Back pain in school children--where to from here?

Young people's low back pain and awareness of postural habits: A cross-sectional study

BACKGROUND

Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders.

OBJECTIVE

To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits.

METHODS

Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.

RESULTS

The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing.

CONCLUSIONS

Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Balance and Posture in Children and Adolescents: A Cross-Sectional Study

Balance and posture are two topics that have been extensively studied, although with some conflicting findings. Therefore, the aim of this work is to analyze the relationship between the postural angles of the spine in the sagittal plane and the stable static balance. A cross-sectional study was conducted with children and adolescents from schools in northern Portugal in 2019. An online questionnaire was used to characterize the sample and analyze back pain. Spinal postural angle assessment (pelvic, lumbar, and thoracic) was performed using the Spinal Mouse^®, while stabilometry assessment was performed using Namrol^® Podoprint^®. Statistical significance was set as α = 0.05. The results showed that girls have better balance variables. There is a weak correlation between the anthropometric variables with stabilometry variables and the postural angles. This correlation is mostly negative, except for the thoracic spine with anthropometric variables and the lumbar spine with BMI. The results showed that postural angles of the spine are poor predictors of the stabilometric variables. Concerning back pain, increasing the postural angle of the thoracic spine increases the odds ratio of manifestation of back pain by 3%.

Influence of School Backpack Load as a Variable Affecting Gait Kinematics among Seven-Year-Old Children

This article investigates schoolchildren's ability to carry an additional load using a backpack (BP). According to scientific research, there is no precise limit to the maximum backpack load, which varies from 10% to 15% of body weight (BW). The purpose of this study was, therefore, to evaluate the influence of an additional external load carried using a backpack on gait kinematics among seven-year-old children in Poland, including assessment of the gender differences. The study was conducted among 26 (13 boys and 13 girls) primary school children aged seven years. The children walked at their preferred speed, under four conditions: with no load (0% BW) and with 10%, 15% and 20% BW. Spatiotemporal parameters were measured using the 2 m Footscan® platform system and photocell Sectro timing system. The children walked more slowly under an additional load. Their step length and single support time decreased. Their base of support, step time and double support time increased. There was no significant effect on their stride length or gait cycle time. The gait kinematic changes were most evident between 10% BW and greater loading. The results highlight how children's gait is affected by carrying additional external loads, which should not exceed 10% BW. That limit is appropriate for both genders.

Exceeding 2-h sedentary time per day is not associated with moderate to severe spinal pain in 11- to 13-year-olds: a cross-sectional analysis

Neck, mid-back and low back pain, collectively known as spinal pain, become more common with increasing age across childhood and adolescence. A common belief among the general community is that sedentary time, including screen time, in adolescents is associated with spinal pain. We aimed to investigate whether exceeding 2-h of sedentary time per day is associated with moderate to severe spinal pain in a sample of Danish adolescents aged 11-13 years. We performed a cross-sectional analysis of the SPACE study baseline data (2010). Adolescents self-reported their spinal pain (outcome) via the Young Spine Questionnaire and duration of engagement in sedentary behaviours (exposure). We provide estimates of associations as odds ratios with 95% confidence intervals, stratified by age and sex. The sample comprised 1,303 adolescents (48.7% female, mean age 12.5 years, range 10.9-14.3 years). Approximately 9 out of 10 adolescents exceeded 2-h sedentary time on weekdays outside of school (88.9%) and weekend days (89.9%). Close to one-quarter, 23.3% (95%CI: 21.0-25.6), of participants experienced moderate to severe spinal pain. We found no association between exceeding 2-h sedentary time per day and experiencing moderate to severe spinal pain; odds ratios ranged from 0.34 (95%CI: 0.04-3.20) to 4.65 (95%CI: 0.26-82.44).Conclusion: We found no association between exceeding 2- or 5-h of sedentary time per day and moderate to severe spinal pain in this sample of 11-13-year-old Danish adolescents. Our cross-sectional analysis does not consider the longitudinal or complex sequences of events necessary to address predictive or causal questions. What is Known: • Up to a third of adolescents experience moderate to severe spinal pain, predisposing them to chronic spinal pain in adulthood. • Frequent and excessive sedentary time is associated with poor overall health in adolescents; there is conflicting evidence to suggest whether it is also related to spinal pain. What is New: • We found no association between sedentary time and moderate to severe spinal pain in 11- to 13-year-old Danes.

Age-Related, Sport-Specific Dysfunctions of the Shoulder and Pelvic Girdle in Athletes Table Tennis Players. Observational Study

Background: Postural skills are fundamental in motor activities, so far no evidence of a direct relationship has been found, it is therefore recommended to consider the following directions, the higher the level of sports competition, the better the body posture; or better athletes also have a better body posture. Around the age of 11-14 years, it is a period of aggressive development, if the rapid growth of the bone system is not associated and symmetrical with the development of soft tissues serious postural deficiencies may develop in table tennis players. Methods: We used the web camera – photographic method (38) related to the Sensor Medica software that allows the acquisition of images in order to detect postural deficiencies and we considered it necessary to have a clear image of the level of technical-tactical training of female juniors III using 5 tests specific to topspin attack in order to assess the influence of body posture on such tests. Eighteen female juniors III (the mean ± SD age, height and weight were 11.1 ± 0.2 years, 147.7 ± 2.6 cm, 39.0 ± 2.0 kg). Descriptive statistical analysis was performed on the procedures for establishing the normality of data distribution, Levene's Test for Equality of Variances, the t test for independent samples. The confidence interval was set at 95% (p < 0.05), Results and Conclusions: Since Sig. (2-tailed) or p < α = 0.001 and taking into account that the confidence interval limits for the difference between the sample mean and the reference value (95% CI for the mean difference) do not contain the zero value, it is accepted that there are statistically significant differences between the shoulder inclination for the female athletes in the sample studied and the reference value. We identified that at the level of alignment between anatomical landmarks, the percentage of deficiency of the entire lot of female juniors III in the case of shoulders is 100% and at the level of PSIS is 66%, which validates several studies that stated that in this period of aggressive growth correlated with repetitive unilateral executions specific to the topspin attack lead to postural deficiencies. In terms of the influence of body posture on the quality level, we identified that Group 1 – (without PSIS imbalance) has a higher average overall efficiency of the 5 tests (11.33) compared to Group 2 (8.58), even if from a statistical point of view these differences are not significant. Keywords: Body posture, Asimmetry, Topspin attack, Table tennis, Sensor Medica,

Musculoskeletal Pain, Related Factors, and Posture Profiles Among Adolescents: A Cross-Sectional Study From Turkey

PURPOSE

The aim of the study was to evaluate musculoskeletal pain due to mechanical reasons and related risk factors in adolescents and to define posture profiles of adolescents.

DESIGN

A cross-sectional study.

METHODS

The study was conducted with 2221 adolescents between February 2015 and May 2015. The questionnaire used to collect data consisted of three parts: (1) descriptive characteristics of the participants, (2) pain assessment of 14 parts of the body, and (3) Back Pain and Body Posture Evaluation Instrument (BackPEI).

RESULTS

The prevalence of low back pain among the participants was 73.3% (n = 1,343), while the prevalence of back pain was 68.4% (n = 1,254). The participants attributed their pain to their poor sitting postures at school (38.1%, n = 847) and carrying school backpacks (84.1%, n = 1,713). There was a statistically significant difference in the physical activities of adolescents and the BackPEI score (z = 4.40; p = .001). Posture factors of the BackPEI score increased while school desk comfort score increased (Spearman's rho = 0.148; p = .001), but it decreased while the school grades of the adolescents increased (Spearman's rho [ρ] = -0.161; p = .001).

CONCLUSIONS

According to this study, body posture was related to musculoskeletal pain and was correlated with physical activities, school desk comfort, and school grades of the adolescents. It is suggested that correct posture and ergonomic positions should be taught to adolescents when using computers, carrying school backpacks, and sitting in school chairs to prevent musculoskeletal pain.

Back pain in elementary schoolchildren is related to screen habits

PURPOSE

Verify the influences of physical activity level, nutritional status and screen habits on the prevalence of back pain in Brazilian students.

METHODS

The sample consisted of 577 schoolchildren (female = 274; male = 303) aged between 10 and 16 years old, regularly enrolled in the 6th grade of elementary school living in the metropolitan area of the Alto Tietê of the state of São Paulo, Brazil. The prevalence, intensity and frequency of pain was verified with the Back Pain Assessment Instrument. The usual practice of physical activity was verified with the Physical Activity Questionnaire for Older Children/Adolescent. Nutritional status was analyzed using Body Mass Index. Screen habits were obtained through a previously structured questionnaire.

RESULTS

The Chi-square test indicated that pain complaint and its prevalence in the cervical region are significantly higher in females (p < 0.05). The multiple logistic regression test revealed that watching television influences the prevalence of cervical pain and that the use of more than one screen increases the occurrence of low back pain in male students (p < 0.05).

CONCLUSION

Female students were the most affected by back pain complain, especially in the cervical region. However, factors associated with the prevalence of back pain were found only in males.

Baseline musculoskeletal pain and impaired sleep related to school pressure influence the development of musculoskeletal pain in N = 107 adolescents in a 5-year longitudinal study

PURPOSE

This longitudinal study followed 10- to 13-year-old adolescents for 5 years to investigate the effects of juvenile musculoskeletal (MSK) pain and psychosocial risk factors on future pain. We further predicted that increased MSK pain at follow-up would be positively related to current school pressure at follow-up and negatively related to current sleep quality. Sleep quality was tested as a potential mediator of the link between school pressure and MSK pain at follow-up after controlling for baseline MSK pain.

METHODS

The baseline sample comprised 189 adolescents, and 5-year follow-up resulted in 107 15- to 18-year-old adolescents who had completed mandatory education. Adolescents responded to an online questionnaire about psychosocial stressors, MSK pain, school achievement and leisure activities. A longitudinal hierarchic linear regression including all significant baseline predictors was run to assess their impact on MSK pain 5 years later. Mediation analysis was used to investigate sleep quality as a potential mediator of the relationship between school pressure and MSK pain at follow-up.

RESULTS

Baseline MSK pain predicted MSK pain over a time lag of 5 years (ß = .26, p = .02). The relationship between follow-up school pressure and current MSK pain was mediated by sleep quality at follow-up (B = .17, SE_B = .07, 95% CI .06-.34) when baseline MSK pain was controlled.

CONCLUSIONS

Juvenile MSK pain predicts MSK pain in adolescence. A psychosocial mediation model including school pressure and sleep impairments has the potential to explain MSK pain mechanisms in adolescents. These slides can be retrieved under Electronic Supplementary Material.

Neck and shoulder pain among elementary school students: prevalence and its risk factors

Background

Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors.

Methods

In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student’s posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression.

Results

The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02–3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37–3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46–6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10–5.84), too much homework (OR = 2.59, 95% CI: 1.49–4.51), RULA score at level III (OR = 2.88, 95% CI:1.64–5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72–5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39–0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34–0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26–4.61) and too much homework (OR = 1.94, 95% CI: 1.10–3.42) increased the risk of shoulder pain.

Conclusion

The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.

Backpack weight and back pain reduction: effect of an intervention in adolescents

BACKGROUND

To assess if an educational intervention is effective to reduce backpack weight and back pain in schoolchildren.

METHODS

We designed an intervention study in schoolchildren aged between 12 and 16 years aimed to reduce the weight of backpacks and back pain. The intervention was multifaceted, including an educational intervention with practical examples, advising on performing sports, postural habits, leaflets, stickers, and so on. The comparison group did not receive any intervention.

RESULTS

A total of 1668 schoolchildren took part in the study. We observed a high prevalence of carrying heavy backpacks, with 66-80% of schoolchildren carrying backpacks surpassing 10% of their body weight. Back pain prevalence was 30%. We observed that the intervention was significant in reducing the backpack weight in first-year schoolchildren but not in second-year. The intervention was also significant in reducing back pain in third-year schoolchildren but only in girls.

CONCLUSION

This study shows that an inexpensive intervention directed to reduce the backpack weight and back pain might have a positive effect in schoolchildren.

A literature review of anthropometric studies of school students for ergonomics purposes: Are accuracy, precision and reliability being considered?

BACKGROUND

Despite offering many benefits, direct manual anthropometric measurement method can be problematic due to their vulnerability to measurement errors.

OBJECTIVE

The purpose of this literature review was to determine, whether or not the currently published anthropometric studies of school children, related to ergonomics, mentioned or evaluated the variables precision, reliability or accuracy in the direct manual measurement method.

METHODS

Two bibliographic databases, and the bibliographic references of all the selected papers were used for finding relevant published papers in the fields considered in this study.

RESULTS

Forty-six (46) studies met the criteria previously defined for this literature review. However, only ten (10) studies mentioned at least one of the analyzed variables, and none has evaluated all of them. Only reliability was assessed by three papers. Moreover, in what regards the factors that affect precision, reliability and accuracy, the reviewed papers presented large differences. This was particularly clear in the instruments used for the measurements, which were not consistent throughout the studies. Additionally, it was also clear that there was a lack of information regarding the evaluators' training and procedures for anthropometric data collection, which are assumed to be the most important issues that affect precision, reliability and accuracy.

CONCLUSIONS

Based on the review of the literature, it was possible to conclude that the considered anthropometric studies had not focused their attention to the analysis of precision, reliability and accuracy of the manual measurement methods. Hence, and with the aim of avoiding measurement errors and misleading data, anthropometric studies should put more efforts and care on testing measurement error and defining the procedures used to collect anthropometric data.

Do schoolbags cause back pain in children and adolescents? A systematic review

OBJECTIVE

To investigate whether characteristics of schoolbag use are risk factors for back pain in children and adolescents.

DATA SOURCES

Electronic searches of MEDLINE, EMBASE and CINAHL databases up to April 2016.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Prospective cohort studies, cross-sectional and randomised controlled trials conducted with children or adolescents. The primary outcome was an episode of back pain and the secondary outcomes were an episode of care seeking and school absence due to back pain. We weighted evidence from longitudinal studies above that from cross-sectional. The risk of bias of the longitudinal studies was assessed by a modified version of the Quality in Prognosis Studies tool.

RESULTS

We included 69 studies (n=72 627), of which five were prospective longitudinal and 64 cross-sectional or retrospective. We found evidence from five prospective studies that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents. The included studies were at moderate to high risk of bias. Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain). We were unable to pool results due to different variables and inconsistent results.

SUMMARY/CONCLUSION

There is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.

Risk factors of non-specific spinal pain in childhood

PURPOSE

Non-specific spinal pain can occur at all ages and current evidence suggests that pediatric non-specific spinal pain is predictive for adult spinal conditions. A 5-year long, prospective cohort study was conducted to identify the lifestyle and environmental factors leading to non-specific spinal pain in childhood.

MATERIALS AND METHODS

Data were collected from school children aged 7-16 years, who were randomly selected from three different geographic regions in Hungary. The risk factors were measured with a newly developed patient-reported questionnaire (PRQ). The quality of the instrument was assessed by the reliability with the test-retest method. Test (N = 952) and validity (N = 897) datasets were randomly formed. Risk factors were identified with uni- and multivariate logistic regression models and the predictive performance of the final model was evaluated using the receiver operating characteristic (ROC) method.

RESULTS

The final model was built up by seven risk factors for spinal pain for days; age > 12 years, learning or watching TV for more than 2 h/day, uncomfortable school-desk, sleeping problems, general discomfort and positive familiar medical history (χ² = 101.07; df = 8; p < 0.001). The probabilistic performance was confirmed with ROC analysis on the test and validation cohorts (AUC = 0.76; 0.71). A simplified risk scoring system showed increasing possibility for non-specific spinal pain depending on the number of the identified risk factors (χ² = 65.0; df = 4; p < 0.001).

CONCLUSION

Seven significant risk factors of non-specific spinal pain in childhood were identified using the new, easy to use and reliable PRQ which makes it possible to stratify the children according to their individual risk. These slides can be retrieved under Electronic Supplementary Material.

Standing Classrooms: Research and Lessons Learned from Around the World

Children spend between 50 and 70 % of their time sitting while at school. Independent of physical activity levels, prolonged sitting is associated with poor health outcomes in adulthood. While there is mixed evidence of health associations among children and adolescents, public health guidelines in the USA, UK, Australia and Canada now recommend young people should break up long periods of sitting as frequently as possible. A potentially effective approach for reducing and breaking up sitting throughout the day is changing the classroom environment. This paper presents an overview of a relatively new area of research designed to reduce youth sitting time while at school by changing the classroom environment (n = 13 studies). Environmental changes included placement of height-adjustable or stand-biased standing desks/workstations with stools, chairs, exercise balls, bean bags or mats in the classroom. These 13 published studies suggest that irrespective of the approach, youth sitting time was reduced by between ~44 and 60 min/day and standing time was increased by between 18 and 55 min/day during classroom time at school. Other benefits include increased energy expenditure and the potential for improved management of students' behaviour in the classroom. However, few large trials have been conducted, and there remains little evidence regarding the impact on children's learning and academic achievement. Nevertheless, with an increasing demand placed on schools and teachers regarding students' learning outcomes, strategies that integrate moving throughout the school day and that potentially enhance the learning experience and future health outcomes for young people warrant further exploration.

IMMEDIATE AND FOLLOW-UP EFFECTS OF A POSTURE EDUCATION PROGRAM FOR ELEMENTARY SCHOOL STUDENTS

OBJECTIVE

To assess the short- and medium-term effects of the posture education program (PEP) for students of elementary school regarding theoretical knowledge and posture during activities of daily living (ADLs).

METHODS

The sample consisted of 38 students (aged 8-12 years) in the third grade of elementary school in Porto Alegre, Rio Grande do Sul (Southern Brazil). The children were evaluated in three moments: prior to attending the PEP (pretest); after attending the PEP (post-test); and five months after the conclusion of the PEP, immediately after a learning review of four lessons (five months follow-up). The posture during ADLs and the theoretical knowledge about spine and body posture were assessed, based on specific instruments (layout for assessing the dynamic posture - LADy; and questionnaire). The Friedman test, post hoc Wilcoxon test, and Bonferroni correction were applied to identify the differences among the evaluative moments, as they are statistically significant at α<0.05.

RESULTS

No statistically significant difference was found between the post-test and follow-up concerning the theoretical knowledge. In addition, no statistically significant difference was found between post-test and follow-up in relation to ADLs; however, the performance of students was higher in the post-test and follow-up, when compared with the pretest.

CONCLUSIONS

Immediately after the PEP's conclusion, the students improved their posture in ADLs. These positive effects and the theoretical knowledge were retained in the follow-up (after the review lessons).

Back pain prevalence and associated factors in children and adolescents: an epidemiological population study

OBJECTIVE

To identify the prevalence of back pain among Brazilian school children and the factors associated with this pain.

METHODS

All 1,720 schoolchildren from the fifth to the eight grade attending schools from the city of Teutonia, RS, Southern Brazil, were invited to participate in the study. From these, 1,597 children participated. We applied the Back Pain and Body Posture Evaluation Instrument. The dependent variable was back pain, while the independent one were demographic, socioeconomic, behavior and heredity data. The prevalence ratio was estimated by multivariate analysis using the Poisson regression model (α = 0.05).

RESULTS

The prevalence of back pain in the last three months was 55.7% (n = 802). The multivariate analysis showed that back pain is associated with the variables: sex, parents with back pain, weekly frequency of physical activity, daily time spent watching television, studying in bed, sitting posture to write and use the computer, and way of carrying the backpack.

CONCLUSIONS

The prevalence of back pain in schoolchildren is high and it is associated with demographic, behavior and heredity aspects.

Backpack-back pain complexity and the need for multifactorial safe weight recommendation

The study analysed backpack-related back pain in school children by investigating the possibility of multiple interactions among causative factors, which may be responsible for the non-conclusive findings on the issue. Using data from 444 prepubescent schoolchildren, a mixed method design combining survey, observation and direct measurement strategies was implemented. Using a multivariate structural equation modelling approach, the study investigated interactions among anthropometry, posture, backpack volume, rating and back pain constructs, with each construct made of 2-4 indicators. Additionally, regression analysis was used to determine the feasibility of considering the two additional factors of age and body mass index along with the globally accepted recommendation of a load of 10-15% of body weight. Our model demonstrated an acceptable model fit and revealed direct and indirect effects of the factors. Obese children were recommended to carry a one-third lighter load than other children. The application of systematic/multiple strategies provided an explanation for some of the issues associated with school children's backpack-related back pain.

Prevalence of postural deviations and associated factors in children and adolescents: a cross-sectional study

Abstract Introduction: Postural deviations are frequent in childhood and may cause pain and functional impairment. Previously, only a few studies have examined the association between body posture and intrinsic and extrinsic factors. Objective: To assess the prevalence of postural changes in school children, and to determine, using multiple logistic regression analysis, whether factors such as age, gender, BMI, handedness and physical activity might explain these deviations. Methods: The posture of 288 students was assessed by observation. Subjects were aged between 6 and 15 years, 59.4% (n = 171) of which were female. The mean age was 10.6 (± 2.4) years. Mean body weight was 38.6 (± 12.7) kg and mean height was 1.5 (± 0.1) m. A digital scale, a tapeline, a plumb line and standardized forms were used to collect data. The data were analyzed descriptively using the chi-square test and logistic regression analysis (significance level of 5%). Results: We found the following deviations to be prevalent among schoolchildren: forward head posture, 53.5%, shoulder elevation, 74.3%, asymmetry of the iliac crests, 51.7%, valgus knees, 43.1%, thoracic hyperkyphosis, 30.2%, lumbar hyperlordosis, 37.2% and winged shoulder blades, 66.3%. The associated factors were age, gender, BMI and physical activity. Discussion: There was a high prevalence of postural deviations and the intrinsic and extrinsic factors partially explain the postural deviations. Conclusion: These findings contribute to the understanding of how and why these deviations develop, and to the implementation of preventive and rehabilitation programs, given that some of the associated factors are modifiable.

Does a prototype 'Experimental' chair facilitate more postural changes in computing adolescents compared to a normal school chair?

BACKGROUND

Prolonged sitting, such as when computing, has been linked to adolescent spinal pain. A chair should fit the user's body dimensions and aid the user in frequently changing sitting posture, rather than support one 'ideal' posture. Such a chair is not currently available to high school learners.

OBJECTIVES

To develop a novel experimental school chair. To determine whether the experimental chair encourages regular small range movement in all directions whilst students work at computers in class. To compare the number of postural changes between the normal static school chair and the experimental chair, whilst students do computing work.

METHODS

A development and validation study was conducted. Twelve high school students were randomly selected from a conveniently selected school. Fifteen minutes of 3D posture measurements were collected in both the prototype and school computer chair. The analysis focused on the frequency of postural movement.

RESULTS

Data of eleven learners were analysed. There were statistically significant increases in the number of postural changes on the 'Experimental' chair compared to the school chair, for both pelvic side-flexion and pelvic rotation (ρ= 0.01).

CONCLUSION

The experimental chair provided more postural movements when compared to the school computer chair. Future studies should use this experimental chair to determine the effect of increased postural movement, of especially the pelvis, on the prevalence and intensity of musculoskeletal symptoms of high school learners in the Cape Metropole area, Western Cape, South Africa.

Effect of unilateral exercise on spinal and pelvic deformities, and isokinetic trunk muscle strength

[Purpose] The purpose of this study was to collect basic data regarding the prevention of spinal and pelvic deformities by investigating the spinal shape and muscular function characteristics of imbalance reduction and functional improvement following asymmetric activities. [Subjects and Methods] The subjects were 14 archery athletes who mostly perform unilateral motion with spinal and pelvic pain, and 19 healthy subjects. All the participants were evaluated using spinal structure analysis and for 60°/sec isokinetic muscular strength of the trunk. [Results] Between the two groups, there were significant differences in the interaction effect of trunk inclination deformities, and flexor and extensor 60°/sec isokinetic muscular strength of the trunk. Also, the main effects of gender comparison showed significant differences in the trunk inclination deformities, pelvic rotation deformities, lordosis angles, and flexor and extensor 60 ˚/sec isokinetic muscular strengths of the trunk. [Conclusion] The basic data obtained in this study can be used to help develop a strategic exercise program for improving unilateral movement and malalignment of the spine and pelvis.

Back Pain Prevalence and Its Associated Factors in Brazilian Athletes from Public High Schools: A Cross-Sectional Study

Most studies on the prevalence of back pain have evaluated it in developed countries (Human Development Index--HDI > 0.808), and their conclusions may not hold for developing countries. The aim of this study was to identify the prevalence of back pain in representative Brazilian athletes from public high schools. This cross-sectional study was performed during the state phase of the 2015 Jogos dos Institutos Federais (JIF), or Federal Institutes Games, in Brazil (HDI = 0.744), and it enrolled 251 athletes, 173 males and 78 females (14-20 years old). The dependent variable was back pain, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, exercise-level, anthropometric, strength, behavioral, and postural factors. The prevalence ratio (PR) was calculated using multivariable analysis according to the Poisson regression model (α = 0.05). The prevalence of back pain in the three months prior to the study was 43.7% (n = 104), and 26% of the athletes reported feeling back pain only once. Multivariable analysis showed that back pain was associated with demographic (sex), psychosocial (loneliness and loss of sleep in the previous year), hereditary (ethnicity, parental back pain), strength (lumbar and hand forces), anthropometric (body mass index), behavioral (sleeping time per night, reading and studying in bed, smoking habits in the previous month), and postural (sitting posture while writing, while on a bench, and while using a computer) variables. Participants who recorded higher levels of lumbar and manual forces reported a lower prevalence of back pain (PR < 0.79), whereas feeling lonely in the previous year, obesity, and ethnicity exhibited the highest prevalence ratio (PR > 1.30). In conclusion, there is no association between exercise levels and back pain but there is an association between back pain and non-exercise related variables.

Approach to the pediatric athlete with back pain: more than just the pars

Back pain in a pediatric patient can present a worrisome and challenging diagnostic dilemma for any physician. Although most back pain can be attributed to muscle strains and poor mechanics, it is necessary to appreciate the full differential of etiologies causing back pain in the pediatric population. The physician must recognize areas of mechanical weakness in the skeletally immature spine and the sport specific forces that can predispose a patient to injury. A comprehensive history involves determining the onset, chronicity, and location of the pain. A focused physical exam includes a neurological exam as well as provocative testing. The combination of a thorough history and focused physical exam should guide appropriate imaging. Radiographic tests are instrumental in narrowing the differential, making a diagnosis, and uncovering associated pathology. Treatment modalities such as activity modification, heat/cold compresses, and NSAIDs can provide pain relief and allow for effective physical therapy. In most cases nonoperative methods are successful in providing a safe and quick return to activities. Failure of conservative measures requires referral to an orthopedic surgeon, as surgical intervention may be warranted.

Influence of the Weight of a School Backpack on Spinal Curvature in the Sagittal Plane of Seven-Year-Old Children

The aim of the paper was to determine a correlation between the weight of a child's backpack, their body weight, and certain features of their body posture. Material and Methods. The study group consisted of 109 children, all aged seven years. The parameters of body posture were determined using the Zebris Ultrasonic System. Results. The number of children carrying a school backpack in accordance with recommendations was 44 subjects (40.37%). Statistically significant changes were found in the total length of the spine (Z = 2.223, p = 0.026) and between backpack weight and changes in the following parameters: the total length of the spine (r_s = −0.3999, p = 0.017), the length and the angle of the lumbar lordosis (r_s = −0.3352, p = 0.049), the angle of the lumbar lordosis (r_s = −0.5065, p = 0.002), and the sacral angle (r_s = −0.4279, p = 0.010). Conclusions. Wearing a backpack heavier than 10% of one's body weight can cause shallowing of the lumbar lordosis and a tendency towards a vertical position of the sacrum. Monitoring the weight of children's school backpacks and enabling them to leave books and notebooks at school would probably be beneficial in reducing the daily burden put on children's spines.

Pain associated with the musculoskeletal system in children from Warsaw schools

OBJECTIVE

To assess the prevalence of pain in the musculoskeletal system and possible reasons for these complaints among early age children from Warsaw schools.

MATERIAL AND METHODS

The study was conducted in 34 randomly selected primary schools in Warsaw in 2011. 2748 survey-questionnaires were given to parents or legal guardians by children. Of these, 1509 surveys were subject to a final analysis. The survey included 66 questions regarding, among other things, pain in the musculoskeletal system in children. Additionally, there were questions about possibly occurring diseases, any postural defects, significant obesity, as well as effects of these complaints on the child's physical activity. Survey data regarded 6-7-year-old children.

RESULTS

In the group of 1509 respondents, 242 children (16%) complained about pain in the musculoskeletal system. Pain was located most frequently in the knee joints, and more rarely in the spine and joints in the upper extremities. In the group of children who complained about pain, moderate physical activity was statistically significantly limited. According to parents, physicians did not diagnose any medical conditions in 106 children. Joint disease was diagnosed in 33 children. Postural defects were diagnosed in 589 children. In 123 children complaining about pain at least one postural defect was diagnosed. Such defects were diagnosed statistically significantly more rarely (p = 0.011) in 1234 children who did not complain about pain (460 children). Platypodia or other foot deformation was observed in 25% of these children, spinal curvature in 12%, abnormal knee joint position in 11% and uneven hip position in 2% children. Of note, 17% of all children were significantly overweight. In overweight children the prevalence of pain, especially in the knee joints and feet, was significantly higher.

CONCLUSIONS

This study aims to underline the problem of musculoskeletal pain in early-age children which limits their physical activity. Also the authors draw attention to the issue of postural defects in a large group of school children. This issue undoubtedly requires more attention and a plan how to create more effective methods of prevention.

Analysis of the most relevant anthropometric dimensions for school furniture selection based on a study with students from one Chilean region

Most of the worldwide standards used for furniture selection suggest the use of the Stature of the school children, assuming that all the other anthropometric characteristics will also be appropriate. However, it is important to consider that students' growth differ with age. The aim of this study is to determine if Popliteal Height can be used as a better, or more adequate, measure for classroom furniture selection when comparing with Stature. This study involved a representative group of 3046 students from the Valparaíso Region, in Chile. Regarding the methodology, eight anthropometric measures were gathered, as well as six furniture dimensions from the Chilean standard. After assigning the level of school furniture using Stature and Popliteal Height to each of the students, six mismatch equations were applied. The results show that when using Popliteal Height, higher levels of match were obtained for the two more important furniture dimensions. Additionally, it also presents a better cumulative fit than Stature. In conclusion, it seems that Popliteal Height can be the most accurate anthropometric measure for classroom furniture selection purposes.

Short-term effects of backpack carriage on plantar pressure and gait in schoolchildren

PURPOSE

To assess the effects of backpack carriage on plantar pressure distributions and spatio-temporal gait parameters among children.

PARTICIPANTS

Two hundred-eighteen schoolchildren, aged 6-13, and attending primary and secondary schools in the city of Cagliari (Italy).

METHODS

Participants were tested at school, during regular days. A pressure plate and wearable inertial sensors were used to measure plantar pressures and spatio-temporal parameters of gait. Measures were obtained during both quiet standing and walking, and both with and without a backpack. The latter contained those items a child had on the testing day.

RESULTS

Participants carried a mean mass in their backpacks of 5.2 kg, and more than half had a backpack/body mass ratio higher than 15%. While spatio-temporal gait parameters were not affected by backpack carriage, significant increases (up to 25%) in plantar pressures were found during both static standing and walking, especially in the forefoot.

CONCLUSION

Under realistic conditions, the impact of backpack carriage was more evident on foot-ground interaction than on gait features. However, long-term consequences of altered plantar pressure need to be assessed in future work, considering the actual durations typically spent carrying school items.

Neck, shoulder and low back pain in secondary schoolchildren in relation to schoolbag carriage: should the recommended weight limits be gender-specific?

The occurrence of neck, shoulder and low back complaints in relation to schoolbag carriage and other potential risk factors were investigated in a cross-sectional study of 586 Iranian schoolchildren aged 12-14 years. The average load carried by schoolchildren was 2.8 kg. Neck, shoulder and low back complaints during the preceding month were reported by 35.3%, 26.1% and 33% of the students, respectively. Gender was an independent factor predicting musculoskeletal symptoms in schoolchildren. Girls were more likely than boys to suffer from neck, shoulder and low back complaints, although there was no significant difference between genders in terms of schoolbag carriage variables. The findings suggest that the recommended weight limit for schoolbag carriage may need to differ between boys and girls. The associations between schoolbag variables and reported symptoms are also discussed. The results provide evidence that the current weight limit should consider a broader combination of factors that influence the use of schoolbags.

Frequency of postural changes during sitting whilst using a desktop computer--exploring an analytical methodology

BACKGROUND

Dynamic movement whilst sitting is advocated as a way to reduce musculoskeletal symptoms from seated activities. Conventionally, in ergonomics research, only a 'snapshot' of static sitting posture is captured, which does not provide information on the number or type of movements over a period of time. A novel approach to analyse the number of postural changes whist sitting was employed in order to describe the sitting behaviour of adolescents whilst undertaking computing activities.

METHODS

A repeated-measures observational study was conducted. A total of 12 high school students were randomly selected from a conveniently selected school. Fifteen minutes of 3D posture measurements were recorded to determine the number of postural changes whilst using computers.

RESULTS

Data of 11 students were able to be analysed. Large intra-subject variation of the median and IQR was observed, indicating frequent postural changes whilst sitting.

CONCLUSION

Better understanding of usual dynamic postural movements whilst sitting will provide new insights into causes of musculoskeletal symptoms experienced by computer users.

The effect of lower body stabilization and different writing tools on writing biomechanics in children with cerebral palsy

A high percentage of children with cerebral palsy (CP) have difficulty keeping up with the handwriting demands at school. Previous studies have addressed the effects of proper sitting and writing tool on writing performance, but less on body biomechanics. The aim of this study was to investigate the influence of lower body stabilization and pencil design on body biomechanics in children with CP. Fourteen children (12.31±4.13 years old) with CP were recruited for this study. A crossover repeated measures design was employed, with two independent variables: lower body stabilization (with/without) and pencil (regular/assigned grip height/biaxial). The writing task was to trace the Archimedean spiral mazes. Electromyography (EMG) of the upper extremity, the wrist flexion/extension movements, and the whole body photography were recorded to quantify the changes in posture and upper extremity biomechanics. Two-way repeated measures ANOVA was used for statistical analysis. No significant main effects were revealed in the EMG and wrist kinematics. The lower body stabilization significantly decreased the trunk lateral and forward deviations, and the visual focus-vertical angle. The biaxial pencil and the assigned grip height design significantly decreased the head, shoulder, trunk, and pelvic deviations compared with the regular design. The results indicated that the lower body positioning was effective in improving the trunk posture. A pencil with an assigned grip height or with a biaxial design could improve head, shoulder, trunk and pelvic alignment, but did not influence the muscle exertion of the upper extremity. This study could provide guidelines for parents, teachers and clinicians regarding the selection of writing tools and the knowledge of proper positioning for the children with handwriting difficulties. Further analyses can focus on the design, modification and clinical application of assitive sitting and writing devices for the use in children with handwriting difficulties.

Instrumentos de avaliação da postura dinâmica: aplicabilidade ao ambiente escolar

INTRODUÇÃO: Para que a avaliação da postura dinâmica seja efetivada é necessário, primeiramente, conhecer os diversos instrumentos, disponíveis e validados na literatura, apropriados para esse fim. OBJETIVO: O objetivo deste artigo de revisão sistemática foi descrever, sintetizar e analisar criticamente os instrumentos encontrados na literatura que objetivem avaliar a postura dinâmica, tanto em adultos quanto em escolares, e refletir sobre a possibilidade de utilização desses métodos no ambiente escolar. MATERIAIS E MÉTODOS: Foi realizada uma busca sistemática de artigos em bases de dados (Scopus, ScienceDirect, PubMed, SciELO) publicados a partir da década de 1980 e no Banco de Teses e Dissertações da Capes. As palavras-chave utilizadas na busca pelos artigos foram back, spine, back injuries, school, back school, postural hygiene program, education, child, student, posture, em combinação com as palavras-chave evaluation, assessment, measurement, e os respectivos termos em português. Os instrumentos propostos deveriam preencher os seguintes critérios: (a) avaliar a postura corporal durante a realização de atividades da vida diária (AVDs); (b) utilizar critérios pré-definidos de avaliação da postura dinâmica; e (c) avaliar a postura a partir de observação, direta ou a partir de filmagem. RESULTADOS: Foram identificados oito artigos originais que apresentam instrumentos de avaliação da postura dinâmica, avaliando a execução de AVDs a partir de critérios biomecânicos pré-definidos por escalas numéricas; destes, apenas quatro instrumentos foram elaborados com o propósito de avaliar a execução de AVDs de escolares. CONSIDERAÇÕES FINAIS: Em geral, os instrumentos apresentam algumas limitações metodológicas, embora sejam de fácil aplicabilidade.

Back pain and body posture evaluation instrument (BackPEI): development, content validation and reproducibility

OBJECTIVES

Following a search conducted in several databases, no instrument was found that jointly evaluates the prevalence of back pain and its associated demographic, social-economic, hereditary, behavioral and postural risk factors. Thus, the present study aims to develop the Back Pain and Body Posture Evaluation Instrument (BackPEI) for school-age children and verify its validity and reproducibility.

METHODS

Twenty-one questions were elaborated to compose the BackPEI instrument, eight experts checked the content validity, and its reproducibility was tested by applying the questionnaire to 260 primary schoolchildren, at two different times with a 7-day interval.

RESULTS

The reproducibility data for the first 20 questions, analyzed using the kappa (k) coefficient, were classified as "very good" (k > 0.8) or "good" (0.6 < k ≤ 0.8). The reproducibility data for the pain intensity question, analyzed using the Wilcoxon test and the intraclass correlation coefficients (ICC), demonstrated that there was no difference between the averages (p = 0.251) and the responses were highly correlated (ICC = 0.937) for these two tests.

CONCLUSIONS

The BackPEI constitutes a valid and reproducible instrument which is relevant for the evaluation of back pain and its associated risk factors.

Prevalência de dor nas costas e fatores associados em escolares do Ensino Fundamental do município de Teutônia, Rio Grande do Sul

OBJETIVOS: verificar a prevalência de dor nas costas em escolares do ensino fundamental da rede municipal de ensino do município de Teutônia e verificar a associação com fatores demográficos, comportamentais e hereditários. MÉTODOS: estudo epidemiológico transversal em que participaram 743 escolares. Os dados, coletados a partir de um questionário composto de questões sobre dor nas costas nos últimos três meses, e de questões demográficas, comportamentais e here-ditárias, foram analisados a partir análise multiva-riável e do cálculo das Razões de Prevalência (RP). RESULTADOS: a prevalência de dor nas costas foi de 54,1% (n=402), sendo que destes, 17,4% referiram que esta dor impossibilitou a realização de atividades do dia-a-dia. Os escolares do sexo feminino (RP=1,08; p=0,002), os praticantes de exercício físico (RP=1,11; p=0,006) e os escolares cujos pais referem dor nas costas (RP=1,19; p=0,001) apresentam maior prevalência de dor nas costas. CONCLUSÕES: os achados indicam alta prevalência de dor nas costas em escolares, associada ao sexo, à prática de exercício físico e à hereditariedade. Informações dessa natureza poderão ser utilizadas no planejamento de programas de educação postural nas escolas municipais de Teutônia.

Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis

BACKGROUND

Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances.

METHODS

Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results.

RESULTS

A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.

CONCLUSIONS

The interventions were successful in significantly increasing the behaviours and knowledge acquired both in the posttest and in the follow-up. The combined treatment of postural hygiene with physiotherapy exercise exhibited the best results. The small number of studies limits the generalizability of the results.

Avaliação do peso e do modo de transporte do material escolar em alunos do ensino fundamental

OBJETIVOS: Identificar e comparar o modo de transporte e o peso do material escolar utilizado por escolares entre o 2º, 5º e 9º anos do ensino fundamental. MÉTODOS: Dentre as escolas do município Dois Irmãos (RS), uma escola foi sorteada e 58 escolares foram pesquisados por meio de questionário, que avaliou o acessório utilizado para transportar o material escolar e a forma de transporte. As variáveis antropométricas e o peso do material escolar foram mensurados ao longo de cinco dias. A análise do questionário envolveu tabelas de frequência e teste do qui-quadrado. O peso médio do material, relativo ao peso corporal e registrado ao longo da semana, foi analisado por ANOVA one-way e ao teste post hoc de Bonferroni. RESULTADOS: Escolares do 2º, 5º e 9º anos transportam seu material nas costas, em mochila com duas alças (60, 77,3 e 85,5%, respectivamente, p<0,05), apoiadas sobre os ombros (60, 77,3 e 81%, respectivamente; p<0,05). A média do peso da mochila relativo ao peso corporal no 2º, 5º e 9º anos foi 7,2±2,3, 8,8±3,0 e 5,9±1,7%, respectivamente, com diferença significativa apenas entre escolares do 5º e 9º anos. CONCLUSÕES: Os escolares do 2º, 5º e 9º anos transportam preferencialmente seu material escolar utilizando a mochila com duas alças nas costas apoiadas simetricamente sobre os ombros. Independentemente do ano escolar, o peso da mochila transportada foi inferior a 10% do peso corporal; os escolares do 5º ano foram os que transportaram mochilas com maiores cargas.

Acute low back pain in high school adolescents in Southern Brazil: prevalence and associated factors

PURPOSE

The aim of this study was to investigate the prevalence of acute low back pain (ALBP) and associated factors in high school students from a Southern Brazilian city.

METHODS

The study was cross-sectional and interviewed 1,233 students 13- to 19-year-olds, attending high schools. A total of 25 schools were included in the sample (15 state institutions, 7 private, 2 federal and 1 municipal). The ALBP was evaluated using two questions. The outcome was LBP in the previous 30 days.

RESULTS

The prevalence of ALBP was 13.7%. Non-white students, who commuted to school walking, showed a higher prevalence of ALBP. The prevalence of ALBP is relatively high.

CONCLUSIONS

Further studies with follow-ups to adulthood are needed to investigate whether physical cumulative loads on the lumbar spine (for example, duration/transport, school bags and inadequate school furniture) during adolescence, may influence the development of ALBP later in life.

Back pain in children: a holistic approach to diagnosis and management

Back pain is a relatively common complaint presenting to the primary care practitioner and is addressed with increasing frequency in the pediatric literature. Back pain is not uncommon in adolescents and often is symptomatic of a relatively benign musculoskeletal etiology. Back pain in children less than 10 years of age and most especially less than 4 years of age can signal a more alarming underlying condition. Evaluation requires a complete history including psychosocial and cultural considerations. Additionally a thorough clinical examination, strategic lab work and judicious imaging are imperative. Management and appropriate referral is specific to the underlying disease process. A holistic, individualized plan of care with inherent involvement of the child and parent/caregiver is essential to ensure safety and enhance outcomes.

School Bag Weight and the Occurrence of Shoulder, Hand/Wrist and Low Back Symptoms among Iranian Elementary Schoolchildren

BACKGROUND

Schoolchildren usually use school bags to carry their school materials. Carry-ing heavy school bags can cause several problems such as musculoskeletal problems among schoolchildren. The aim of this study was to investigate the association between the weight of school bags and the occurrence of low back, shoulder and hand/wrist symptoms among pri-mary school children.

METHOD

This cross-sectional, descriptive-analytical study was conducted among a sample of 307 elementary school children in Tabriz, Iran. Data were collected using a questionnaire and from measurement of the school bag weight, body weight and height of each participant. Data were analysed using SPSS software.

RESULTS

The average load carried by schoolchildren was 2.9 kg, representing approximately 10% of the children's body weight. Girls and lower grade children carried a greater percent-age of their body weights. Approximately 86% of the children reported some kind of muscu-loskeletal symptoms. The occurrence of shoulder, wrists/hands, and low back pain among school-children was 70%, 18.5% and 8.7%, respectively. The results of binary logistic regres-sion indicated that the school bag weight (expressed as a percentage of body weight) was only significantly associated with hand/wrist symptoms (P<0.05). Girls were more likely to com-plaint from low back pain than boys were. Age was significantly negatively associated with hand/wrist symptoms. Body mass index was also significantly associated with shoulder symptoms.

CONCLUSION

The results indicate a high prevalence of musculoskeletal symptoms among elemen-tary schoolchildren. Preventive measures and appropriate guidelines with regard to safe load carriage in schoolchildren are therefore needed to protect this age group.

Low back pain at school: unique risk deriving from unsatisfactory grade in maths and school-type recommendation

Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils' back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4 weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.

Risk factors associated with back pain in New Zealand school children

This study investigated risk factors associated with back pain in 245 New Zealand intermediate school children aged 11-14 years in a cross-sectional survey, using a self-completion questionnaire for demographic details, pain prevalence, psychosocial parameters, school and leisure activities and family characteristics. The strongest relationships were between back pain and common childhood complaints (stomach ache, headache and sore throats) (p < 0.01) and psychosocial factors (conduct and hyperactivity) (p < 0.01). For physical factors, there was a significant relationship between neck and low back pain and attributes of chairs. Low back pain was significantly related to low desk height (as reported by students) (p < 0.05). School bag weight was not significantly related to low back pain but carrying the bag on one shoulder was (p < 0.05). It is concluded that, amongst these intermediate school children, psychological, social and emotional factors had a stronger relationship with back pain than physical factors. STATEMENT OF RELEVANCE: This study investigated risk factors associated with back pain amongst New Zealand intermediate school children. It showed that psychological, social and emotional factors may have a stronger relationship with back pain than physical factors.

Risk factors for the first episode of low back pain in children are infrequently validated across samples and conditions: a systematic review

QUESTION

What risk factors have been identified for the first episode of low back pain in children and adolescents? Have these risk factors been validated?

DESIGN

Systematic review of prospective studies designed to identify possible modifiable and non-modifiable risk factors for the onset of low back pain in children and adolescents.

PARTICIPANTS

School children aged up to 18 years without low back pain at enrolment.

RESULTS

Five studies were included in the review. The included studies varied considerably in methods used to gather data, definitions of low back pain, and recall periods for an episode of low back pain. Forty-seven possible risk factors had been assessed for association with a first episode of low back pain in children. Of these, 13 were significantly associated with a first episode of low back pain. No risk factor was found to be associated with future low back pain in children in more than one study.

CONCLUSION

Inconsistency in definitions of low back pain, pre-defined recall periods, and methods used to collect and analyse data limit conclusions that can be drawn about factors that identify children at risk of developing low back pain. As no risk factor has been validated in independent investigation, we have no certainty that any factor places children at risk of developing low back pain.

The prevalence and characteristics of back pain among school children in New Zealand

A cross-sectional survey among 245 children was conducted to establish the prevalence and characteristics of back pain in school children aged 11-14 years. A self-complete questionnaire was used to ascertain demographic details, pain prevalence, psychosocial parameters, school and leisure activities and family characteristics. In the last month, 58% of children had experienced spinal pain. In total, 31% of children reported that pain occurred in one part of the back, while 28% stated that pain presented in more than one spinal region. Pain in the last month was found to be equally prevalent in the low back (35%) and neck (36%) regions. Low back pain was associated with the most severe pain and pain lasting for the longest duration when compared with the upper back and neck regions. Further research should be directed towards investigating pain in the neck region and understanding the characteristics of symptom co-occurrence. STATEMENT OF RELEVANCE: A survey was conducted to establish the prevalence and characteristics of back pain in school children. The results provide additional evidence that back pain is a serious problem in children aged 11-14 years, whilst also indicating widespread co-occurrence of pain in the neck, upper back and lower back spinal regions.

Postural sway modifications induced by backpack carriage in primary school children: a case study in Italy

The aim of this investigation is to assess modifications in sway parameters introduced by backpack carriage in Italian primary school children (6-10 years old, n = 447). Two 30-s trials (without and with backpack) were performed directly at a school on a regular school day to collect data on sway area, centre of pressure path length and maximum displacement range in antero-posterior and medio-lateral directions. The results show a significant load-induced increase in all sway parameters and the existence of a linear relationship between sway area and backpack weight. Since postural sway represents an effective indicator of balance abilities, the alterations observed suggest that backpack carriage originates balance impairment and thus may increase the risk of unintentional falls in children. STATEMENT OF RELEVANCE: Loss of balance is among the primary causes of unintentional falls and postural sway represents an effective indicator of balance abilities. In this study, sway parameters were assessed in primary school children wearing backpacks. The differences that were observed show that backpack carriage potentially increases the risk of falls.

Evidence-based guidelines for the wise use of computers by children: physical development guidelines

Computer use by children is common and there is concern over the potential impact of this exposure on child physical development. Recently principles for child-specific evidence-based guidelines for wise use of computers have been published and these included one concerning the facilitation of appropriate physical development. This paper reviews the evidence and presents detailed guidelines for this principle. The guidelines include encouraging a mix of sedentary and whole body movement tasks, encouraging reasonable postures during computing tasks through workstation, chair, desk, display and input device selection and adjustment and special issues regarding notebook computer use and carriage, computing skills and responding to discomfort. The evidence limitations highlight opportunities for future research. The guidelines themselves can inform parents and teachers, equipment designers and suppliers and form the basis of content for teaching children the wise use of computers. STATEMENT OF RELEVANCE: Many children use computers and computer-use habits formed in childhood may track into adulthood. Therefore child-computer interaction needs to be carefully managed. These guidelines inform those responsible for children to assist in the wise use of computers.

Prevalence of neck pain and headaches: impact of computer use and other associative factors

Headaches and neck pain are reported to be among the most prevalent musculoskeletal complaints in the general population. A significant body of research has reported a high prevalence of headaches and neck pain among adolescents. Sitting for lengthy periods in fixed postures such as at computer terminals may result in adolescent neck pain and headaches. The aim of this paper was to report the association between computer use (exposure) and headaches and neck pain (outcome) among adolescent school students in a developing country. A cross-sectional study was conducted and comprehensive description of the data collection instrument was used to collect the data from 1073 high-school students. Headaches were associated with high psychosocial scores and were more common among girls. We found a concerning association between neck pain and high hours of computing for school students, and have confirmed the need to educate new computer users (school students) about appropriate ergonomics and postural health.