Prevalence of Lower Back Pain and Risk Factors in Equestrians: A Systematic Review

Abstract

This systematic review aimed to determine the prevalence of lower back pain (LBP) in equestrian athletes (EAs) and identify associated risk factors. Following the PRISMA guidelines, observational studies published between 2004 and 2024 in English, Portuguese, Spanish, and German were included. The review identified relevant studies through the Web of Science, EBSCO, MEDLINE, and SCOPUS (last search performed on 30 October 2024), yielding 14 studies with a total of 4527 participants. The question format for the included studies specified the population as equestrian athletes, the exposure as equestrian sports, and the outcome as lower back pain. The risk of bias was evaluated using the Observation Study Quality Evaluation tool, and six studies were deemed high-quality. LBP prevalence in EAs was higher than in the general and athlete population, with point prevalence ranging from 27.9% to 87.9%. Sport-specific factors, including workload and stable duties, were significant risk factors. Methodological inconsistencies, such as varying definitions of LBP and a lack of standardized exposure assessment, and the overall low quality of studies limited the comparability of findings. This review underscores the need for more high-quality research and tailored interventions addressing both riding and off-horse activities in EAs.

Keywords: equestrian athletes; equestrian sports; injury prevention; lumbar pain; musculoskeletal disorders; occupational health.

Figure 1

Study selection process.

Figure 2

Equestrian disciplines represented in the studies and numbers of studies with populations practicing each discipline. NC—non-competitive. More details in Supplementary Materials SI, Table S6.

Figure 3

Numbers of studies reporting on pain in different trunk and body locations: upper back [20,21,23,29,30,31,33]; mid-back [20,24,29,33]; lower back [20,21,22,23,24,25,26,27,28,29,30,31,32,33]; all back [20,22,30,33]; other [21,22,23,24,31].

Figure 4

SF-MPQ—Short-Form McGill Pain Questionnaire [21,23,31]; ODI—Oswestry Disability Index (or the Oswestry Low Back Pain Disability Questionnaire) [20,31,32,33]; NSQ—non-standardized questionnaire tool [20,22,24,25,26,27,28,29,30,33]; NMQ—Nordic Musculoskeletal Questionnaire [28]; NRS—Numeric Rating Scale [28] for severity of pain; PSEQ—Pain Self-Efficacy Questionnaire [28] only for those reporting CLBP; VAS—Visual Analog Scale [30,32] to measure intensity of pain; RMDQ—Roland Morris Disability Questionnaire [27].

Figure 5

Prevalence of LBP within study population. Results of included studies divided into different recall periods. Pilato et al. 2017 [29], Deckers et al. 2021 [20], Cejudo et al. 2020 * [25], Cejudo et al. 2020 ** [26], Lewis and Baldwin 2018 [21] and Lewis and Kennerley 2017 [22].

Figure 6

Prevalence, with confidence limits, of LBP in EAs. Results of included prevalence studies, divided into different recall periods. When not provided, confidence limits were calculated by the review team; more details are given in Table S12, Supplementary Materials SII. Kraft et al. 2007 [30], Kraft et al. 2009 [32], Hobbs et al. 2014 [24], Lewis et al. 2018 [23], Lewis et al. 2023 [31], Ferrante et al. 2021 [28] and Duarte et al. 2024 [27].

Figure 7

Levels of pain felt by equestrians based on VAS ratings [34]. Location of pain: LBP [23,28,31,32,33]; BP [20,30]; pain in general [21]. * Values of intensity of pain given as quantitative variables (medians with standard deviations above and below). ** Values of intensity of pain given as qualitative variables. Kraft et al. 2007 [30], Kraft et al. 2009 [32], Lewis et al. 2018 [23], Lewis and Baldwin 2018 [21], Deckers et al. 2021 [20], Ferrante et al. 2021 [28], Puszczałowskalizis et al. 2022 [33] and Lewis et al. 2023 [31].