Common in footballers, and mostly minorEmerging evidence
The NHS says back pain "usually improves within a few weeks but can sometimes last longer or keep coming back". Across 44 studies of adult professionals, "The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women" (LBP is low back pain, CI the confidence interval), yet "The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women", and days missed ranged from 2 to 10 on average. In the review's words, "The frequency and incidence of LBP (compared with other conditions and sports) seems to be low".
In injury records of professional men, "The trunk was the second most commonly injured region (0.4 per 1000 hours of exposure, 95% CI 0.3 to 0.5, I2=97.67)" (I2 is a measure of how much the studies differ), far behind the leg, and "Minor injuries (1-3 days of time loss) were the most common". In 43 studies of players aged 19 and under, "Minimal injuries were the most common in both sexes", and trunk injury rates were higher in girls than boys "but were still relatively low for both sexes". At a Japanese junior tournament, of 494 players examined for pain, 4.0% had findings in the lower back, against 40.1% at the knee and 45.7% at the heel. These are professional or selected players; grassroots adult football has been studied less.
Sources 1, 2, 3, 4, 5
Not more than other active peopleEmerging evidence
In 277 elite Norwegian women footballers, 190 handball players and 167 active women who didn't play, "There were no significant group differences in the prevalence of LBP ever (p = 0.62), the previous year (p = 0.85) or the previous 7 days (p = 0.63)". In 181 young Dutch elite athletes, 64% of footballers had back pain in the past year, close to field hockey and speed skating, and "No sport-related risk factors were found in football".
Across 86 studies of athletes in all sports, back pain was common, and "Current evidence is insufficient to identify which sports are at highest risk"; football was the sport studied most often in a review of Olympic sports, with very varied figures. These are surveys: they show how often players notice their backs, not what causes the pain.
Sources 6, 7, 8, 9
Load, past pain and the kickEmerging evidence
Across sport, "A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors". In teenage athletes, sport volume or intensity, pain in the legs, older age and being a girl went with back pain, and Norwegian women reported more back pain in the competitive season than the rest period.
A full instep kick works the whole body: in 20 adult players it acted as a two-stage release of a tension arc between the upper and lower body, first "increases in concentric hip flexion and transverse lumbo-pelvic velocities towards the ball", then the low back and pelvis bending forward as the knee straightens. A biomechanics review describes "the influences of the upper body, support leg and pelvis on the kicking action". That describes load, not harm: no study has followed players' kicking load or technique and found it causes back pain. Long passes, shots, corners and goal kicks, sprints and sharp turns are the actions players most often link with back pain (our reading).
Goalkeepers dive, land and kick long: "Seventy percent of the goalkeepers in both football and handball had experienced LBP the previous year" in Norwegian elite women. Outfield findings disagree: in 204 Italian teenage boys, strikers reported more than midfielders and goalkeepers. These are small surveys, and no position is a reason to stop playing.
Sources 8, 10, 11, 12, 6, 13
Young players: the stress fracture of the lower spineStrong evidence
Spondylolysis is a crack, usually a stress fracture, in the thin bridge of bone at the back of a vertebra, most often the fifth in the low back. The American Academy of Orthopaedic Surgeons (AAOS) says "Spondylolysis is a weakness or stress fracture in one of the vertebrae, the small bones that make up the spinal column", and the NHS says a stress fracture is "more common in young athletes and gymnasts". In a review of teenage athletes, "The most common morphology reported was spondylolysis".
In a US hospital sports clinic, 308 of 1,025 (30%) teenage athletes with back pain had one; among boys the share was 48% in soccer, but "Baseball was the only sport to demonstrate a significant increased risk of spondylolysis". In a US community practice's 533 cases, "Soccer, gymnastics/cheer, football, and basketball were the most common sports associated with spondylolysis", which reflects who plays as much as risk. Clinic samples overstate how common it is among all young players with sore backs; for comparison, 5.9% of 2,000 Japanese adults scanned for other reasons had a defect, most without knowing.
Sources 14, 15, 10, 16, 17, 18
What is different in young footballersEmerging evidence
Unlike the one-sided stress of fast bowling in cricket, "Playing soccer is associated with a more symmetrical distribution of bone stress response, including stress fracturing". In 33 Japanese boys with spondylolysis from football, 20 (60.6%) had it on both sides, and "Soccer players had greater numbers of multiple (p < 0.001) and bilateral (p < 0.001) lesions than baseball players". In Japanese academy boys screened by MRI (magnetic resonance imaging), "The incidence of bilateral lumbar BSI was common at 26.2%" (BSI is bone stress injury), and where one side got worse, it was more often the standing-leg side (33 players) than the kicking side (14).
One small cohort of 195 Japanese boys aged 12 to 13 found that "Increase in iliopsoas muscle tightness in the kicking leg was a predictive risk factor of developing extension-based lumbar pain after adjusting for developmental age and body mass index (odds ratio, 1.54; 95% confidence interval, 1.05-2.27)" (the iliopsoas is the deep hip flexor). In 57 child and teenage players at a US children's hospital, "Of the patients, 43% noticed that pain started after a high-velocity kick". These are small cohorts and case series: links, not proof that kicking or tight hip flexors cause the fracture.
Sources 19, 20, 21, 22, 23, 24
When a scan matters, and what changes on scans meanStrong evidence
Most back pain after football needs no scan. The National Institute for Health and Care Excellence (NICE) says "Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica", and the Chartered Society of Physiotherapy (CSP) says "You rarely need a scan and it can do more harm than good". Scans of people without symptoms often show changes: "The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals", and in 40 professional players with no back symptoms, "Disc desiccation was the most common pathologic condition, which was found in 82.5% of athletes", with a pars defect in 20%.
A scan does matter for a young player with a suspected stress fracture: the NHS says "The GP may arrange an X-ray to see if a bone in your spine has slipped forward", and the recent trial diagnosed active spondylolysis by MRI, which avoids the radiation of a computed tomography (CT) scan in a young person (our note). An urgent MRI in hospital matters with the cauda equina signs, and an X-ray after a hard fall or a blow with pain in one spot over the spine.
Sources 25, 26, 27, 28, 15, 29
What usually happensEmerging evidence
In 33 groups of people with recent low back pain, average pain fell from 52 out of 100 to 23 at 6 weeks and 6 at a year: "Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks". The CSP: "It can be disabling and worrying but it is very common and rarely dangerous". In professional players, back pain kept them out for 2 to 10 days on average, though "Estimates of the recurrence, intensity, and severity of LBP are uncertain".
Spondylolysis in young people: in the 2026 trial, physiotherapy straight away brought players back 38 days sooner than resting first, and "At 3 months, 81% of participants demonstrated healing on MRI, 8% demonstrated no change, and 11% demonstrated worsened findings"; "Adolescent athletes RTP 92.2% of the time with nonoperative management" (RTP is return to play); and in 34 young Spanish footballers, "The mean time of cessation of sports activity was 3.9 months (SD 0.8) and 5.2 months (SD 2.1) for a complete return to sports" (SD is the standard deviation). Caught early, bone healing was the rule in one Japanese series. A previous episode is the strongest known risk factor for back pain in athletes, which is a reason to keep the strength work going once you're back. No one can promise a date.
Sources 30, 26, 2, 29, 31, 32, 33, 34, 8
When it isn't football: the causes the warning signs cover
Some back pain has causes football didn't create, or needs more than a plan, and the warning signs follow the pages behind them. Numbness around the genitals or bottom, bladder or bowel changes or symptoms in both legs can be cauda equina syndrome, in the NHS back pain and sciatica pages' words; leg symptoms that are getting worse follow an NHS trust's leg pain leaflet; and foot drop, a burst aortic aneurysm, a kidney infection and back pain after cancer have NHS and NICE pages of their own, which the back hub's lines follow. After a fall or a blow, the NHS falls page, NHS inform's back problems and neck injury pages and NICE's spinal injury guideline say who needs 999 or same-day care.
A hot, swollen joint can be an infection, as the NHS septic arthritis page says, and fainting or chest pain during exercise needs a 999 call, as the NHS fainting and chest pain pages say. A young athlete's stress fracture of the spine is described in a long-term study of 500 children and a 45-year follow-up; two NHS children's physiotherapy services say when a child's back needs a GP; the NHS ankylosing spondylitis page and NICE's spondyloarthritis guideline describe inflammatory back pain; and the Royal Osteoporosis Society, the AAOS, the UK osteoporosis guideline and NICE describe spine fractures after minor falls. The back hub's pain rule follows the World Health Organization (WHO) guideline and a review of leg symptoms that move back towards the spine, and the young athletes' rule a review of non-surgical care and the CSP's myth busters.
Sources 1, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75
