Training activities associated with lumbar pain exacerbation in competitive swimmers with prior lumbar spine injury: a cross-sectional survey

Competitive swimmers often accumulate high training volumes that place repetitive stress on the lumbar spine, potentially worsening injury and pain. This study examined training activities associated with self-reported lumbar spine pain exacerbation in competitive swimmers with prior lumbar spine injury. We conducted a retrospective cross-sectional survey of 285 swimmers (mean age 18.7 ± 3.1 years) assessing demographics, training exposures, and injury history. 29 swimmers (10.2%) reported a prior lumbar spine injury, including disc pathology (20.7%), spondylolysis/spondylolisthesis or facet pain (27.6%), lumbar strain (27.6%), and scoliosis or sacroiliac pain (24.1%). All activity-related analyses were conducted on these 29 swimmers. The frequency of self-reported pain exacerbation differed significantly across the 12 training activities (Cochran’s Q(11) = 80.02, p < 0.001). Butterfly (86.2%), dryland strength training (75.9%), and turns (72.4%) were most frequently reported as pain-provoking, whereas paddles (13.8%) and pull buoys (13.8%) were least frequently reported as pain-provoking. Among competitive swimmers with a history of lumbar spine injury, the frequency of reported pain exacerbation varied across training activities, with butterfly, turns, and dryland strength training most frequently reported as exacerbating symptoms. These findings can inform practical activity-modification strategies and may inform future prospective studies evaluating activity modification and return-to-swimming strategies in swimmers with lumbar spine pain.