There Is a Ceiling, and Elite Athletes Are Above It

The SparkNotes

• Among 1,114 German elite athletes, 88.5% had experienced back pain in their lifetime and 49% had it in the past week.

• Those rates were significantly higher than in a physically active but non-elite control group.

• Rowers, dancers, gymnasts, fencers and several others sat well above the control group. Elite triathletes sat below it.

• The authors describe a U-shaped curve: too little activity and too much both appear to be hard on a spine.

• It is a survey, so it cannot prove which direction the arrow points.

The Whole Story

Two articles on this site argue that movement is good for backs. This one is about where that stops being true.

Researchers surveyed 1,114 German national and international elite athletes across a wide range of sports, and compared them with 166 physically active but non-elite sports students.

The elite athletes had more back pain. Not less.

The numbers

Among the elite athletes, 88.5% had experienced back pain at some point in their lives, 81.1% within the past twelve months, 68.3% within the past three months, and 49% within the past week.

In the physically active control group the figures were 80.7, 69.9, 59.0 and 42.8%.

The differences at lifetime, twelve months and three months were statistically significant. So this is not a small gap that appeared by chance — although note that both groups are high. Back pain is common in people who move a lot and people who do not.

It is not uniform across sports

The prevalence was significantly higher than the control group in elite rowers, dancers, fencers, gymnasts, track and field athletes, figure skaters and marksmen, and in those playing underwater rugby, water polo, basketball, hockey and ice hockey.

And it was significantly LOWER in elite triathletes.

That last one is worth pausing on, because it is the only group that beat the control. Triathlon is three sports. Whatever else it does, it spreads load across different movements and different tissues rather than repeating one pattern thousands of times.

Which lines up with something in the running literature: one of the risk factors reported for back pain in runners is doing no other aerobic activity during the week.

The shape this suggests

The authors put it as a U-shaped curve. Too little activity is hard on a spine. So is too much. Somewhere in between is the bottom of the curve.

Read alongside the systematic review on runners — where back pain was less common than in the general population, and the reviewers cautiously suggested running might be protective — a rough picture emerges.

Sedentary is bad for backs. Recreationally active looks good, possibly protective. Elite volume looks bad again.

THE PART THAT MATTERS FOR MOST PEOPLE READING THIS: if you train hard four or five times a week and have a job, you are almost certainly nowhere near the elite end of that curve. Whatever is going on with your back, "I train too much" is unlikely to be the explanation, and cutting training is unlikely to be the fix.

What this study cannot tell you

It is cross-sectional. Everyone was surveyed at one moment, so it cannot establish which came first.

It also cannot separate training volume from everything else that comes with being an elite athlete — the competition, the travel, the pressure, the fact that a rower and a marksman have almost nothing in common except a classification.

And the control group was 166 sports students. Physically active young adults are a reasonable comparison, but they are not the general population and they are not you.

So take the direction, not the decimal places.

What I have seen up close

The high-level athletes I have seen compete through back pain mostly did one of two things. They ignored it, or they fought through it.

And then they built quiet rules around it. Never squat heavy. Never deadlift. No back squats at all.

Those rules are the part worth questioning, because the training being cut out is often the training that would have helped.

What to do with it

• If your back hurts and you train recreationally, the evidence does not point at your training volume as the cause.

• If you do one thing repeatedly and nothing else, variety is the cheapest change available — and it is the one variable that separated the only sport that outperformed the controls.

• If you genuinely are at the high end — high volume, one sport, year round — that is the population where prevention work has actually been recommended.

• And in all three cases, the response to a sore back is to modify what you are doing rather than to stop.

Follow along as Resurgo comes together.

Read next: Runners Get Less Back Pain, Not More · Ten Things About Back Pain That Should Change How You Train