Muscle pain, physical activity, self-efficacy and relaxation ability in adolescents

Do intensity of pain alone or combined with pain duration best reflect clinical signs in the neck, shoulder and upper limb?

OBJECTIVES

It is important to validate self-reported musculoskeletal pain used in epidemiological studies for evaluation of pain outcome measures. The main objective of this paper was to assess the association between self-reported neck/shoulder/upper limb pain and clinical signs of disorders in the region, especially by comparing a measure that only used pain intensity with a measure that combined pain intensity and pain duration.

METHODS

Four hundred and twenty technical school students of both genders were included with a median age of 17 years (16-28). The students stated the pain in four intensity grades and the pain duration in four period lengths within the preceding four weeks period. A pain severity index was calculated by multiplying the pain intensity (0-3) and the duration (1-4). A clinical examination was performed within a week after completing the form. The associations were evaluated by agreement, correlation and symmetric strength of association (contingency).

RESULTS

The study found low correlation and low positive agreement for neck/shoulder and upper limb pain related to clinical signs of disorders in the region. However, the relationship showed high negative agreement and high contingency. The negative agreement increased for the neck/shoulder region with higher cut-off points for dichotomization, but not for the upper limb region. The index combining reports of pain intensity with pain duration, do not improve agreement, correlation or contingency with clinical signs compared to use of pain intensity alone.

CONCLUSIONS

This study showed an association between self-reported neck/shoulder/upper limb pain intensity and clinical signs of musculoskeletal disorders of the region. An index combining pain intensity and duration (Pain Severity Index) did not increase this association. From the results we suggest using pain intensity reports alone and if dichotomizing is wanted, choosing a cut-off point at high pain levels, especially for neck and shoulder pain.

Associations of neck and shoulder pain with objectively measured physical activity and sedentary time among school-aged children

Objectives The potential effects of physical activity and sedentary time on children's increasing neck and shoulder pain are unclear. The aim of this cross-sectional study was to evaluate the associations between objectively measured physical activity or sedentary time and neck and shoulder pain in children. Methods Children (n=905; 10-15 years old) filled in an electronic questionnaire during school hours on the frequency of their neck and shoulder pain. Daytime moderate to vigorous physical activity and sedentary time were measured objectively with an ActiGraph accelerometer. A multinomial logistic regression was applied to study the associations. The results were adjusted for age, gender, body mass index and bedtime. Results Neck and shoulder pain experienced at least once a week was reported by 26.1% of children. A higher proportion of boys (45.9%) than girls (24.2%) achieved at least 60 min of moderate to vigorous physical activity/day (p<0.001). Girls were more sedentary than boys (sedentary time 66.4 vs. 63.1%) (p<0.001). Higher moderate to vigorous physical activity time was associated with a lower probability of experiencing neck and shoulder pain among boys, but not among girls. No association was found between sedentary time and neck and shoulder pain. Conclusions A quarter of the girls and boys reported frequent neck and shoulder pain. Boys achieved more moderate to vigorous physical activity than girls and higher moderate to vigorous physical activity was associated with a lower probability of having neck and shoulder pain, but only in boys. Neck and shoulder pain is the most common musculoskeletal pain and its prevalence is increasing. Preventing childhood pain is important, as neck and shoulder pain causes restrictions in daily living and is persistent to adulthood. Our study showed, that boys with more moderate to vigorous physical activity, had less weekly neck and shoulder pain symptoms. The present results are an addition to the list of benefits of physical activity and are valuable to, for example, healthcare personnel and teachers, who guide and teach children and adolescents. Families can benefit from new knowledge when considering supportive parenting activities. Municipalities can use the new information to design services for children or families.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study

BACKGROUND

The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs.

METHODS

This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors.

RESULTS

The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls.

CONCLUSIONS

In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Low back pain and physical activity--A 6.5 year follow-up among young adults in their transition from school to working life

BACKGROUND

The association between leisure time physical activity and low back pain in young adults is unclear and is in the need of prospectively obtained evidence. This study examined the course of low back pain and the association between low back pain and leisure time physical activity in a cohort of young adults in their transition from school to working life.

METHODS

Both low back pain and leisure time physical activity was monitored over a 6.5 year period in 420 subjects starting out as students within hairdressing, electrical installation and media/design. The association between physical activity and low back pain was investigated through the follow-up period by using linear mixed models analysis.

RESULTS

Low back pain was significantly influenced by time and overall there was a decreasing trend of low back pain prevalence throughout the follow-up. Analysis showed a weak trend of decreasing low back pain with moderate/high physical activity levels, but this association was not significant.

CONCLUSIONS

Low back pain decreased during follow-up with baseline as reference. Findings in our study did show non-significant trends of reduced low back pain with increased leisure time physical activity. Still, we could not support the theory of moderate/high levels of physical activity acting protective against low back pain in young adults entering working life. Our results, in combination with previous relevant research, cannot support a clear relationship between physical activity and low back pain for young adults. Thus, recommendations regarding effect of physical activity on reducing low back pain for this group are not clear.

Work with prolonged arm elevation as a risk factor for shoulder pain: a longitudinal study among young adults

This prospective study aimed at examining if work with prolonged arm elevation predicts shoulder pain among 41 young adults in their first years of working life. Fifteen hairdressers, 15 electricians, 5 students and 6 with various work were followed over a 2.5-year period (2006/7-2009). Arm elevation was measured with inclinometers during a full working day at baseline. Shoulder pain was reported at baseline and twice in the follow-up period. Data were analyzed by generalized estimating equations (GEE-analysis), stratified by gender and adjusted for time, mechanical workload, work demand, physical activity, tobacco use and prior shoulder pain. Work with prolonged arm elevation with angles >60° and >90° were associated with shoulder pain among women. Even though the shoulder pain levels are low the study suggests work with arms elevated as an early work-related risk factor among women, and indicates the importance of early prevention strategies.

The association between physical activity and neck and low back pain: a systematic review

The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. Publications were systematically searched from 1980 to June 2009 in several databases. The following key words were used: neck pain, back pain, physical activity, leisure time activity, daily activity, everyday activity, lifestyle activity, sedentary, and physical inactivity. A hand search of relevant journals was also carried out. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Seventeen studies were included in this review, of which 13 were rated as high-quality studies. Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.

A prospective study of neck, shoulder, and upper back pain among technical school students entering working life

PURPOSE

The aim of this prospective study was to relate the prevalence of neck, shoulder, and upper back pain to occupational and individual risk factors among a population of technical school students in their transition from school to working life. In addition, we wanted to assess the changes in pain prevalence during follow-up.

METHODS

A cohort consisting of 173 technical school students was followed up during a 3-year period, from their last year of school through their first years of working life. Data on self-reported neck, shoulder, and upper back pain and factors such as mechanical exposure, perceived stress, and physical activity in leisure time were collected.

RESULTS

A high prevalence of pain in the neck, shoulder, and upper back among the technical school students was found. There were however few students reporting severe pain. Reporting pain at baseline gave over three times higher risk of reporting it at follow-up. A high level of physical activity outside working hours gave a lower risk of reporting neck, shoulder, and upper back pain at follow-up. High and moderate levels of mechanical exposure and high stress level were not found to be risk factors for pain after entering working life.

CONCLUSION

Neck, shoulder, and upper back pain are common among adolescents and may persist into working life. These results may give potential for preventive efforts at a young age. There is still much uncertainty about the factors leading to musculoskeletal pain, and more research is needed on this topic.

Fitness, motor competence and body composition as correlates of adolescent neck/shoulder pain: an exploratory cross-sectional study

Background

Adolescent neck/shoulder pain (NSP) is a common and sometimes debilitating problem. Several risk factors for this condition have been investigated, but no studies have previously evaluated associations between fitness, motor competence, body composition and adolescent NSP.

Methods

1608 males and females of mean age 14 years answered questions on their history of NSP (4 measures), and were tested for aerobic fitness, upper and lower limb power, trunk endurance, grip strength, shoulder flexibility, motor competence and anthropometric factors. Univariate and multivariate logistic regressions were used to test for associations between NSP and physical variables.

Results

There were significant gender differences for most physical and pain variables. After multivariate analysis, males had lower odds of NSP if they had reduced back endurance [OR: 0.66 (95% CI: 0.46–0.97)], reduced persistent control [0.42 (0.19–0.95], and increased muscle power [0.33 (0.12–0.94)], and higher odds of NSP if they had a higher basketball throw [2.47 (1.22–5.00)] and jump performance [3.47 (1.55–7.74)]. Females had lower odds for NSP if they had a reduced jump performance [0.61(0.41–0.92)], a better basketball throw [0.60(0.40–0.90)], lower shoulder flexibility [0.54 (0.30–0.98)] and a higher aerobic capacity [0.61 (0.40–0.93)], and higher odds for NSP if they had greater abdominal endurance [1.57(1.07–2.31)] and greater bimanual dexterity [1.77(1.18–2.65)]. Females showed a U shaped relationship between NSP and back endurance [low: 2.12 (1.20–3.74); high 2.12 (1.18–3.83)].

Conclusion

Adolescent NSP was associated with fitness and motor competence, although the associations varied with gender, and their strength was limited.