Body mass index is associated with low back pain in childhood and adolescence: a birth cohort study with a 6-year follow-up in Niigata City, Japan

Age-Related Differences in the Limited Range of Motion of the Lower Extremity and Their Relation to Low Back Pain in Young Baseball Players: A Cross-Sectional Study of 1215 Players

BACKGROUND

Age-related differences in the limited range of motion of the lower extremities and their relationship with low back pain in juvenile athletes have not been well assessed. This study investigated the relationship between low back pain and limited range of motion of the hip and knee in young baseball players during the baseball season.

RESULTS

Participants comprised 1215 baseball players (216 pitchers, 999 fielders) aged 6-16 years who underwent medical checkups (self-completed questionnaire and physical examination). Of the 1215 players, 255 (21.0%) experienced seasonal low back pain requiring rest during the previous year. The prevalence of low back pain and a positive Thomas test, straight-leg-raising test, and heel-to-buttock test increased with age. Univariate analysis revealed that a positive heel-to-buttock test in both the throwing and non-throwing arm sides in the 11-12 age group and a positive Thomas test in the throwing arm side in the 13-14 age group were associated with seasonal low back pain (P = 0.0051, P = 0.021, and P = 0.048, respectively). Multivariate analysis, adjusted for factors associated with low back pain, showed significant associations between the positive heel-to-buttock test (odds ratio 1.75, 95% confidence interval 1.11-2.79; P = 0.016) and low back pain in players aged 11-14 years.

CONCLUSIONS

A positive heel-to-buttock test is potentially associated with low back pain among juvenile baseball players. Particular attention should be paid to the limited range of motion of the knee joint and tightness of the quadriceps femoris muscle among baseball players with low back pain aged 11-14 years.

Early age at menarche is associated with post-menarche back pain: An analysis of the Raine Study

INTRODUCTION

Back pain (BP) experienced by females during adolescent years appears to predispose them to an increased likelihood of its presence in adulthood. Understanding this phenomenon by identifying risk factors of those at risk potentially fosters preventative strategies and effective treatments.

OBJECTIVES

To investigate for associations between post-menarche BP and low back pain (LBP) and age at menarche (AAM) in Australian adolescents using the Western Australian pregnancy cohort (The Raine Study).

METHODS

This study used data from a longitudinal cohort study. BP data were collected retrospectively using a questionnaire. Menarche data was split into three established age classifications early (<12-years), normal (≥12 to >14-years) and late (≥14-years). Logistic regression models examined the effect of AAM on BP.

RESULTS

666 female participants provided valid menarche data with 183 (27.5%) early AAM, 429 (64.4%) normal AAM and 54 (8.1%) with late AAM. The mean AAM was 12.59 years. BP was disclosed by 27.5% in the 14-year follow-up and 31.5% in the 17-year follow-up. Participants who had early AAM had 79% higher odds of experiencing BP compared to participants who had normal AAM, after adjusting for confounders at the 14-year follow-up (adjOR 1.79, 95% CI 1.18-2.64).

CONCLUSION

There is evidence of an association, in this cohort, of early AAM with post-menarche BP. This result identifies an area for future exploration, including understanding this mechanism which may lead to the development of effective intervention measures.

SIGNIFICANCE

Age at menarche is related to a range of health issues. This study sought to investigate if it was a risk factor for spinal pain. We used an existing Australian data base to explore this possibility and found an association with early age onset and post-menarche back pain. This result identifies an area for future exploration, including understanding this mechanism which may lead to the development of effective intervention measures.

Epidemiology and pain in elementary school-aged players: a survey of Japanese badminton players participating in the national tournament

Pain is common in athletes which should be well managed. To identify risk factors for shoulder pain, and the association between shoulder pain, lower back pain and knee pain among elementary school-aged badminton players, we conducted a cross-sectional study to collect data of the past year among 611 elementary school age (7-12 years old) badminton players belonging to the Japan Schoolchildren Badminton Federation using a questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by multivariate logistic regression analysis. The overall incidence rate of shoulder injuries, lower back injuries and knee injuries was 0.38 injuries per 1000 h of badminton training. Players with training time per day > 2.5 h were 2.64 times (95% CI 1.03-6.78, p = 0.043) more likely to sustain shoulder pain than those with training time per day ≤ 2.5 h. A significant association was revealed between shoulder pain and knee pain as well as between lower back pain and knee pain as training hours per day > 2.5 h. Moreover, lower back pain was significantly associated with shoulder pain independent of training hours per day (≤ 2.5 h: p = 0.001; > 2.5 h: p < 0.001). These findings indicate that training time per day is risk factor, and shoulder pain, lower back pain and knee pain were associated with each other in elementary school-aged badminton players.

Investigating the Relationship between Body Mass Index and Pain in the Spine in Children or Adolescents: A Systematic Review

Background: Neck pain (NP), back pain (BP), and low back pain (LBP) are generally defined as "pain in the spine." With the increasing prevalence of childhood obesity, secondary problems such as pain in the spine have arisen. The purpose of this review was to investigate the relationship between body mass index (BMI) and pain in the spine in children or adolescents. Methods: Publications were searched in PubMed, Web of Science, Scopus, and Google Scholar databases up to December 12, 2020. The search strategy in the database consisted of free text words and MeSH terms. Results: Twelve studies were reviewed. It was determined that different methods were used in all 12 studies to evaluate pain. In the evaluation of overweight/obesity, these studies performed BMI assessment by dividing body weight in kilograms by height squared. Five studies showed a relationship between LBP and BMI, two studies showed a relationship between BP and BMI, and two studies showed a relationship between NP and BMI. Conclusions: The review shows that there is a relationship between BMI and pain in the spine, especially LBP. There may be factors affecting this condition such as mechanical loading and hormonal metabolic activity in childhood and adolescence. Different methods are used in the studies in literature for the assessment pain in the spine and BMI, overweight, and obesity.

Physical function characteristics in Japanese high school volleyball players with low back pain: A case-controlled study

Low back pain (LBP) is a typical symptom in volleyball players, yet associated physical function factors have not been identified. This study purpose is to determine the relationship between LBP and physical function factors in order to identify potential factors for the management of LBP.Participants were 123 male and female volleyball players of 15- to 17-year-olds who, completed a questionnaire regarding demographic details, presence of LBP, and years of volleyball experience. Participants were divided into 2 groups based on the presence of current LBP and evaluated on physical function tests. The results of the questionnaire response and physical function test were compared between the 2 groups. Data were analyzed using a multivariate logistic regression analysis with presence and absence of current LBP as the explanatory variable.11.4% of all participants reported current LBP. Physical function factors associated with current LBP were a positive modified Thomas test, years of volleyball experience and reduced range of motion of shoulder horizontal abduction on the dominant hand side.The associations between physical function factors and LBP found in this survey suggest that attention should be given to more experienced players with decreased flexibility of hip and shoulder flexors on the dominant side in order to manage LBP in high school volleyball players.

Factors associated with non-specific low back pain in children aged 10-12 from Bucaramanga, Colombia: A cross-sectional study

BACKGROUND

There are no Colombian studies published that assess non-specific low back pain (NSLBP) risk factors in children.

OBJECTIVE

To determine the factors associated with NSLBP in 73 children (19.2% girls) aged 10-12 years in one military school in Bucaramanga, Colombia.

METHODS

A questionnaire was used to obtain information of risk factors. Subsequently, children's weight and height were measured. The backpack was weighed at the beginning of each day from Monday to Friday. Crude and adjusted prevalence ratios were calculated, with their respective 95% confidence interval (CI).

RESULTS

The one-month prevalence of NSLBP was 39.7% (95% CI 28.4-51.9). In the multivariate analysis, carrying backpacks wearing between 12% and 20% of body weight, having a perception that the backpack is very heavy, and being a passive smoker increase the likelihood of NSLBP, while being 11-year-old compared to 10-year-old decreases the likelihood of having NSLBP, adjusted for gender, body mass index, and history of LBP in parents.

CONCLUSIONS

High prevalence of low back pain was found in children between 10 and 12 years old. The study of the decisive factors of low back pain is important to identify children at risk, as well as to develop efficient primary prevention programs.

Body Mass Index, Age, Sexual Maturation and Incidence of Hyperlordosis in Children and Adolescents

Abstract Introduction: Hyperlordosis can cause several degenerative spinal pathologies in children and adolescents. Objective: Determine whether body mass index, age and sexual maturation predict the occurrence of hyperlordosis in children and adolescents. Method: The study analyzed 380 students aged between 10 and 18 years. Body mass index was evaluated using the reference values suggested by the Fitnessgram test battery, and sexual maturation through Tanner’s scale of self-assessed pubic hair growth. Postural assessment was conducted using the DIPA photogrammetry method, version 3.1. (Digital Image Based Postural Assessment) The SPSS 24.0 program was used to analyze the data, and the following statistical tests were applied: chi-squared, Mann-Whitney, Fisher’s exact and binary logistic regression. Results: There was statistical significance between hyperlordosis, girls’ age and puberty in boys (p <0.05). The adjusted binary logistic regression for the girls (OR = 0.656) indicated that this disorder declined by 34% with advancing age and for stage P2 of puberty in boys (OR = 4.292), and the likelihood of boys’ presenting with hyperlordosis at this stage is approximately 4-fold higher. There was no statistical significance between body mass index and hyperlordosis (p> 0.05). Conclusion: The girls’ age and boys’ stage of puberty were associated with the occurrence of hyperlordosis.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Background

Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case.

Objective

Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature.

Methods

A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

Results

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.

Conclusion

Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Factors associated with low back pain in elite high school volleyball players

[Purpose] To determine the relationship between low back pain and a range of demographic, environmental, and injury history factors to identify potential factors for the management of low back pain. [Participants and Methods] The participants were 123 elite high school male and female volleyball players. They answered an extensive questionnaire regarding demographic details, low back pain in the previous year, volleyball-specific movements, previous regional injuries, and years of volleyball experience. Questionnaire responses were analyzed. Data were analyzed using a multivariate logistic regression analysis using the presence and absence of low back pain within 1 year as the explanatory variable. [Results] Of the 123 volleyball players, 48.0% reported low back pain. The volleyball-specific movements that induced pain were diverse (e.g., spike, serve, and pass) with no common factor. The factors associated with low back pain were an ankle injury within the previous year and years of volleyball experience. [Conclusion] The associations found in this survey indicate that particular attention should be given to more experienced players with a history of ankle injury to manage low back pain in high school volleyball players.

Gender differences in the prevalence of low back pain associated with sports activities in children and adolescents: a six-year annual survey of a birth cohort in Niigata City, Japan

BACKGROUND

This study was conducted to determine gender differences in the relationship between extracurricular sports activities (ECSA) and low back pain (LBP) in children and adolescents.

METHODS

In a cohort analysis of a 6-year birth cohort annual survey, students were followed from the fourth to sixth grades of elementary school (E4-E6; 9-12 years old) through the first to third grades of junior high school (J1-J3; 12-15 years old). All students completed annual questionnaires on ECSA and LBP. The odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association strength between ECSA and LBP. We also calculated the population attributable fraction (PAF), which was defined as the proportion of students with ECSA-related LBP among all students with LBP.

RESULTS

ECSA was significantly associated with LBP only in grade J3 among boys (OR: 2.00, 95% CI: 1.47-2.71). On the other hand, among girls, ECSA was significantly associated with LBP in grades E5 (OR: 1.48, 95% CI: 1.00-2.20), E6 (OR: 1.91, 95% CI: 1.33-2.75), and J3 (OR: 1.81, 95% CI: 1.26-2.61). Among boys, PAF was similar in all grades (range, 10-16%), whereas among girls, the PAF varied (- 11 to 29%) and was significantly higher in girls than in boys in grades E5 (19.0% vs. 1.1%, P < 0.01) and E6 (28.8% vs. 12.8%, P < 0.01).

CONCLUSIONS

Although there was a link between ECSA and LBP in both boys and girls, girls were more susceptible to ECSA-related LBP, especially in grades E5 and E6.

Risk Factors for Low Back Pain in Childhood and Adolescence: A Systematic Review

OBJECTIVES

To identify factors associated with low back pain (LBP) in children and adolescents.

MATERIALS AND METHODS

A systematic review was conducted (Prospero CRD42016038186). Observational studies analyzing LBP risk factors among participants aged between 9 and 16 were searched for in 13 electronic databases and 8 specialized journals until March 31, 2016, with no language restrictions. In addition, references in the identified studies were manually tracked. All identified studies that included ≥50 participants aged 9 to 16, were reviewed. Their methodological quality was assessed by 2 reviewers separately, using validated tools, which scored, from worst to best, 0 to 100 for cross-sectional and 0 to 12 for cohort studies. A sensitivity analysis only included studies that had adjusted for confounders, had ≥500 participants, and had a methodological score of ≥50%.

RESULTS

A total of 5142 citations were screened and 61 studies, including 137,877 participants from 5 continents, were reviewed. Their mean (range) methodological scores were 74.56 (50 to 100) for cross-sectional studies and 7.36 (5 to 9) for cohort studies. The studies had assessed 35 demographic, clinical, biological, family, psychological, ergonomic, and lifestyle risk factors. The mean (range) prevalence of LBP ranged between 15.25% (3.20 to 57.00) for point prevalence and 38.98% (11.60 to 85.56) for lifetime prevalence. Results on the association between LBP and risk factors were inconsistent. In the sensitivity analysis, "older age" and "participation in competitive sports" showed a consistent association with LBP.

DISCUSSION

Future studies should focus on muscle characteristics, the relationship between body and backpack weights, duration of carrying the backpack, characteristics of sport practice, and which are the factors associated with specifically chronic pain.

The Risk Factors of Low Back Pain in Female High School Students

STUDY DESIGN

A prospective cross-sectional study.

OBJECTIVE

The aim of this study was to evaluate the prevalence and associated factors with low back pain (LBP) in female adolescents of high school age.

SUMMARY OF BACKGROUND DATA

The prevalence of LBP in Tehran is high, and the majority of previous studies on LBP in adolescent and its risk factors have been performed in the developed countries. Therefore, identification of risk factors and planning appropriate protocols for prevention of LBP in adolescents may substantially decrease the prevalence of LBP and its burden in developing countries in future.

METHODS

In a prospective cross-sectional study, demographic characteristics, including age, body mass index (BMI), weight and mode of using backpack, family history of LBP in first degree relatives, and passive smoking status of the participants along with a history of LBP were recorded. Joint hypermobility was assessed using Beighton scale. Also, anthropometric measurements, spinal flexion, and hip joint range of motion were measured for each participant.

RESULTS

In total, 372 students participated in the study. The mean (SD) age of the participants was 15.8 (0.9) years. The lifetime, more than 3 months, and last month history of LBP was 46.2%, 11.6%, and 31.2%, respectively. Positive history of LBP in the first-degree relatives was significantly associated with LBP in the participants (P < 0.01). The prevalence of passive smoking was significantly higher in the participants with last month history of LBP (P = 0.03). The prevalence of joint hypermobility was 15.9% and was significantly higher in those with the lifetime and last month history of LBP (P < 0.01).

CONCLUSION

LBP is a common complaint among adolescent and high school girl students. The results of this study identified the prevalence and associated factors with LBP in high school students and will help develop strategies for prevention and treatment of LBP in the adolescent population.

LEVEL OF EVIDENCE

3.

Trunk muscle endurance in Chinese adults

BACKGROUND

Previous studies in non-Chinese populations have found a relationship between performance on isometric trunk muscle endurance tests and low back pain (LBP). However, the relationship between trunk muscle endurance and LBP in Chinese populations has received little attention and age-referenced data have not been reported.

OBJECTIVE

Evaluate the relationship between age-referenced isometric trunk muscle endurance values and LBP in a Chinese cohort.

METHODS

One hundred and eighty-eight participants (20-59-years) performed four timed-endurance tests (Biering-Sørensen, plank, left/right side bridge) in random order. Participants with a history of LBP completed an Oswestry Disability Index (ODI) and pain scale. Holding-times for the four tests were summed and receiver operating characteristic (ROC) curve analysis was performed to differentiate participants with and without LBP.

RESULTS

Data were grouped by age. Analysis revealed similar endurance values to those reported in non-Chinese populations, except longer holding times were recorded in the 50-59 yr Chinese cohort. Pain scores were positively correlated with ODI scores. ROC curve analysis showed that the area under the curve was 0.723 and optimal cut-off was 288 sec (sensitivity and specificity both 0.75).

CONCLUSIONS

This study is the first to describe trunk muscle endurance reference data in Chinese people. Individuals with a summed endurance time of < 288 seconds appear more likely to suffer LBP.

Cluster-randomized, controlled evaluation of a teacher led multi factorial school based back education program for 10 to 12-year old children

BACKGROUND

The aim of this cluster-randomised, controlled study was to examine whether a teacher-led multifactorial back education programme could improve back pain in pupils, motor skills, back behaviour, and back knowledge over a 10-month period.

METHODS

There were 176 children from two schools, who were cluster-randomised into intervention and control groups. The intervention programme consisted of 3 parts: 1) knowledge improvement, 2) posture awareness training, and 3) reducing imbalance of core muscles through mandatory back and abdominal muscle exercises at the beginning of each physical education lesson. Outcome measures included a clinical orthopaedic examination, a health questionnaire, a motor test, a back-behaviour trial, and a knowledge test.

RESULTS

Clinical examination showed a reduction of orthopaedic abnormalities in both groups, from 90.5 to 42%, with a posture test showing an improvement in both groups at the post-test. However, the rate of children reporting back pain at least once a month could not be reduced below 30%. Long lasting physical activity, carrying heavy schoolbags, and long periods of sitting were the top three causes for back pain. Push-up number and balancing skills improved significantly in both groups from pre- to post-test. In the water crate carrying task and knowledge test, only the intervention group (IG) showed a statistically significant improvement from pre- to post-test.

CONCLUSIONS

The results show that back pain rate could not be decreased. However, back care knowledge and parts of back-friendly behaviour could be significantly improved. On the other hand, the problem of prolonged sitting and using heavy schoolbags persists.

TRIAL REGISTRATION

Deutsches Register Klinische Studien DRKS00013794 ; Date of Registration: 15.1.2018; Retrospectively registered.

Demographic and Life Styles Determinants of Somatic Complaints' Structures: A Cross-sectional Study on a Large Sample of Iranian Adults Using Factor Mixture Model

Background:

To identify somatic complaints dimensions, classify studied population and study the association of demographic and lifestyle factors with somatic complaints dimensions.

Methods:

In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 30-item questionnaire. Self-administered standard questionnaires were used to assess demographic and lifestyle factors. Factor mixture modeling (FMM) was used to identify somatic complaints dimensions and classify studied population.

Results:

The mean age of participants was 36.58 ± 0.13 years, 55.8% were females, 81.2% were married, and 57.2% had college education. About 9.4% of individuals were obese, and 34.8% of participants had regular physical activity. Four domains of somatic complaints were extracted, including “psychological,” “gastrointestinal,” “neuro-skeletal,” and “pharyngeal-respiratory.” Females, obese and inactive participants, and those in low educations had significantly greater scores in terms of four domains than the others (P < 0.05). A two-class, four-factor structure fitted to the somatic complaints based on FMM. Two classes were labeled “high psychological complaints” (519 individuals (11%) and “low psychological complaints” (4243 individuals (89%). There were no significant differences between two classes in terms of demographic and lifestyle factors, except in educational level.

Conclusions:

This study suggested that somatic complaints had a dimensional-categorical structure within studied population so that it could be useful for dealing with diagnostic and therapeutic approaches. The results did not show any association between somatic complaints dimensions and demographic, lifestyle factors, except in educational level.