OBJECTIVE: To assess the role of exercise targeting proper trunk stabilization and segmental spinal movement in back pain and sensory perception among cross-country skiers. DESIGN: Randomized, controlled trial with blinded outcome assessors. SETTING: University Hospital, Department of Rehabilitation and Sports Medicine. PARTICIPANTS: Twenty elite cross-country skiers aged 17 to 27 years. INTERVENTIONS: Ten cross-country skiers integrated 3 types of exercise targeting segmental motion in mid-thoracic spine into their routine training practice for 2 months. The 10 controls performed routine athletic training. MAIN OUTCOME MEASURES: The Young Spine Questionnaire to measure intensity and frequency of back pain was completed at the start and end of study. Tactile sensory perception using 10-g Semmes-Weinstein monofilament, thermic perception using TIP THERM device, graphesthesia assessed by a touch monitor pencil, 2-point discrimination assessed by a digital caliper, and vibration perception assessed by a 128-Hz tuning fork measured in mid-thoracic spine 5 times. RESULTS: No significant group differences in pain and sensory perception were identified at baseline. Over the 2-month study interval, repeated-measures analysis of variance revealed that the experimental group improved significantly relative to the control group on pain intensity (P = 0.005 for cervical, P = 0.004 for thoracic, and P = 0.014 for lumbar) and frequency of pain in the thoracic area only (P = 0.011). Improvements were also observed in the experimental relative to control group on graphesthesia (P < 0.001), vibration perception (P = 0.002), and 2-point discrimination (P < 0.001). CONCLUSIONS: Exercise targeting the mid-thoracic spine may decrease back pain and improve sensory perception in cross-country skiers. LEVEL OF EVIDENCE: Original research, level I.

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University University Hospital Motol Prague Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

School of Aging Studies University of South Florida Tampa Florida; and

See more in PubMed

Frank BC. Risk of injuries, symptoms of excessive strain and preventive possibilities in cross-country skiing. A comparison between classical technique and skating technique [German]. Sportverletz Sportschaden. 1995;9:103–108.

Eriksson K, Németh G, Eriksson E. Low back pain in elite cross-country skiers. A retrospective epidemiological study. Scand J Med Sci Sports. 1996;6:31–35.

Alricsson M, Björklund G, Cronholm M, et al. Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers. J Exerc Rehabil. 2016;12:21–28.

Bergstrøm KA, Brandseth K, Fretheim S, et al. Back injuries and pain in adolescents attending a ski high school. Knee Surg Sports Traumatol Arthrosc. 2004;12:80–85.

Renstrom P, Johnson RJ. Cross-country skiing injuries and biomechanics. Sports Med Auckl NZ. 1989;8:346–370.

Foss IS, Holme I, Bahr R. The prevalence of low back pain among former elite cross-country skiers, rowers, orienteerers, and nonathletes: a 10-year cohort study. Am J Sports Med. 2012;40:2610–2616.

Bahr R, Andersen SO, Løken S, et al. Low back pain among endurance athletes with and without specific back loading—a cross-sectional survey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine. 2004;29:449–454.

Alricsson M, Werner S. The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study. Br J Sports Med. 2004;38:148–153.

Alricsson M, Werner S. Self-reported health, physical activity and prevalence of complaints in elite cross-country skiers and matched controls. J Sports Med Phys Fitness. 2005;45:547–552.

Mahlamäki S, Soimakallio S, Michelsson JE. Radiological findings in the lumbar spine of 39 young cross-country skiers with low back pain. Int J Sports Med. 1988;9:196–197.

Federolf P, Bakker E. Muscle activation characteristics in cross-country skiers with a history of anterior compartment pain. Sports Biomech. 2012;11:452–463.

Hintermann B. Overuse damage in modern cross-country skiing [German]. Z Unfallchir Versicherungsmed. 1993(suppl 1):274–285.

Lawson GE, Hung LY, Ko GD, et al. A case of pseudo-angina pectoris from a pectoralis minor trigger point caused by cross-country skiing. J Chiropr Med. 2011;10:173–178.

Roosink M, McFadyen BJ, Hébert LJ, et al. Assessing the perception of trunk movements in military personnel with chronic non-specific low back pain using a virtual mirror. PLoS One. 2015;10:e0120251.

Hidalgo B, Gobert F, Bragard D, et al. Effects of proprioceptive disruption on lumbar spine repositioning error in a trunk forward bending task. J Back Musculoskelet Rehabil. 2013;26:381–387.

Wand BM, Di Pietro F, George P, et al. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation. Physiotherapy. 2010;96:317–323.

Rabey M, Slater H, O'Sullivan P, et al. Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis. Pain. 2015;156:1874–1884.

Moseley GL. I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain. 2008;140:239–243.

Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med. 2011;45:437–440.

Lauridsen HH, Hestbaek L. Development of the young spine questionnaire. BMC Musculoskelet Disord. 2013;14:185.

Kobesova A, Valouchova P, Kolar P. Dynamic neuromuscular stabilization: exercises based on developmental kinesiology models. Functional Training Handbook. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.

Kobesova A, Safarova M, Kolar P. Dynamic neuromuscular stabilization: exercise in developmental positions to achieve spinal stability and functional joint centration. Oxford Textbook of Musculoskeletal Medicine. Oxford: Oxford University Press; 2016;678–689.

Gutknecht M, Mannig A, Waldvogel A, et al. The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. J Bodyw Mov Ther. 2015;19:722–731.

Trapp W, Weinberger M, Erk S, et al. A brief intervention utilising visual feedback reduces pain and enhances tactile acuity in CLBP patients. J Back Musculoskelet Rehabil. 2015;28:651–660.

Wojtys EM, Ashton-Miller JA, Huston LJ, et al. The association between athletic training time and the sagittal curvature of the immature spine. Am J Sports Med. 2000;28:490–498.

Alricsson M, Werner S. Young elite cross-country skiers and low back pain—A 5-year study. Phys Ther Sport. 2006;7:181–184.

Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13:361–370.

Lotze M, Moseley GL. Role of distorted body image in pain. Curr Rheumatol Rep. 2007;9:488–496.

No significant links between somatognosia, stereognosia, and hypermobility: sensory processing unlikely to drive common complaints in hypermobile population