the human locomotor system. Aromaa A. general risk factors for low back pain. Am Jf Sports Med 1989. Storey M. 1987:23. Micheli L. limb injuries. Jackson D. factor.4:82-6. Despite the relative absence of amongst competitive triathletes. Frymoyer J. The shoulder is the most common site of upper Common triathlon injuries: special considerations for multisport training. Freke M. Hiller D. Sports Med other strong indications for possible asso. increase the risk of low back pain must be more 22 Parniapour M.