Low back pain in 15- to 16-year-old children in relation to school furniture and carrying of the school bag

Effect of Muscle Energy Technique on Hamstring Flexibility: Systematic Review and Meta-Analysis

Since 2005, there have been no systematic reviews on the effects of multiple manual therapies, including muscle energy technique (MET), on the hamstrings. Therefore, this systematic review aimed to provide clinical evidence for the effectiveness of the MET on hamstring flexibility. We queried 10 electronic databases (PubMed, EMBASE, The Cochrane Library, KISS, NDSL, KMBASE, KISTI, RISS, Dbpia, and OASIS) up to the end of March 2022. This study only included randomized controlled trials (RCTs) investigating the use of MET for the hamstring. The literature was organized using Endnote. Literature screening and data extraction were conducted by two researchers independently. The methodological quality of the included RCTs was evaluated using the Cochrane risk-of-bias tool 1.0, and the meta-analysis was performed using RevMan 5.4. In total, 949 patients from 19 RCTs were selected according to the inclusion criteria. During active knee extension tests, the efficacy between MET and other manipulations did not significantly differ. For sit and reach tests, MET groups had higher flexibility compared to stretching (MD = 1.69, 95% CI: 0.66 to 2.73, p = 0.001) and no treatment (MD = 2.02, 95% CI: 0.70 to 3.33, p = 0.003) groups. No significant differences were observed in the occurrence of adverse reactions. Overall, we found that MET is more efficacious for improving hamstring flexibility compared to stretching and having no treatment during sit and reach tests because it combines isometric contraction with stretching. Owing to clinical heterogeneity, uncertain risk of bias, and the small number of included studies, further high-quality studies should assess the effectiveness of MET.

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.

The impact of a school backpack's weight, which is carried on the back of a 7-year-old students of both sexes, on the features of body posture in the frontal plane

Background

The lifestyle of children has a significant impact on the future health of the whole society. Therefore, health education, prevention and monitoring of health determinants is important at every stage of ontogenesis. This requires a thorough knowledge of the schoolchild's environment, perceived as a wide set of stressors, including not only genetic but also epigenetic factors. One of them is the issue of the correct and abnormal body posture at school and on the way there. The goal of the study was to show the influence of the weight of the back carried container with school supplies on body posture.

Method

The research was carried out as part of a project that examined the impact of carrying weights, which are school supplies, by children on their posture. The research material consisted of data obtained from a group of 65 students (35 girls, 30 boys) aged 7 years. Body posture tests were carried out, using the projection moiré method in 4 positions: 1-habitual posture, 2-posture after 10-min of asymmetric axial load, 3-a posture after 1 min of the load removal, 4-a posture after two minutes of the load removal. Physical fitness was measured with the Sekita test. The obtained data were statistically analyzed.

Results

The significance of differences between the 1st and 2nd measurements was analyzed to determine the impact of the backpack load and the correlation with physical fitness, and to study its influence on the value of the differences in posture features. Considering the differences in the volume of posture features among boys between the 1st and 2nd measurement, the Wilcoxon’s rank test showed a statistically significant difference in the range of all analyzed variables, except for the torso bend angle to the right (KNT+), where no statistically significant change was noted. A statistically significant difference in the volume of all analyzed variables was observed among the girls.

Conclusions

Carrying school supplies on the back induces significant changes in the value of the features describing the body posture in the frontal plane. The greater weight of the container and carrying time, and intensity of physical effort is the greater the changes will be. Physical fitness has a various and sex-dependent influence on the value of changes in body posture features because of carrying school supplies. Among boys it significantly affects the asymmetry of the torso bend, shoulder height, the waist triangles height and width, whereas among girls it affects the asymmetry of the shoulders and the distance of the angles of the lower shoulder blades from the line of the spinous processes of the spine. Among boys the changes in the value of posture features are mostly influenced by endurance and speed, but strength, power and agility are of lower influence, whereas among girls only agility matters.

Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain

The prevalence of low-back pain (LBP) in adolescents ranges from 7 to 72%. We aimed to define the radiologic characteristics of the lumbar spine in children and adolescents with LBP with/without leg pain. Two hundred and fourteen children and adolescents, who were born between 2001 and 2009 and had lumbar spine MRI for LBP with/without leg pain, were evaluated in terms of intervertebral disc degeneration (IVDD), end-plates and paraspinal muscle changes on lumbar spine MRIs. Severe IVDD was detected at all lumbar levels except for L2-L3. Modic changes were present in 4.2% of the patients. Modic changes were more common in patients with severe IVDD than in those with mild-to-moderate IVDD. Severe IVDD was significantly associated with Modic changes at the corresponding L1-L2 and L3-L4 disc levels. Girls had significantly more fatty infiltration in the paraspinal muscles when compared to boys. The risk of having severe IVDD concomitant with Modic changes was high [odds ratio (OR), 8.6]. The OR was 20.7 for predicting the presence of severe IVDD at any level if Modic changes presented particularly at the L3-L4 level. The ORs of Modic changes presented at any lumbar level at the background of fat-infiltrated multifidus at L3-L4 and L4-L5 levels were 8.3 and 9.1, respectively. Fatty infiltration in the paraspinal muscles and IVDD were closely associated with Modic changes in children and adolescents with LBP. Lumbar IVDD in children and adolescents could be the result of a mechanical pathology.

Validation of Two Instruments for the Correct Allocation of School Furniture in Secondary Schools to Prevent Back Pain

BACKGROUND

Back pain is common in secondary school students. If we adjust the school furniture to the anthropometric characteristics of the pupils, we will improve their posture and reduce back pain. There is a high degree of mismatch between the furniture used by students and that which should be used. The objectives of this research are to discover the degree of mismatch and validate two instruments that allow a correct allocation of the furniture.

METHODS

The selected sample was 132 secondary students (14.08 ± 1.10 years). An anthropometer was used to determine the ideal height of the chair and table; data were taken from body segments. The recorded values were compared with those obtained by the two measurement instruments to be validated. Inter-measurer and intra-measurer reliability and validation were performed using t-tests and Pearson's coefficient, respectively. Different analysis techniques were used: descriptive, one-way ANOVA, t-test, and effect size. The established level of significance was ρ < 0.05.

RESULTS

The mismatch between the anthropometric dimensions of the students and the existing furniture in the classrooms was 98.5 % for the chairs and 100 % for the tables. The correlational analysis of the instruments to be validated shows an r = 0.993 in the chair and r = 0.996 in the table.

CONCLUSIONS

There is a high degree of mismatch between the furniture and the anthropometric characteristics of the students. The proposed furniture allocation instruments are adequate.

Parents' knowledge and attitudes when choosing their children's school bag: An introductory study

Background/Aim: A school bag is a device whose purpose is to store things that are necessary for a child in performing daily productive activities. The aim of the research was to examine how much parents are informed about the school bag and which specifications are crucial when choosing a school bag for their children. Material and methods: The prospective study included 150 parents of students aged 11 to 12 from Banja Luka. For the purposes of the research, a questionnaire with closed and open questions was used. Results: More than 97 % of the surveyed parents belonged to the age range of 30 to 49 years. The largest number of surveyed parents have had secondary education 44 %, but the number of university-educated parents was also very high 39.3 %. Ninety-six percent of students used a backpack. School bags in 97.4 % of cases were purchased in stores. Only in 10 % of cases, school bags fully meet the basic criteria. In the remaining 90 % of cases, there was an absence of at least one or more desired characteristics. Using the Chi-squared test (ch2 = 245.45; p < 0.001), a significant difference between the desired and the achieved result was statistically proven. 77.3 % of parents did not receive information about the school bag. Salespeople (11.3 %), other parents and friends (9.3 %) were the main source of information before purchasing a school bag. In the future, 54 % of parents would like to get information about the school bag through lectures and practical workshops for children and parents. Conclusion: Greater information enables adequate selection and reduces the possibility of marketing tricks and influences on consumers when choosing the desired product such as a school bag. Parents have an important role to play in ensuring unhindered growth and development during the educational process and in raising children's awareness and supervision of the proper use of the school bag.

Childhood overweight and obesity and back pain risk: a cohort study of 466 997 children

OBJECTIVES

To assess the association between age, sex, socioeconomic group, weight status and back pain risk in a large general population cohort of children.

DESIGN AND SETTING

A dynamic cohort of children aged 4 years in the Information System for Research in Primary Care (SIDIAP) electronic primary care records data in Catalonia. Multivariable Cox models were fitted to explore the association between back pain and weight status categories according to the WHO 2007 growth reference groups (body mass index for age z-score). Models were adjusted for age, sex, socioeconomic status and nationality.

PARTICIPANTS

Children seen at age 4 years at paediatric primary care clinics between 1 January 2006 and 31 December 2013 and followed up until 31 December 2016 or age 15 years.

OUTCOME MEASURES

Incident back pain registered by paediatricians at primary care using the International Statistical Classification of Diseases and Health Related Problems, 10th Edition code M54.

RESULTS

466 997 children were followed for a median 5.0 years (IQR 5.1). In multivariable models, overweight and obesity increased back pain risk, with adjusted HRs of 1.18 (95% CI 1.09 to 1.27) and 1.34 (95%CI 1.19 to 1.51) for overweight and obesity, respectively. Females were at greater risk of back pain than males with adjusted HR 1.40 (95%CI 1.35 to 1.46). Adjusted HR was 1.43 (95%CI 1.33 to 1.55) for back pain in children from the most deprived socioeconomic groups compared with the least deprived socioeconomic groups.

CONCLUSIONS

Maintaining a healthy weight from an early age may reduce the prevalence of back pain in both children and adults. Overweight female children from deprived socioeconomic groups are at greatest risk of back pain and represent a target population for intervention.

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.

Back pain and school bag weight - a study on Indian children and review of literature

Back pain in children is a complex phenomenon, which has been shown to be associated with physical and psychosocial factors. None of the studies on Indian children have investigated the possible association between back pain and psychosocial factors. We decided to determine the prevalence of back pain in students and association with both physical and psychosocial factors. A cross-sectional study was conducted on 163 students from two city schools. Physical factors were evaluated using a structured questionnaire. Strengths and difficulties questionnaire was used to assess psychosocial factors. The studied sample consisted of 49.7% boys and 50.3% girls. Mean school bag weight was 6.1±2.4 kg (range: 2.2-15.6 kg). Mean weight of school bag as a percentage of body weight was 13.5±6.2%. Approximately 76% students carried more than 10% of their body weight. The prevalence of back pain (over last 1 month) was 53.9%. No associations were found between back pain and weight of school bag, weight of school bag as a percentage of body weight and physical activities. Significant associations were found between back pain and number of hours spent watching television [odds ratio (OR): 3.3, 95% confidence interval (CI): 1.5-7.5; P=0.003], history of injury to the back (OR: 4.8, 95% CI: 1.47-15.8, P=0.003), presence of a family member complaining of back pain (OR: 1.98, 95% CI: 1.25-3.14, P=0.002), conduct (P=0.042) and hyperactivity problems (P=0.045). Thus, there appears a need to consider psychosocial factors along with physical factors when evaluating a young student with back pain.

Classroom Furniture Mismatch and Back Pain Among Adolescent School-Children in Abha City, Southwestern Saudi Arabia

Objective: To explore the potential classroom furniture mismatch with students’ anthropometric measurements and back pain related to sitting for extended periods. Methods: This cross-sectional study was carried out on all twelve male and female intermediate and secondary schools located in Abha city. Anthropometric and classroom furniture measurements were assessed, and the mismatch was determined using standardized methods. Students were also screened for back pain related to long sitting at school. Results: A total number of 879 students was selected. The study revealed seat height mismatch in both intermediate, and secondary school of 84.3%, and 75.6%, respectively. Seat depth mismatch was 74.0% in intermediate schools and reached 84.5% in secondary schools. The desk height was improper for 94.1%, and 82.3% of students in intermediate, and secondary schools, respectively. The levels of mismatch differ significantly by grade level and gender. A prevalence of 10.8% of back pain related to long sitting at school was found. In multivariable logistic regression, males, intermediate school children, and the presence of buttock-popliteal length/seat depth mismatch were significantly associated with pain. On the other hand, practicing exercise was a significant protective factor. Conclusions: There is a prevalent mismatch between students’ dimensions and existing schools’ furniture. School furniture providers should take in consideration the average Saudi students’ dimensions, while designing school furniture especially for males, and at intermediate schools, or provide schools with adjustable seats and desks.

Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial

Background

This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability.

Material/Methods

Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison.

Results

The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group.

Conclusions

Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.

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.

School Bag Weight as a Barrier to Active Transport to School among New Zealand Adolescents

Background: Excessive school bag weight is a barrier to active transport to school (ATS). This study examined parents’ and adolescents’ perceptions of school bag weights and actual school bag weights for adolescents in New Zealand. Methods: Parents (n = 331; 76.7% women) completed a survey. Adolescents (n = 682; age 15.1 ± 1.4 years; 57.3% boys) completed a survey, underwent anthropometry, and had their school bags weighed. Results: Overall, 68.3% of parents perceived that adolescents’ school bags were too heavy to carry to school. This parental perception differed by adolescents’ mode of transport to school (active/motorized/combined: 35.1%/78.4%/68.8%, p < 0.001). Adolescents perceived that their school bags were too heavy to carry to walk (57.8%) or cycle (65.8%) to school. Adolescent perceptions differed by mode of transport to school (for walking (active/motorized/combined): 30.9%/69.2%/55.9% agree, p < 0.001; for cycling: 47.9%/72.8%/67.7%; p < 0.001). Actual school bag weight was, on average, 5.6 ± 2.1 kg. Relative school bag weight (% of body weight) was higher for boys and underweight adolescents compared to their counterparts. Neither absolute nor relative school bag weight differed by mode of transport to school. Conclusions: School bag weight was perceived a barrier to ATS and was a greater perceived barrier among users of motorized versus active transport. Perceptions of school bag weights should be considered in future ATS interventions.

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.

Prevalence and risk factors of low back pain among school age children in Iran

Background: Most available data on the prevalence and characteristics of back pain in schoolchildren is related to industrialised and developed countries. The aim of this study was to investigate the prevalence of low back pain (LBP) and potential risk factors among schoolchildren and adolescents in a developing country, Iran.

Methods: A cross-sectional study was conducted among 1611 Iranian schoolchildren aged 11–14 years. A self-complete questionnaire was used to assess LBP prevalence, physical leisure activities, school-related and psychosocial factors.

Results: The prevalence of LBP was 34.3%. Female gender (odds ratio [OR] = 1.57, 95% CI:1.28–1.94), family member with back pain (OR = 1.82, 95% CI: 1.40–2.36), difficulty in viewing the (black)board (OR = 1.50, 95% CI: 1.13–1.99), too much homework (OR = 1.47, 95% CI:1.09–1.99), time spend carrying a schoolbag (min/d) (OR = 1.37, 95% CI: 1.01–1.85), and psychosocial factors (emotional symptoms) (OR = 2.28, 95% CI: 1.54–3.39) were independently associated with LBP. Physical activity, having a job, watching television, using a computer, playing games and schoolbag weight had no effect.

Conclusion: It can be concluded that both physical and psychosocial factors influenced the risk for LBP, but emotional symptoms had a stronger association with LBP than physical factors. Knowledge about LBP in school children and adolescents could be important in assessment and treatment of such symptoms in this population.

Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review

Background

Adolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.

Methods

Systematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.

Results

The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.

Conclusion

The results of this systematic review indicate that adolescents with idiopathic scoliosis frequently experience low back pain. However, there was insufficient evidence to confidently estimate low back pain prevalence in adolescents with idiopathic scoliosis and further studies are needed in this area.

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-017-0143-1) contains supplementary material, which is available to authorized users.

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.

The influence of school furniture on students' performance and physical responses: results of a systematic review

The purpose of this study was to determine, using a systematic review, whether the design and/or dimensions of school furniture affect the students' physical responses and/or their performance. Of the review studies, 64% presented positive results, i.e. proven effects; 24% presented negative effects or no change/effect; and the remaining 12% showed an unclear effect. The compatibility between school furniture dimensions and students' anthropometric characteristics was identified as a key factor for improving some students' physical responses. Design characteristics such as high furniture, sit-stand furniture, and tilt tables and seats also present positive effects. Finally, we concluded that further research should be conducted exploring various aspects of those variables, particularly focusing on more objective measures complemented by controlled and prospective design. Practitioner Summary: A systematic review of the literature presents a clearly positive effect of school furniture dimensions on students' performance and physical responses. Similar results appeared when school furniture design was tested. However, studying the effects of design and dimensions together produced an unclear positive effect.

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.

Layout for Assessing Dynamic Posture: Development, Validation, and Reproducibility

PURPOSE

To determine the psychometric properties of the layout for assessing dynamic posture (LADy).

METHODS

The study was divided into 2 phases: (1) development of the instrument and (2) determination of validity and reproducibility. The LADy was designed to evaluate the position adopted in 9 dynamic postures.

RESULTS

The results confirmed the validity and reproducibility of the instrument. From a total of 51 criteria assessing 9 postures, 1 was rejected. The reproducibility for each of the criteria was classified as moderate to excellent.

CONCLUSIONS

The LADy constitutes a valid and reproducible instrument for the evaluation of dynamic postures in children 11 to 17 years old. It is low cost and applicable in the school environment.

Postural education and behavior among students in a city in southern Brazil: student postural education and behavior

[Purpose] The aim of the present study was to assess the knowledge of the spine and posture among adolescent female students and to determine if they had access to postural education in or outside school. [Subjects and Methods] This was an epidemiological survey of a representative sample of 495 female students aged 14 to 18 years attending a regular secondary school in São Leopoldo, RS, Brazil. Data were collected through a questionnaire. [Results] The results showed that 16.8% of teens did not know what a spine was, 8.3% had no knowledge of posture, and 61% reported receiving no posture education. Posture awareness was associated only with posture while using a computer, while having postural education class was not associated with any postural behavior. [Conclusion] The results showed that, although most students are familiar with the spine and posture, a sizable group is not, and over half had no postural education. These findings suggest that inclusion of postural education programs in schools should be encouraged in order to promote health and prevent diseases related to the spine.

The effects of bag style on muscle activity of the trapezius, erector spinae and latissimus dorsi during walking in female university students

Back pain is common in adolescents which has been associated with carrying a bag. However, there is little research examining the effects of bag style in female adolescents. The aim of the study was to investigate the effects of different bag conditions on muscle activity of the trapezius, erector spinae and latissimus dorsi muscles in female university students during walking. Twelve female university students walked on a treadmill for 5 minutes at 1.1 m/s during five conditions; control, 1 strapped rucksack, 2 strapped rucksack, ipsilateral shoulder strap and contralateral shoulder strap, each containing 10% bodyweight. Electromyography for the trapezius, erector spinae and latissimus dorsi was recorded for the last 30 s of each condition. Two-way ANOVA and paired t-tests were used to identify differences between right and left muscles and between bag conditions. Results showed that muscle activity of the left trapezius was significantly higher than the right trapezius during the 1 strap rucksack condition. For the left trapezius, the 2 strapped rucksack and the control condition had significantly lower muscle activity compared to the 1 strapped rucksack and the ipsilateral shoulder strap. For the left erector spinae muscle, there was significantly greater muscle activity when wearing the contralateral shoulder strap compared to the control. For the right erector spinae, significantly lower muscle activity was observed when wearing the 2 strapped rucksack compared to the ipsilateral shoulder strap and contralateral shoulder strap. There were no significant differences in muscle activity of the latissimus dorsi muscles between any of the bag conditions. These findings suggest that a two strapped rucksack should be used when carrying loads to reduce spinal muscle activity which may, in turn, reduce reports of back pain in female adolescents.

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.

Schoolbag weight limit: can it be defined?

BACKGROUND

Carrying a schoolbag is a daily activity for most children and much research has been conducted in an effort to identify a safe load limit for children to carry in their schoolbags. Despite this, there is still no consensus about guideline weight and other factors associated with carrying a schoolbag. The objective of this article is to review the literature on schoolbags with particular emphasis on the load limit guidelines and schoolbag-related musculoskeletal pain, and to suggest directions for school health and future research.

METHODS

Science Direct, PubMed, AMED, CINAHL, OVID, EMBASE, and Scopus were searched for peer-reviewed articles using combinations of the following key words: schoolbag, backpack, rucksack, knapsack, satchel, book bag, book pack and included combinations of children, pain, gait, and posture. Article references were also checked for further citations. All are in English, with the exception of one which is in German but is widely cited.

RESULTS

There are conflicting findings in the literature. The recommended load limit for schoolchildren to carry varies from 5% to 20% of their body weight, and the evidence linking backpack weight and back pain is inconclusive.

CONCLUSIONS

The shortcomings in the current literature should be addressed so that evidence-based guidelines can be provided to schoolchildren, parents, and teachers. It is suggested that general guidance may be more appropriate than a single load limit guideline.

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.

Physical therapy treatments for low back pain in children and adolescents: a meta-analysis

Background

Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents.

Methods

Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments).

Results

Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant.

Conclusions

Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.

Prevalence of low back pain in children and adolescents: a meta-analysis

BACKGROUND

Low back pain (LBP) is common in children and adolescents, and it is becoming a public health concern. In recent years there has been a considerable increase in research studies that examine the prevalence of LBP in this population, but studies exhibit great variability in the prevalence rates reported. The purpose of this research was to examine, by means of a meta-analytic investigation, the prevalence rates of LBP in children and adolescents.

METHODS

Studies were located from computerized databases (ISI Web of Knowledge, MedLine, PEDro, IME, LILACS, and CINAHL) and other sources. The search period extended to April 2011. To be included in the meta-analysis, studies had to report a prevalence rate (whether point, period or lifetime prevalence) of LBP in children and/or adolescents (≤ 18 years old). Two independent researchers coded the moderator variables of the studies, and extracted the prevalence rates. Separate meta-analyses were carried out for the different types of prevalence in order to avoid dependence problems. In each meta-analysis, a random-effects model was assumed to carry out the statistical analyses.

RESULTS

A total of 59 articles fulfilled the selection criteria. The mean point prevalence obtained from 10 studies was 0.120 (95% CI: 0.09 and 0.159). The mean period prevalence at 12 months obtained from 13 studies was 0.336 (95% CI: 0.269 and 0.410), whereas the mean period prevalence at one week obtained from six studies was 0.177 (95% CI: 0.124 and 0.247). The mean lifetime prevalence obtained from 30 studies was 0.399 (95% CI: 0.342 and 0.459). Lifetime prevalence exhibited a positive, statistically significant relationship with the mean age of the participants in the samples and with the publication year of the studies.

CONCLUSIONS

The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

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.

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.

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.

Benefícios de um programa de educação postural para alunos de uma escola municipal de Garibaldi, RS

A fisioterapia tem importante papel no meio escolar, pois estudantes desenvolvem maus hábitos e alterações posturais que, a longo prazo, podem gerar restrição funcional. O objetivo deste estudo foi analisar os efeitos de um programa de educação postural em estudantes do ensino fundamental da cidade de Garibaldi, RS. Participaram 48 alunos com idade entre 8 e 10 anos, que responderam um questionário sobre hábitos posturais e foram submetidos à avaliação de peso, modelo e modo de transporte da mochila antes e após uma sessão educativa; quatro semanas mais tarde foi feita uma reavaliação. Os pais participaram do estudo respondendo um questionário sobre a postura dos filhos. Quanto aos hábitos escolares, constatou-se mudança positiva na adoção de postura adequada dos pés na posição sentada (p=0,001); e, nas atividades de vida diária, mudanças na posição ao ver televisão (p<0,0001), dormir (p=0,019), pegar objetos no chão (p<0,0001) e costume de ler e/ou escrever na cama (p=0,002). Em relação ao peso da mochila obteve-se redução significativa após a intervenção (p=0,002), enquanto no modelo e modo de transporte não houve diferença. Segundo os pais, os filhos têm bons hábitos de postura e costumam utilizá-los no dia-a-dia. Concluiu-se que a realização de uma sessão de educação postural para alunos promoveu o conhecimento de hábitos posturais saudáveis e modificação de algumas posturas, mas não se pode afirmar que provocou mudanças nos hábitos posturais.

Nonspecific low back pain during childhood: a retrospective epidemiological study of risk factors

OBJECTIVES

In contrast to what was believed in the past, nonspecific low back pain is a fairly frequent condition in children, whose pathophysiology remains unclear as yet. Although many factors have been implicated in its development, results are often contradictory.

METHODS

Our study aims to examine most of the reasons investigated in the international literature, as well as the previously unexamined impact of passive smoking in its clinical appearance. It is a retrospective study that investigates the symptom of nonspecific low back pain during a 12-month period before the visit of children to our department. The research included 692 children aged 7.5 to 14 years. The data were collected using a semi-structured questionnaire, which included a mix of open and closed questions, followed by physical examination during their visit.

RESULTS

A total of 153 children were considered to present nonspecific low back pain during the previous year. The determinant factors appear to be greater age, the male sex, larger height, increased weight, dissatisfaction with school chairs, the clinical presentation of back pain in at least 1 parent, and coexisting anatomic orthopedic conditions. On the contrary, the weight of the school bag, the way in which it was carried and participation in sports, as well as the time spent by children in front of the TV or PC playing video or play station games, did not appear to have a statistically significant correlation with its appearance. In general, passive smoking does not appear to be a risk factor (P[r] = 0.341), and does not seem to play a leading role in the etiology of the condition. Furthermore, even the heaviness of parental smoking (over 20 cigarettes a day) does not seem to alter the appearance of the disease. The effect of nonspecific low back pain in children's activities was measured using Hannover Functional Ability and Rolland Morris questionnaires, appropriately modified to childhood, where he found a moderate or severe restriction of activity in 23.52% (score >5) and 19.61% (score >6), respectively.

CONCLUSIONS

The data analysis shows that nonspecific low back pain in children is a benign disorder with an unknown pathophysiological mechanism. Many anthropometric characteristics and environmental factors are implicated, but to a different degree each time. Passive smoking as well as the heaviness thereof does not appeal to play in important role in its clinical presentation. Further investigation is deemed necessary to determine the existence of other risk factors, as well as the level of their participation in the condition's pathophysiology.

A detailed characterisation of pain, disability, physical and psychological features of a small group of adolescents with non-specific chronic low back pain

The objective of the study was to provide a detailed biopsychosocial evaluation of adolescent NSCLBP compared to those without LBP. NSCLBP was described by pain level, duration, levels of disability and kinesiophobia, aggravating factors and functional movements. Each pain subject was sub-classified using the O'Sullivan system. Groups were compared on physical activity levels, sitting posture, trunk extensor and thigh muscle endurance, psychosocial behaviour, depression, family functioning and exposure to stressful life events. Adolescents with NSCLBP reported moderate levels of pain (4.4/10 +/- 1.9), disability (17.9 +/- 10.1%) and fear avoidance beliefs (36.1/68 +/- 7.1). Differences between control and pain groups were only found for back muscle (p = 0.033) and squat endurance times (p = 0.032) and stressful life events (p = 0.030). Differences in sitting posture between pain and no pain groups were only found when pain subjects were sub-classified (lumbar angle p = 0.001). In conclusion, adolescents with NSCLBP reported moderate pain and disability with deficits in trunk and squat endurance. That they remained physically active is at odds with the activity avoidance and subsequent deconditioning model proposed for adults with NSCLBP. Differences between control and pain groups on history of stressful life events suggest this may contribute to adolescent NSCLBP. Differences with sitting posture are only seen when patients were sub-classified.