This study evaluated how accurately medical history questions and hands-on physical examinations can identify common spinal conditions in elite-level gymnasts. The findings from these clinical assessments were compared directly against magnetic resonance imaging (MRI), an advanced medical scan that creates detailed images of bones and soft tissues, which served as the benchmark reference.
The project was conducted as a prospective cross-sectional study, meaning it examined participants at a specific point in time and followed the Standards for Reporting Diagnostic Accuracy (STARD) guidelines, a standardized protocol designed to ensure complete reporting. Testing took place at an MRI facility in Birmingham, United Kingdom. An experienced musculoskeletal physiotherapist administered the clinical assessments without knowing the participants' imaging results, while two specialist musculoskeletal radiologists evaluated the MRI scans independently of one another.
A group of 40 elite gymnasts agreed to participate. The researchers enrolled consecutive gymnasts from the target population regardless of whether the athletes were experiencing lower back pain at the time of the study.
The researchers evaluated individual clinical tests and grouped test combinations using two main statistical indicators: sensitivity (the percentage of athletes with a spinal condition who test positive) and specificity (the percentage of athletes without a spinal condition who test negative).
Among the 40 gymnasts, 75 percent demonstrated structural abnormalities on their MRI scans. The clinical findings with the highest specificity included:
- For degenerative disc disease (wear and breakdown of the spinal discs): symptoms easing when bending the spine forward, and enlargement of the primary lower back muscles (erector spinae hypertrophy).
- For disc herniation (where a spinal disc bulges or ruptures): enlarged lower back muscles, pain provoked by bending forward from a standing position, and pain provoked by leaning backward while bending sideways to the left.
- For pars oedema (fluid accumulation and swelling within the bone) and spondylolysis (a stress fracture in the rear segment of a vertebra): pain when bending forward while standing combined with pain during backward and leftward bending.
- For spondylolisthesis (the slipping of one spinal bone over another): symptom relief when bending forward, combined with the standing forward-bending and backward/leftward-bending pain cluster.
The clinical tests and exploratory test groups that demonstrated high specificity accurately identified gymnasts who did not have degenerative disc disease, disc herniation, or pars oedema and spondylolysis. However, because the study participants were recruited without regard to whether they had active lower back pain symptoms, these results must be applied with caution in real-world clinical care.