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. 2025 Feb 1;60(2):170-176.
doi: 10.4085/1062-6050-0151.24.

Low Back Pain or Injury Before Collegiate Athletics, a Potential Risk Factor for Noncontact Athletic Injuries

Marcie Harris-Hayes  1 , Steven Solomon  1 , Sylvia Lin  1 , Heidi Prather  2 , Devyani Hunt  3 , Mansi Agarwal  4 , Nancy J Bloom  1 , Lauren Mills  1 , John C Clohisy  3   4
Affiliations

Low Back Pain or Injury Before Collegiate Athletics, a Potential Risk Factor for Noncontact Athletic Injuries

Marcie Harris-Hayes et al. J Athl Train. .

Abstract

Context: Surrounding the predictive value of clinical measurements and assessments for future athletic injury, most researchers have not differentiated between contact and noncontact injuries.

Objectives: We assessed the association between clinical measures and questionnaire data collected before sport participation and the incidence of noncontact lower extremity (LE) injuries among Division III collegiate athletes.

Design: Prospective cohort study.

Setting: University setting, National Collegiate Athletic Association Division III.

Patients or other participants: Here, 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations.

Main outcome measure(s): Prospective incidence of noncontact LE injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single-leg squat to identify dynamic knee valgus, and hip range of motion. Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable generalized estimating equation models were used to analyze the relationship between each clinical measure and the first occurrence of noncontact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs).

Results: Of the 488 athletes, 369 athletes (75%) were included in the final analysis. Sixty-nine noncontact LE injuries were reported. Responding yes to, "Have you ever had pain or an injury to your low back?" was associated with an increased risk of noncontact LE, odds ratio = 1.59 (95% confidence interval = 1.03, 2.45; P = .04). No other clinical measures were associated with an increased injury risk.

Conclusions: A history of prior low back pain or injury was associated with an increased risk of sustaining a noncontact LE injury while participating in National Collegiate Athletic Association Division III athletics.

Keywords: injury prediction; injury risk; noncontact injury.

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