Physical risk factors for adolescent neck and mid back pain: a systematic review

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

OBJECTIVE

To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).

RESULTS

We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.

CONCLUSION

Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

[Spinal manipulation techniques in the treatment of arterial hypertension. (A literature review)]

There is a long-observed relationship between the pathology of the spine and arterial hypertension. There are a number of explanations for this, including one based on reflex effects and obstruction of blood flow to the cerebral vasodilatory centre localized in the rhomboid fossa projection. Obstruction can be absolute and relative, preventing the increase of blood flow during stress, when the brain turns on additional energy demand (phenomenon of «selfish brain»). In conditions of insufficient blood supply anaerobic metabolism is included, requiring in the future, the addition of anaerobic glycolysis products. This leads to the persistence of an elevated level of AD and is part of the theory of centralized compensation of aerobic-anaerobic balance (theoretical aerobic-anaerobic energy concept, TAAEBC). The existing methods of manual manipulation and physical action on the spine, mainly the atlantoacral section of the cervical spine, have, according to existing publications, varying degrees of effectiveness. The modern approach to treatment of arterial hypertension and correction of metabolic disorders by A. Shishonin is promising. It is based on the TAAEBC concept and assumes a system approach and long-term effect through a consistent three-step manual and physical interventions aimed at restoring, retaining and long-term support of the vertebral blood flow.

Risk factors for neck pain in college students: a systematic review and meta-analysis

BACKGROUND

During the COVID-19 epidemic, the prevalence of neck pain among college students has increased due to the shift from offline to online learning and increasing academic and employment pressures. Therefore, this systematic review aimed to identify the personal, occupational, and psychological factors associated with the development of neck pain to promote the development of preventive strategies and early intervention treatment.

METHODS

Seven electronic databases were searched from inception to December 2022 for cross-sectional studies, cohort studies, case----control studies, and randomized controlled trials (RCTs) on neck pain. The quality of the selected studies were assessed by American Agency for Healthcare Research and Quality (AHRQ) or the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the effects of the included risk factors on neck pain.

RESULTS

Thirty studies were included, including 18,395 participants. And a total of 33 potentially associated risk factors were identified. Ultimately, 11 risk factors were included in the meta-analysis after assessing, and all results were statistically significant (P < 0.05). The factors supported by strong evidence mainly include the improper use of the pillow (OR = 2.20, 95% CI: 1.39 to 3.48), lack of exercise (OR = 1.88, 95% CI: 1.53 to 2.30), improper sitting posture (OR = 1.97, 95% CI: 1.39 to 2.78), history of neck and shoulder trauma (OR = 2.32, 95% CI: 1.79 to 3.01), senior grade (OR = 2.86, 95% CI: 2.07 to 3.95), staying up late (OR = 1.80, 95% CI: 1.35 to 2.41), long-time electronic product usage daily (OR = 1.53, 95% CI: 1.33 to 1.76), long-time to bow head (OR = 2.04, 95% CI: 1.58 to 2.64), and emotional problems (OR = 2.09; 95% CI: 1.66  to 2.63). Risk factors supported by moderate evidence were high stress (OR = 1.61, 95% CI: 1.02 to 2.52) and female gender (OR = 1.69, 95% CI: 1.52 to 1.87).

CONCLUSION

This study obtained 11 main risk factors affecting college students neck pain, including improper use of the pillow, lack of exercise, improper sitting posture, history of neck and shoulder trauma, senior grade, staying up late, long-term electronic product usage daily, long time to bow head, high stress, emotional problems and female gender.

Thoracic Spine Pain in High School Adolescents: A One-Year Longitudinal Study

Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to determine the incidence of TSP and ongoing TSP and identify its predictors in high school students. This longitudinal study was conducted in 2017 (baseline-T1), and follow-up surveys were completed in 2018 (T2). The variable "thoracic spine pain" was observed using the Nordic questionnaire, and associated variables were observed through the Baecke questionnaire and the Strengths and Difficulties Questionnaire. Statistical association methods were used for bivariate and multivariate logistic regression analysis. Among the participants, the one-year prevalence (ongoing TSP) was 38.4%, and the one-year incidence (new TSP) was 10.1%. Significant risk factors for ongoing TSP were adolescent females (RR = 2.14), in the age group of 15 to 18 years (RR = 1.41), clinical mental health problems (RR = 3.07), borderline mental health problems (RR = 2.02), mental health problems, sitting while using a tablet (RR = 1.93), distance of the eye from cell phone screen of or more than 20 cm (RR = 1.69), distance of the eye from the PC screen of or more than 30 cm (RR = 1.53), cell phone mobile use duration of or more than 3 h (RR = 1.60), tablet use time of or more than 3 h (RR = 2.08), and semi-lying prone position while using the cell phone (RR= 1.47), and these were also significant predictors of TSP episodes. Significant risk factors for new TSP were adolescent female sex (RR = 1.88), level, clinical mental health problems (RR = 4.26), borderline mental health problems (RR = 2.07), semi-lying prone position while using cell phone (RR = 1.71) or tablet (RR = 2.31), and mobile phone use duration equal to or greater than 3 h (RR = 1.72). We conclude that there is a high prevalence of TSP in high school students, which is associated with the female sex, mental health problems, and use of electronic devices for an inappropriate duration in an improper position.

Laboured reading and musculoskeletal pain in school children - the role of lifestyle behaviour and eye wear: a cross-sectional study

Background

Lifestyle behaviour in children and adolescents has become increasingly sedentary and occupied with digital work. Concurrently, there has been an increase in the prevalence of headache, neck- and low back pain, which are leading causes of disability globally. Extensive near work and use of digital devices are demanding for both the visual system and the upper body head-stabilizing musculature. Uncorrected vision problems are present in up to 40% of Nordic school children, and a lack of corrective eye wear may cause eyestrain, musculoskeletal pain and headache. The aim of this study was to investigate associations between laboured reading, musculoskeletal pain, uncorrected vision, and lifestyle behaviours in children and adolescents.

Methods

This was a cross-sectional study with a total of 192 Norwegian school children aged 10–11 and 15–16 years. As a part of a school vision testing program, the children completed an online questionnaire about general and ocular health, socioeconomic status, academic ambition, near work and related symptoms, upper body musculoskeletal pain, and physical and outdoor activities.

Results

The 15–16-year-olds had a more indoor, sedentary, digital-based lifestyle with higher academic demands, compared with the 10–11-year-olds. Concurrently, reading became more laboured and upper body musculoskeletal pain increased with age. Girls reported more symptoms, higher academic ambitions, and more time spent on schoolwork and reading, compared with boys. Non-compliance in wearing prescribed eye wear (glasses or contact lenses), increased use of near digital devices, and experiencing visual stress (glare) were positively associated with laboured reading and upper body musculoskeletal pain.

Conclusions

A screen-based lifestyle with high academic demands challenges the ability to sustain long hours of static, intensive near work. Extensive near work tires the visual system and upper body musculature and provokes laboured reading and musculoskeletal pain symptoms. This study emphasizes the importance of regular eye examinations in school children, and the need to raise awareness among children, parents, and school- and health personnel about the importance of optimal vision and visual environment for academic performance and health.

Spine Posture, Mobility, and Stability of Top Mobile Esports Athletes: A Case Series

Professional esports athletes spend a long time in the same sitting posture during training and competition. Mobile esports may exacerbate potential postural problems because of the closer and unsupported arms and because athletes spend more time in a forward-/flexed-head posture. Prolonged sitting in these postures carries significant health risks and may lead to musculoskeletal problems and injuries. The objective of this retrospective study is to assess the posture, mobility, and stability of the spine for professional mobile esports athletes. We collected spine-assessment data from 48 athletes participating in a top-tier league on a real-time-strategy battle-arena online game. The spinal assessment was conducted using the SpinalMouse® under upright standing and trunk flexion in addition to the Matthiass test. Measurements were converted into Idiag Scores by the SpinalMouse® software. The Idiag Posture, Idiag Mobility, and Idiag Stability scores were 62.50 (IQR: 21), 63.50 (IQR: 19.5), and 54.50 (IQR: 14.5), respectively, and were significantly lower (p < 0.001) than the reference normative value (100). Age was found to have a weak positive correlation with the posture score (ρ = 0.29, p = 0.048). Although career duration appeared to lower the scores, the association was insignificant (p > 0.05). The scores also had no significant association with body height, body mass, body mass index, and esports team (p > 0.05). It was anticipated that mobile-based esports would attenuate the biomechanics of the spine and increase the likelihood of musculoskeletal problems, such as neck and back pain.

Prevalence and Characteristics of Back Pain in Children and Adolescents from the Region of Murcia (Spain): ISQUIOS Programme

Puberty is a vulnerable period for musculoskeletal disorders due to the existence of a wide inter-individual variation in growth and development. The main objective of the present study was to describe the prevalence of back pain (BP) in the past year and month in school-aged children according to sex, age, maturity status, body mass index (BMI) and pain characteristics. This study involved 513 students aged between 9 and 16 years. Anthropometric measures were recorded to calculate the maturity stage of the students using a regression equation comprising measures for age, body mass, body height, sitting height and leg length. An ad hoc questionnaire composed of eight questions was used to describe BP prevalence in school-aged children. The results showed that the prevalence of BP in school-aged children was observed in 35.1% over the last year (45% boys and 55% girls), and 17.3% (40.4% boys and 59.6% girls, with an association found between female sex and BP) in the last month. The prevalence of back pain in the past year and month was higher the older the students were, or the more pubertal development they had experienced. The prevalence of BP in the last year was also higher in those with overweight or obesity. After adjustment for sex, there was an association between BP and older age and higher BMI in boys and an association between BP and higher pubertal development in girls. In summary, the present study showed that the prevalence of BP was related to the maturity stage and weight of the participants, with different prevalence patterns found according to sex.

Headache and musculoskeletal pain in school children are associated with uncorrected vision problems and need for glasses: a case-control study

Musculoskeletal pain and headache are leading causes of years lived with disability, and an escalating problem in school children. Children spend increasingly more time reading and using digital screens, and increased near tasks intensify the workload on the precise coordination of the visual and head-stabilizing systems. Even minor vision problems can provoke headache and neck- and shoulder (pericranial) pain. This study investigated the association between headaches, pericranial tenderness, vision problems, and the need for glasses in children. An eye and physical examination was performed in twenty 10–15 year old children presenting to the school health nurse with headache and pericranial pain (pain group), and twenty age-and-gender matched classmates (control group). The results showed that twice as many children in the pain group had uncorrected vision and needed glasses. Most children were hyperopic, and glasses were recommended mainly for near work. Headache and pericranial tenderness were significantly correlated to reduced binocular vision, reduced distance vision, and the need for new glasses. That uncorrected vision problems are related to upper body musculoskeletal symptoms and headache, indicate that all children with these symptoms should have a full eye examination to promote health and academic performance.

Neck pain and associated factors in a sample of high school students in the city of Bauru, São Paulo, Brazil: cross-sectional study

BACKGROUND

Neck pain is a major public health problem.

OBJECTIVE

The aim of the present study was to determine the prevalence of neck pain among high school students and to analyze associations with sociodemographic variables, use of electronic devices, habitual physical activity practices and mental health problems.

DESIGN AND SETTING

Cross-sectional epidemiological study on a sample of high school students in the city of Bauru, São Paulo, Brazil.

METHOD

Participants were selected through cluster sampling in two stages and data were collected via face-to-face interviews. Data collection comprised the following steps: 1. sociodemographic characteristics; 2. use of electronic devices; 3. habitual physical activity levels; 3. mental health; and 4. neck pain.

RESULTS

A total of 1,628 participants were interviewed. The prevalence of neck pain was 49.1% (95% confidence interval, CI 46.7 to 51.5), with 40.4% (95% CI 37.0 to 43.7) in men and 57.5% (95% CI 54.2 to 60.9) in women. The variables associated with in neck pain were: female (prevalence ratio, PR = 2.04), use of cell phone in standing posture (PR = 1.47), use of tablet in sitting posture (PR = 1.72), length of computer use greater than 3 hours/day (PR = 1.54), length of cell phone use greater than 3 hours/day (PR = 1.54), length of tablet use greater than 3 hours/ day (PR = 1.34) and mental health problems (PR = 1.56).

CONCLUSION

There is high prevalence of neck pain among students and striking associations with female sex, use of electronic devices and mental health problems.

Back Pain Related with Age, Anthropometric Variables, Sagittal Spinal Curvatures, Hamstring Extensibility, Physical Activity and Health Related Quality of Life in Male and Female High School Students

Spinal pain (SP) is widely extended among adolescents. The origin of SP can be multifactorial; thus, the present study aimed to estimate the prevalence and risk of SP in high school students and to determine the differences in sagittal spinal curvatures and pelvic tilt, hamstring extensibility, age, anthropometric variables and healthy lifestyle habits dependent on SP between sexes. Two hundred seventy-three teenagers took part in this cross-sectional study. Age, sagittal spinal curvatures, hamstring extensibility, physical activity, sedentary lifestyle, anthropometric variables and health related quality of life (HRQL) were recorded. SP was reported by 16.12% of adolescents. Differences were observed in the HRQL according to SP (p < 0.05). Participants without SP were less sedentary (22.12%) and younger (13.10 years old) than participants with SP (40.91% and 13.66, respectively) (p < 0.05). A logistic regression model showed that both variables were significantly collinear (VIF = 1.01; Durbin-Watson = 2.10). Subjects with low back pain (LBP) had a higher weight, body max index, and hip girth than subjects without pain (p < 0.05). A misalignment in the lumbar spine was associated with LBP for males (Cramer’s V = 0.204, p = 0.022). In conclusion, adolescents with SP were older and had a lower HRQL in all dimensions. SP could be predicted according to age and sedentary habits.

Risk factors for non-specific neck pain in young adults. A systematic review

BACKGROUND

Young adulthood is a sensitive period of life where development of musculoskeletal neck pain may be established and impact future health. The objective of this systematic review was to investigate risk factors for non-specific neck pain in young adults.

METHODS

Systematic searches were conducted in six databases in September 2019. Prospective cohorts and registry studies including participants in whom the risk factor or the outcome (neck pain) was registered in the ages 18-29 years old were included. The Quality in Prognosis Studies tool was used for quality assessment. A modification of the Grading of Recommendations Assessments, Development and Evaluation was used to assess the overall quality of the evidence. Potential risk factors investigated in more than one study were summarised.

RESULTS

Searches yielded 4527 articles, of which six matched the eligibility criteria. Fifty-six potential risk factors were investigated in the six studies, covering a broad range of domains. Five risk factors were investigated in more than one study (female sex, body mass index (BMI), physical activity, duration of computer use and perceived stress). Physical activity and BMI showed no association with neck pain, and inconsistent results were found for female sex, duration of daily computer use and perceived stress. Risk of bias was moderate or high in all studies, and the overall quality of evidence was very low.

CONCLUSION

The studies included many potential risk factors, but none of them showed consistent associations with neck pain. There is a paucity of high-quality studies investigating risk factors for neck pain in young adults.

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.