Prevalence, risk factors, and conservative management of low back pain in competitive gymnasts: a systematic review

Low back pain (LBP) is among the most prevalent musculoskeletal complaints in competitive gymnasts, yet synthesized evidence evaluating its epidemiological burden and conservative management in this population remains limited. This systematic review aimed to investigate the prevalence, risk factors, and efficacy of conservative interventions for LBP in competitive gymnasts. This review was conducted following the PRISMA guidelines and registered with PROSPERO (ID: 420251238218). Five databases (PubMed, Scopus, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to February 2025. Eligible studies included randomized controlled trials (RCTs), cohort, case-control, cross-sectional, and quasi-experimental studies involving competitive gymnasts aged 12 years or older with LBP. Methodological quality was assessed using the Cochrane Risk of Bias 2.0 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Due to substantial clinical and methodological heterogeneity, a narrative synthesis was performed. Ten studies (7 RCTs, 3 cross-sectional) involving 736 participants were included. LBP prevalence ranged from 25% to 50% across disciplines, with higher rates observed in rhythmic gymnastics. Prevalence increased with advancing age and greater weekly training volume. Core stability training reduced pain intensity by 1.5 to 3.1 points on a 10-point VAS/NRS scale, while postural re-education methods (notably the Mézières method) yielded reductions of 1.2 to 2.5 points. Multimodal protocols integrating core training with postural correction demonstrated the largest reductions (1.8 to 3.2 points). No adverse effects on athletic performance were reported. LBP is highly prevalent among competitive gymnasts and is closely associated with cumulative training exposure. Core stability training and global postural re-education lasting 8 to 12 weeks can produce clinically meaningful pain reductions. However, the current evidence base is limited by small sample sizes, short follow-up periods, and inherent challenges in participant and personnel blinding. Future large-scale, multicenter RCTs with standardized outcome measures and long-term follow-up are warranted.