Evaluation of factors associated with severe and frequent back pain in high school athletes

Instruments for assessing back pain in athletes: A systematic review

Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.

Utility of ultrasonography in the diagnosis of lumbar spondylolysis in adolescent patients

BACKGROUND

This study aims to investigate the utility of the Doppler effect on ultrasonography for the diagnosis of very early- and early-stage lumbar spondylolysis in adolescent patients.

METHODS

In total, 76 adolescent patients with acute and subacute low back pain were prospectively enrolled, with 46 having lumbar spondylolysis and the remaining 30 having low back pain without spondylolysis. MRI and/or computed tomograms scans revealed very early- and early-stage lumbar spondylolysis. Furthermore, positive Doppler findings in ultrasonography around the area from the facet joint to the laminae were investigated.

RESULTS

There were no significant differences in age (p > 0.99) and body mass index (p = 0.11) between cases with and without spondylolysis. Very early- and early-stage spondylolysis were observed in 27.6% and 72.4% of patients, respectively. Positive power Doppler was 91.3% and 33.3% in cases with and without spondylolysis, respectively, which was significantly higher in spondylolysis (p < 0.001). The sensitivity and specificity of this positive power Doppler were 91.4% and 66.7%, respectively. Furthermore, the rate of positive power Doppler was significantly higher in early-stage spondylolysis (p = 0.02), with 75.0% and 97.6% sensitivity in very early- and early-stage spondylolysis, respectively.

CONCLUSIONS

A positive Doppler effect on ultrasonography is effective for screening very early- and early-stage spondylolysis in adolescent patients in an outpatient clinic.

Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain?: Psychosocial factors related to severe low back pain

BACKGROUND

Low back pain (LBP) is a global public health issue. Psychosocial factors are linked to LBP. However, there is a lack of knowledge about the relation of psychosocial factors to clinical outcomes of patients with severe LBP.

OBJECTIVE

To investigate the relationship between specific psychosocial factors with severe pain and functional limitation of patients with LBP.

METHODS

A cross-sectional study of 472 participants with LBP was conducted. Participants completed self-reported questionnaires, including psychosocial factors, characteristics of pain, and functional limitations. Two multivariable logistic regression models were performed with severe pain intensity (≥ 7 out of 10) and functional limitation (≥ 7 out of 10) (dependent variables) and 15 psychosocial factors (independent variables).

RESULTS

One hundred twenty-five (26.5%) participants had severe LBP. Patients with catastrophising symptoms were 2.21 [95%Confidence Interval (CI): 1.30, 3.77] times more likely to have severe pain and 2.72 (95%CI: 1.75, 4.23) times more likely to have severe functional limitation than patients without catastrophising symptoms. Patients with maladaptive beliefs about rest were 2.75 (95%CI: 1.37, 5.52) times more likely to present with severe pain and 1.72 (95%CI: 1.04, 2.83) times more likely to have severe functional limitation. Patients with kinesiophobia were 3.34 (95%CI: 1.36, 8.24) times more likely to present with severe pain, and patients with social isolation were 1.98 (95%CI: 1.25, 3.14) times more likely to have severe functional limitation.

CONCLUSION

Catastrophising, kinesiophobia, maladaptive beliefs about rest, and social isolation are related to unfavourable clinical outcomes of patients with LBP.

Factors associated with intensity and frequent low back pain in high school students

Introduction: Low back pain is frequent among schoolchildren and the variables related to high intensity and high back frequency are important predictors for the increase of such complaints in adulthood. Objective: To determine the high intensity and high frequency of low back pain and its associated factors in high school students. Methods: This cross-sectional study included 760 students (319 boys and 441 girls) who reported low back pain. Demographic, socioeconomic, electronic devices, habitual physical activity practice, mental health, and high frequency and high intensity low back pain data were collected. Descriptive analyzes and bivariate and multivariate logistic regressions were used. Results: Of the total number of subjects with low back pain, 14.6% reported high frequency of pain, being 36.9% boys and 63.1% girls, while 42.6% reported high intensity, being 35.8% boys and 47.2% girls. The variables associated with the high frequency of low back pain were altered mental health, posture lying on the use of tablet, time of daily use of the cell phone and distance of the screen to the eyes of the computer user, while the female sex, mental health problem, posture lying on the use of cell phone and the distance of the screen to the eyes of the computer user with severe intensity of low back pain. Conclusion: The demographic factors and related to the use of electronic devices were associated with high intensity and high frequency of low back pain.

Motor performance and back pain in children and adolescents: A systematic review

BACKGROUND AND OBJECTIVE

Motor performance during childhood and adolescence is recognized as a relevant determinant of present and future health, but its effects on back pain (BP) remain unclear. In this systematic review, we aimed to identify the association between motor performance and BP in children and adolescents.

DATABASES AND DATA TREATMENT

A literature search was performed in the MEDLINE, Scopus, Embase, SPORTDiscus and CINAHL databases. We included cross-sectional, cohort, case-control and controlled clinical trials (data from control groups). The inclusion criteria were as follows: (a) participants aged 6-19 years; (b) assessment motor performance components; (c) assessment of BP and (d) reported measures of association. The risk of bias was assessed by the Downs and Black instrument and the quality of evidence by the grading of recommendations, assessment, development and evaluation (GRADE).

RESULTS

A total of 2360 articles were identified, 25 of which were included in our systematic review. Of the 25 studies, 19 were evaluated as having a low risk of bias. GRADE indicated that 20 studies presented low or very low quality. Most of the studies evaluated flexibility (n = 16), muscle endurance (n = 18) and muscle strength (n = 9). Aerobic capacity, balance and speed were also examined in some studies (n < 5). Overall, motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of the supporting evidence. Prospective studies with a low risk of bias are warranted to further clarify this relationship in childhood and adolescence and findings may support more targeted and effective health promotion interventions.

SIGNIFICANCE

This systematic review shows that motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP in children and adolescents. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of supporting evidence.

The health-related determinants of eating pattern of high school athletes in Goiás, Brazil

Background

Athletes put their health at short- and long-term risk and a detailed investigation of health outcomes is important because it should allow the development of more specific interventions. This study aimed to evaluate the health-related determinants of eating pattern of high school athletes.

Methods

The study enrolled 248 Brazilian athletes aged 14–20 years. Eating pattern outcomes included skipping breakfast, vegetable and fruit consumption, and sweets consumption. The following factors were considered as independent variables: sociodemographic, economic, anthropometry, body weight control, psychosocial, sedentary behavior, sleeping time, meals, alcohol and smoking, and strength variables. Data were analyzed using Poisson regression model and the effect measure was the prevalence ratio (PR).

Results

The results showed that 45.6% of the athletes skipped breakfast, 29.8% ate sweets regularly, and only 8.9% consumed vegetables and fruit regularly. Multiple analysis revealed the following positive associations: breakfast skipping and vomiting or using laxatives to lose weight (PR, 1.12; 95% CI, 1.01–1.26); low fruit and vegetable consumption and using pills to lose weight (PR, 1.05; 95% CI, 1.02–1.07); high sweets consumption and female athletes (PR, 1.32; 95% CI, 1.12–1.55); high sweets consumption and more than 2 h spent watching TV (PR, 1.19; 95% CI, 1.02–1.39).

Conclusions

Our findings indicated that sociodemographic, body weight control and sedentary factors are determinants on eating patterns of high school athletes.

Motor performance and back pain in children and adolescents: a systematic review and meta-analysis protocol

BACKGROUND

The relationship between motor performance and back pain in children and adolescents remains unclear. This article describes the protocol for a systematic review to summarize the knowledge about the association between motor performance, such as agility, flexibility, balance, strength, muscle endurance, and cardiorespiratory fitness, and back pain. Thus, our aim is to identify the influence of motor performance on back pain among children and adolescents.

METHODS

Two independent researchers will search MEDLINE, Scopus, Embase, SPORTDiscus, and CINAHL databases, with no period or language restrictions. We will include cross-sectional, cohort, case-control, and controlled clinical trial studies based on the following criteria: (a) participants from 6 to 19 years of age, (b) assessment of motor performance, (c) assessment of back pain, and (d) report measures of associations between motor performance and back pain. Study quality and risk of bias will be assessed using an adapted version of the Downs and Black instrument. Grading of Recommendations, Assessment, Development, and Evaluations will be used to assess the strength of the body of evidence. Meta-analyses of association measures will be performed for each type of motor performance, separately for different study types. The results will be reported using forest to show the pooled effect of findings and funnel plots to assess precision of the data. If studies are not homogeneous, results from the meta-analyses will not be reported. Associations will then be synthesized descriptively using a pragmatic approach.

DISCUSSION

This systematic review will provide critical insights into the association between motor performance and back pain among children and adolescents; this information may help support clinical practice guidelines as well as public health programs.

ETHICS AND DISSEMINATION

Protocol was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020178496.

Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8-12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

Back pain and its risk factors in Brazilian adolescents: a longitudinal study

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Sports participation and low back pain in schoolchildren

BACKGROUND

Low back pain (LBP) is one of the biggest health problems worldwide.

OBJECTIVES

The purpose of this study was to investigate the association between sports participation (duration and type) and LBP related outcomes in childhood.

METHODS

This cross-sectional study involved 5th and 6th grade primary school students. The final sample included 2,032 children aged 10-12 years old. Children completed a questionnaire about the prevalence of LBP and some LBP-related outcomes. In addition, the participants were surveyed about the type of sport they did and the duration.

RESULTS

There appears to be no relation between sports participation and severity of LBP-related outcomes studied, independently of their duration. Participating in football ⩾ 4 hours per week was associated with a decrease of six LBP-related outcomes (OR ranging from 0.54 to 0.66). Basketball participation does not seem to affect the development of back problems amongst children.

CONCLUSIONS

It can be suggested with caution that doing sport is not dangerous for LBP problems in children aged 10-12 years old. Nevertheless, this suggestion should be tested with further longitudinal and intervention studies to confirm the results.

High prevalence of inadequate sitting and sleeping postures: a three-year prospective study of adolescents

There is a paucity of information regarding the development of body posture during adolescence. This three-year prospective study aimed to evaluate sitting and sleeping postures among adolescents, and to determine whether these postures are associated with age and sex. We assessed 525 adolescents aged 11-16 years from the fifth to eighth grades. These adolescents were reassessed three years later. The Back Pain and Body Posture Evaluation Instrument was used to evaluate the sleeping posture and three sitting positions: sitting to write, to use a computer, and during leisure activities. Our findings indicated a low prevalence of adequate sleeping and sitting postures at baseline, with a decrease in prevalence observed after three years for all postures. These changes were similar for both sexes. Moreover, we found a strong reduction of adequate posture prevalence for younger adolescents, but the oldest adolescents demonstrated no significant differences after three years. Early, rather than late, adolescence is a critical period for establishing inadequate sitting and sleeping postures. This has implications for posture throughout adulthood; hence, interventions targeted at this age group are needed.