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Associations between different sports and low back pain: a population-based study with a 15-year follow-up

European Spine Journal · 28 Aug 2026

Rigour48/100
Clinical57/100
Impact†48/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

It's a commonly asked clinical question, whether recommending specific sports (rather than just 'more exercise') can help prevent recurrent low back pain, and this study offers population-level, though modest, evidence that not all physical activity is equal.

The evidence

Using the Northern Finland Birth Cohort 1966 (n=3352), researchers looked at whether the type and frequency of sport played in adulthood (age 31) predicted low back pain (LBP) status 15 years later (age 46). After adjusting for sex, BMI, smoking, education, occupational exposure, and comorbidities, only cross-country skiing remained associated with lower odds of repeatedly reported LBP (OR 0.77, 95% CI 0.60-0.98 for skiing up to once a week; OR 0.71, 95% CI 0.51-1.00 for at least twice a week), while running and gym training lost significance after adjustment, and no sport was associated with new-onset or resolved LBP.

Repeatedly observed low back pain: Odds ratio 0.77 (95% CI 0.6 to 0.98; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.

Why this rigour score?

Prospective cohortDesign starting point: 40

48/ 100

Raised the score

  • 180-month follow-up+3.4
  • Aligned time zero+2.5

Lowered the score

    No negative adjustments recorded.

    Methods at a glance

    Recorded assessment
    • Confounding adjustmentMultivariable regression
    • Covariate balance confirmedNot applicable
    • Outcome assessors blindedNot applicable
    • Comparable start of follow-upMet
    • Adequate statistical powerCalculation absent
    • Prospective registrationNot applicable

    Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

    See the full score breakdown
    Study design starting point
    40
    Aligned time zero
    +2.5
    Compared against an accepted alternative
    +1.7
    180-month follow-up
    +3.4
    Journal prior (not an observed method)
    +0.7
    Final rigour score rounded
    48 / 100

    Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

    Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

    For journal club

    1.If a patient with recurrent low back pain asks which sport to take up, should cross-country skiing be specifically recommended over running or gym training based on this evidence?

    2.How should clinicians counsel patients about the limits of this data (borderline confidence intervals, self-reported pain, no dose-response causality) when discussing exercise choices for LBP prevention?

    Original publication title

    Associations between different sports and low back pain: a population-based study with a 15-year follow-up

    Read original paper