Epidemiology of juvenile low back pain: a review

Frequency of back pain occurrence among high school youth including their physical activity

BACKGROUND

Back pain diseases are among frequently reported health problems. Unfortunately, more often this problem also affects young people, high school students. Lifestyle that people are representing nowadays has a negative impact on their spine. Development of technology and transportation eliminates daily basic physical activity such as taking a walk to the school. Prolonged and inappropriate sitting posture during classes and using the computer at home are predisposing factors for back pain occurrence. The aim of this paper was to analyze the frequency of back pain occurrence among high school youth and attempt to relate their occurrence frequency with sex, time spent in sitting position, anthropometric parameters and physical activity of examined students.

METHODS

The examined group initially counted 272 teenagers, but ultimately 218 were taken into account for the analysis and 54 questionnaires were filled in incorrectly and rejected. All of them were high school students. Customized survey consisting of general part and closed questions regarding physical activity (subjective experience of work load) was used as an examination tool.

RESULTS

Examined youth spent on average 10.04 hours daily in a sitting position. As much as 195 (89.45%) of examined teenagers declared to experience back pain at least once in their lives. The most of teenagers (117; 53.67%) indicated lumbar spine pain. Girls more often felt spine pain issues in comparison to boys. Short stature of teenagers was often related to back pain occurrence. No correlation between time spent in sitting position and frequency of skeleton axis pain occurrence was noted. Among group of boys a relation between more frequent physical activity and less often spine pain occurrence was observed.

CONCLUSIONS

Spine pain is an important health problem of examined youth, occurring more frequent among girls than boys. Body height correlate negatively with frequency of spine pain occurrence among youth. Despite spending more than 10 hours daily in sitting position by examined youth, it did not affect the frequency of back pain issues occurrence. Higher physical activity of examined boys was related to less often back pains.

Current Clinical Concepts: Management of Common Lumbar Spine Posterior Column Disorders in Young, Active Individuals

Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.

Sports injuries patterns in children and adolescents according to their sports participation level, age and maturation

BACKGROUND

Growth can make young athletes more vulnerable to sports injuries. Increased knowledge about injury profile and its predictors is an important part of an overall risk management strategy but few studies have produced information.

METHODS

Information about injury profile and sports participation (SP) level was obtained by LESADO and RAPIL II questionnaires. They were distributed to 651 participants aged between 10 and 18 years attending four schools. Maturity measures were evaluated through maturity offset (MO) and Tanner-Whitehouse III method. Bivariate analysis was used to identify the set of candidate predictors for multinomial logistic regression analysis that was used to determine significant predictors of injury type and body area injury location.

RESULTS

Regarding injury type predictors recreative boys had more chances of having a sprain or a fracture than a strain. Also, recreative and scholar girls had more chances of having a sprain than a strain. As MO decreased, the chances of girls having a strain or a fracture when compared to sprains were higher. For body area location boys with 10-11 years were more likely to have upper limbs injuries than boys of other ages. This was also confirmed by MO. Spine and trunk injuries were more likely to occur in federate and no sports participation girls.

CONCLUSIONS

Injury type and body area injury location differed significantly by SP level, age group and MO.

What are important consequences in children with non-specific spinal pain? A qualitative study of Danish children aged 9-12 years

OBJECTIVES

It is currently unknown whether children, adolescents and adults experiencing non-specific spinal pain are affected by their pain in a similar manner. It is also unclear whether questionnaires developed for adults can simply be transferred to paediatric populations. The objective of this study was to explore the physical, psychological and social consequences of a life with non-specific spinal pain among Danish children and to compare these consequences with the content of common adult questionnaires.

DESIGN AND SETTING

A qualitative study based on individual interviews and focus group discussions with participants recruited from two public schools in Denmark.

PARTICIPANTS

Thirty-six children aged 9-12 years with spinal pain were invited to an interview using a purposive sampling strategy with age, pain intensity and frequency, and general well-being status as inclusion criteria. Nineteen (9 girls, 10 boys) accepted to participate.

METHODS

Data were transcribed verbatim and coded by following a thematic approach to elicit key concepts relevant to spinal pain. Subsequently, focus group interviews were conducted, and all codes were assigned categories corresponding to the International Classification of Function, Disability and Health (ICF) for comparison to adult questionnaires.

RESULTS

Nineteen interviews were included, and 21 individual codes identified. Across the codes, five themes emerged in relation to children's experiences of living with spinal pain: 'Sports and play', 'Axial loading', 'Coping strategies', 'Mood changes' and 'Pain anxiety'. Codes and themes were elaborated on by the focus groups. Only approximately 40% of the identified ICF categories were covered by adult spinal questionnaires.

CONCLUSIONS

The negative impact of non-specific spinal pain on children aged 9-12 years pivots around codes which are considerably different to adults. Psychological and social factors were more prominent and pain anxiety was dominant in the lived lives of children. New questionnaires should be age specific and include the identified codes within each theme.

Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.

A prospective 1-year study on load reduction of school backpacks shows reversible changes of body posture in schoolchildren

BACKGROUND

The impact of backpack carrying on body postural changes in schoolchildren has been discussed intensively. However, findings are inconsistent mainly due to the lack of long-term results.

OBJECTIVE

The purpose of this investigation was to study the influence of backpack weight on body posture and prevalence of back pain.

METHODS

In our prospective, comparative study, we investigated the influence of backpack weight on 77 schoolchildren (average age 10.8 ± 0.7 years) over a 1-year period. Participants were evaluated at the beginning of the study by clinical examination and formal static posture analysis. Forty-nine students comprised the control group while 28 students in the intervention cohort had the weight of their backpacks reduced by 2 kg. All students were reevaluated after 6 and 12 months by formal postural examination.

RESULTS

Children with reduced backpack weights had a significantly improved bending posture when wearing their backpacks when compared to the participants of the control group, whereas the analysis of the children while they did not wear their backpacks revealed no difference between the groups. Within the follow-up period all postural changes were reversible once the backpack weight was removed.

CONCLUSIONS

Schoolchildren with heavy backpack loads show postural changes while carrying their backpack but this impact was reversible when backpacks were removed. Continuous reduction of backpack loads minimizes prevalence of back pain.

High prevalence of self-reported injuries and illnesses in talented female athletes

Background

A thorough knowledge of the epidemiology and severity of injuries and illness in youth female elite sports is lacking due to the methodological challenges involved in recording them. In this study, the prevalence and incidence of injuries and illness are assessed among youth female elite athletes. Instead of solely focusing on time-loss injuries, our study included all substantial and non-substantial health problems (ie, injuries, mental problems and illnesses).

Methods

Sixty young elite Dutch female athletes (age: 16.6 years (SD: 2.3), weight: 58.3 kg (SD: 15.1), height: 154.1 cm (SD: 44.2)) participating in soccer (n=23), basketball (n=22) and gymnastic (n=15) talent development programmes were prospectively followed during one season (September 2014 to April 2015). To collect health problem data, all athletes completed the Oslo Sports Trauma Research Center Questionnaire on Health Problems every other week. Main outcome measures were average prevalence of injury and incidence density of injury.

Results

At any given time, 47.9% of the athletes reported an injury (95% CI 43.6% to 52.6%) and 9.1% reported an illness (95% CI 5.1 to 19.0). The average injury incidence density was 8.6 per 1000 hours of athlete exposure. The average number of self-reported injuries per athlete per season was significantly higher in soccer athletes (4.3±2.7) than in basketball athletes (2.6±2.0) (p=0.03) and not significantly higher than in the gymnastic squad. The knee and the ankle were two of the most common injury locations for all squads. Knee injuries in basketball and soccer and heel injuries in the gymnastic squad had the highest impact on sports participation.

Conclusion

High prevalence of self-reported injuries among talented female athletes suggests that future efforts towards their prevention are warranted.

The elite young athlete: strategies to ensure physical and emotional health

This article presents a current review of the risk of physical and psychological injury associated with participation in elite youth sport, and suggests strategies to ensure the physical and emotional health of these young athletes. Although there is lack of epidemiological data, especially with regard to psychological injury, preliminary data suggest that the risk of injury is high in this population. While there is lack of incident and follow-up data, there is also concern regarding burnout, disordered eating, and the long-term consequences of injury. Modifiable injury risk factors identified include postural control, competition anxiety, life events, previous injury, and volume of training. There are presently no studies designed to determine the effectiveness of injury prevention measures in elite youth sports. However, there is adequate evidence arising from injury prevention studies of youth sports participants - including neuromuscular training, protective equipment, mental training to enhance self-esteem, and sport rules modification - to prevent injuries in elite youth sports settings. Although not tested, psychosocial prevention strategies such as adoption of task-oriented coping mechanisms, autonomous support from parents, and a proactive organizational approach also show promise in injury prevention.

Risk assessment of back pain in youth soccer players

The purpose of this study is to identify several responsible parameters for back pain (BP) in youth soccer players to create a risk assessment tool for early prevention.

An iPad-based survey was used to screen for parameters in a cross-sectional study. This questionnaire includes items regarding anthropometric data, training habits and sports injuries and was put into practice with 1110 athletes. Sex (odds ratio (OR): 1.84), age group (1.48) and playing surface (1.56) were significantly associated with BP. A history of injuries especially to the spine and hip/groin increased the likelihood for evolving recurrent BP (1.74/1.40). Overall 15 factors seem to influence the appearance of pain and were integrated into a feasible nomogram. The nomogram provides a practical tool to identify the risks of developing BP for youth soccer players. Although most factors we identified are non-modifiable, this method allows to rank the importance of factors and especially their prevention treatments for athletes.

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

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

Is puberty a risk factor for back pain in the young? a systematic critical literature review

Background

Back pain is a common condition that starts early in life and seems to increase markedly during puberty. A systematic review was performed in order to investigate the link between puberty and back pain, using some Bradford Hill criteria for causality.

Objectives

We sought to obtain answers to the following questions: 1) Is there an association between puberty and back pain? If so, how strong is this association? And do the results remain unchanged also when controlling for age and sex? 2) Are the results of the studies consistent? 3) Is there a dose-response, showing a link between the increasing stages of puberty and the subsequent prevalence of back pain? 4) Is there a temporal link between puberty and back pain?

Design

A systematic critical literature review.

Methods

Systematic searches were made in March 2014 in PubMed, Embase, CINAHL and PsycINFO including longitudinal or cross-sectional studies on back pain for subjects <19 years, written in French or English. The review process followed the AMSTAR recommendations. Interpretation was made using some of the Bradford-Hill criteria for causality.

Results

Four articles reporting five studies were included, two of which were longitudinal. 1) Some studies show a weak and others a strong positive association between puberty and back pain, which remains after controlling for age and sex; 2) Results were consistent across the studies; 3) There was a linear increase of back pain according to the stage of puberty 4) Temporality has not been sufficiently studied.

Conclusion

All our criteria for causality were fulfilled or somewhat fulfilled indicating the possibility of a causal link between puberty and back pain. Future research should focus on specific hypotheses, for example investigating if there could be a hormonal or a biomechanical aspect to the development of back pain at this time of life.

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-014-0027-6) contains supplementary material, which is available to authorized users.

[Nonspecific low back pain in young adults: associated risk factors]

OBJECTIVE

The aim of the study was to evaluate potential risk factors related to low back pain in the daily routines of two sets of youths: individuals complaining of chronic low back pain and a control group.

METHODS

The sample consisted of 198 university-age students (male and female) aged between 18 and 29. In accordance with back pain diagnoses, they were separated into two groups: with or without nonspecific chronic low back pain. Both groups were evaluated by a "blinded" observer with no knowledge to the presence or otherwise of lower back pain. Questionnaires concerning clinical-demographic characteristics, life style, quality of life (SF-36 questionnaire), pain visual analogical scales (VAS), and physical examination were applied.

RESULTS

A univariate analysis showed a statistically significant association (P<0.05) with the presence of low back pain and some factors. There was a negative association between low back pain and the following variables: BMI, health self-assessment, VAS and some SF-36 domains (physical functioning, body pain, general health, vitality, social functioning). There was a positive correlation with the following variables: global pain by VAS, presence of diffuse pain and number of tender points. However, the multivariate analysis showed statistically significant correlations (P<0.05) between low back pain and few variables: global pain VAS and number of tender points.

CONCLUSION

Some variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary.

Development of the young spine questionnaire

Background

Back pain in children is common and early onset of back pain has been shown to increase the risk of back pain significantly in adulthood. Consequently, preventive efforts must be targeted the young population but research relating to spinal problems in this age group is scarce. Focus has primarily been on the working age population, and therefore specific questionnaires to measure spinal pain and its consequences, specifically aimed at children and adolescents are absent. The purpose of this study was to develop a questionnaire for schoolchildren filling this gap.

Methods

The Young Spine Questionnaire (YSQ) was developed in three phases – a conceptualisation, development and testing phase. The conceptualisation phase followed the Wilson and Cleary model and included questions regarding spinal prevalence estimates, pain frequency and intensity, activity restrictions, care seeking behaviour and influence of parental back trouble. Items from existing questionnaires and the “Revised Faces Pain Scale” (rFPS) were included during the development phase. The testing phase consisted of a mixed quantitative and qualitative iterative method carried out in two pilot tests using 4^th grade children and focusing on assessment of spinal area location and item validity.

Results

The testing phase resulted in omission of the pain drawings and the questions and answer categories were simplified in several questions. Agreement between the questionnaire prevalence estimates and the interviews ranged between 83.7% (cervical pain today) and 97.9% (thoracic pain today). To improve the understanding of the spinal boundaries we added bony landmarks to the spinal drawings after pilot test I. This resulted in an improved sense of spinal boundary location in pilot test II. Correlations between the rFPS and the interview pain score ranged between 0.67 (cervical spine) and 0.79 (lumbar spine).

Conclusions

The Young Spine Questionnaire contains questions that assess spinal pain and its consequences. The items have been tested for content understanding and agreement between questionnaire scores and interview findings among target respondents. These preliminary results suggest that the YSQ is feasible, has content validity and is a well understood questionnaire to be used in studies of children aged 9 to 11 years.

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.

Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity

STUDY DESIGN

Cross-sectional baseline data set on the sagittal standing posture of 1196 adolescents.

OBJECTIVE

To describe and quantify common variations in the sagittal standing alignment in boys and girls who are in the same phase of growth and to explore the association between habitual standing posture and measures for spinal pain.

SUMMARY OF BACKGROUND DATA

Data on postural characteristics and spinal pain measures in adolescence are sparse, especially when somatic and biological maturity status is to be considered. Our understanding of the relationship between standing posture in the sagittal plane and spinal pain is also deficient.

METHODS

A total of 639 boys (age [mean ± SD], 12.6 ± 0.54 yr) and 557 girls (10.6 ± 0.47 yr), with predicted years from peak height velocity (PHV) being 1.2 ± 0.71 and 1.2 ± 0.59 pre-PHV, respectively, were studied. Postural examination included the assessment of global alignment and local spinopelvic characteristics, using post hoc analyses of digital images and direct body measurements (palpation, digital inclinometry, and wheeled accelerometry). Spinal pain experience was assessed by questionnaire.

RESULTS

A wide interindividual variation in sagittal posture characteristics was observed. Logistic regression analyses yielded global alignment parameters to be associated with low back pain (lifetime prevalence), neck pain (lifetime prevalence, 1-mo prevalence, and doctor visit), and thoracic spine pain (doctor visit) outcome measures. None of the included local spinopelvic parameters could be identified as an associated factor with measures of spinal pain.

CONCLUSION

The orientation of gross body segments with respect to the gravity line seems superior to local spinopelvic features in terms of clinical importance, at least in the current pre-PHV cohort. Opportunities may exist for postural subgrouping strategies to begin with global alignment parameters in order to gain further insight into the relationship between sagittal alignment and the relative risk of developing spinal pain/seeking medical consultation for this pain.

Low back pain

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

Low back pain in the United States: incidence and risk factors for presentation in the emergency setting

BACKGROUND CONTEXT

Low back pain is prevalent in the United States. At the present time, no large longitudinal study is available characterizing the incidence of this condition in the US population or identifying potential risk factors for its development.

PURPOSE

To characterize the incidence of acute low back pain requiring medical evaluation in the emergency department and establish risk factors for its development.

STUDY DESIGN

Cross-sectional study.

PATIENT SAMPLE

United States population estimates.

OUTCOME MEASURES

Incidence rate ratios were calculated to determine the influence of age, sex, and race on the development of low back pain requiring emergent medical evaluation.

METHODS

The National Electronic Injury Surveillance System was queried for all cases of low back pain presenting to emergency departments between 2004 and 2008. Incidence rate ratios were then calculated with respect to age, sex, and race. The chi-square statistic was used to identify statistically significant differences in the incidence of low back pain requiring emergent medical evaluation between subgroups.

RESULTS

An estimated 2.06 million episodes of low back pain occurred among a population at risk of over 1.48 billion person-years for an incidence rate of 1.39 per 1,000 person-years in the United States. Low back pain accounted for 3.15% of all emergency visits. Injuries sustained at home (65%) accounted for most patients presenting with low back pain. Low back pain demonstrates a bimodal distribution with peaks between 25 and 29 years of age (2.58/1,000 person-years) and 95 to 99 years of age (1.47/1,000) without differentiation by underlying etiology. When compared with females, males showed no significant differences in the rates of low back pain. However, when analyzed by 5-year age group, males aged 10 to 49 years and females aged 65 to 94 years had increased risk of low back pain than their opposite sex counterparts. When compared with Asian race, patients of black and white race were found to have significantly higher rates of low back pain. Older patients were found to be at a greater risk of hospital admission for low back pain.

CONCLUSION

Age, sex, and race are significant risk factors for the development of low back pain necessitating treatment in an emergency department.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

QUESTION

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

DESIGN

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

PARTICIPANTS

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

RESULTS

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

CONCLUSION

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

Prevalence of diagnosis and direct treatment costs of back disorders in 644,773 children and youths in Germany

Background

Many authors have reported about the high prevalence rates of self-reported back pain in children. Nevertheless, little is known about the diagnosis of back disorders - regardless of whether the diagnosis is associated with back pain or not. Therefore, the aim of this study was to analyse the prevalence rates and costs of diagnosis of back disorders in childhood and youth.

Methods

We conducted a secondary data analysis of a large, population based German data set (2,300,980 insurants of statutory health insurance funds) which allowed for identification of prevalence rates of diagnoses of back disorders in children (age group 0-14 years) and youths (age group 15-24 years) using three digit ICD-10 codes for dorsopathies (M40 - M54: kyphosis and lordosis; scoliosis; spinal osteochondrosis; other deforming dorsopathies; ankylosing spondylitis; other inflammatory spondylopathies; spondylosis; other spondylopathies; spondylopathies in diseases classified elsewhere; cervical disc disorders; other intervertebral disc disorders; other dorsopathies, not elsewhere classified; dorsalgia). Direct treatment costs were calculated based on the real incurred costs for cases with a singular diagnosis of a back disorder. Wherever possible, the results of the random sample were extrapolated to all insurants of statutory health insurance funds (i. e., about 90% of the German population).

Results

We found prevalence rates for the diagnosis of back disorders to range between 0.01 - 12.5%. "Scoliosis" (M41) and "dorsalgia" (M54) were the most frequent diagnoses in both age groups. Based on these results, it was calculated that in 2002 alone, approximately 1.4 million children/youths in Germany were diagnosed with "dorsalgia" (M54), and that the direct costs for back disorders in childhood and youth accounted for at least 100 million Euros.

Conclusions

Instead of focusing on the individual, and self-reported disorder or disability, this analysis allowed for the detailed evaluation of medical experts' opinion on back disorders in childhood and youth and for a more objective or public health oriented insight in the topic of diagnosis of back pain and other back disorders. However, due to the methodological limitations by using ICD-10 coding, standardized random validity checks of population based data sets should be mandatory.

Work exposures, injuries, and musculoskeletal discomfort among children and adolescents in dairy farming

Little research is available about the specifics of child or adolescent work on dairy farm operations. The objective of this study was to investigate work performed by children and adolescents on these operations. The authors administered mail questionnaires to a community-based, age- and operation size-stratified sample of individuals aged 6 to 18 (n = 240) who worked on dairy operations in Wisconsin. Data were collected in 1999. The 197 children and adolescents reported averaging 567 hours of dairy farm work in the last year (10.9 hours/week) and completed over 1/3 of all calf feeding, 1/5 of the milking, 1/5 of cow feeding, and 1/10 of tractor operation hours on their farm during the weeks they worked. Some of these young workers reported accomplishing duties also judged by some experts as hazardous work, including nearly half of the 9- to 11-year-olds driving tractors. Six nonfatal injuries were reported that required stopping work (14.6 per 100 full time equivalents per year), including those that required medical attention. Musculoskeletal discomfort and disability reports were unremarkable compared to existing studies of general and working populations. Wisconsin dairy farm youth appeared to be working no more hours per week than their peers in other studies of agricultural populations. Adolescents and some children largely performed the same range of tasks and often the same scope of work as adults, including some performing hazardous work. There is a need for further investigations with larger samples of dairy youth to confirm these findings. The exposures of very young workers to hazardous tractor driving and tower silo tasks suggest that there is an urgent need for improved and validated interventions to reduce these exposures.

Streamlining the evaluation of low back pain in children

The workup of low back pain in children often results in overimaging so as not to miss organic back pain. The primary goal of this study was to identify which combination of imaging modalities provides the most sensitive and specific screening protocol for children with low back pain. Medical records from 100 consecutive patients between 2 and 18 years of age presenting with low back pain, without night pain or constitutional symptoms, were evaluated. A hyperextension test combined with a radiograph showed a negative predictive value of 0.81 and sensitivity of 0.90. The addition of a bone scan was highly effective in achieving good negative predictive value and sensitivity. Bone scans had perfect negative predictive value and sensitivity when symptom duration was less than 6 weeks. We identified a set of factors that is highly predictive for distinguishing organic back pain from mechanical back pain. Painless hyperextension combined with negative anteroposterior, lateral, and oblique lumbar radiographs and magnetic resonance images predicts mechanical back pain. For patients with nonneurologic back pain of less than 6 weeks duration, bone scan is the most useful screening test because it is accurate, accessible, inexpensive, and unlikely to require sedation.

LEVEL OF EVIDENCE

Level III, diagnostic study.

Physical activity and low-back pain in schoolchildren

Design of the experiment is to study the cross-sectional sample with retrospective information. The objective is to identify the types of physical activity associated with the decreased occurrence of low-back pain (LBP) in schoolchildren. Physical activity may be hypothesized to possess a potential for LBP prevention. The possible connection between LBP and specific sports activities is however sparsely documented. A total of 546, 15- to 16-year-old schoolchildren filled a questionnaire on current physical activities and LBP occurrence and severity. In multiple logistic regressions, the association of LBP with exposure variables was corrected for body height and weight (data from school health service files) and for anthropometric and school furniture parameters. More than half of the children reported pain or discomfort in the low-back region during the preceding 3 months, and 1/4 experienced a decreased functioning or need of care because of LBP. LBP correlated with physical inactivity, e.g. time spent on homework and hours watching TV or video, and with a series of sports activities, e.g. jogging, handball playing and gymnastics. Among sports activities, only swimming and the number of hours per week participating in soccer were associated with a decreased LBP prevalence. With the exception of swimming and soccer, the types of sport reported by this schoolchild population do not offer themselves for consideration as tools for LBP prevention. Based on the associations found with indicators of physical inactivity, attempts to motivate the children to increase their general physical activity level should be considered for trial.

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

STUDY DESIGN

Cross-sectional sample with longitudinal information.

OBJECTIVE

To estimate the relationship between the occurrence of low back pain (LBP) and various types of school furniture and anthropometric dimensions in schoolchildren, and physical loading by school bag carrying.

SUMMARY OF BACKGROUND DATA

Some types of school furniture may be hypothesized to prevent or cause LBP. Despite strong opinions in the public debate about a possible relationship between use of various types of school furniture and LBP, scientific research on this matter is sparse.

METHODS

Five hundred forty-six schoolchildren aged 14 to 17 years answered a questionnaire about sitting positions during school hours and the presence and severity of LBP. Furthermore, the anthropometric dimensions and the weight of the school bags were measured. The types and dimensions of the school furniture were described and measured. In multivariate analyses was adjusted for physical activity and other possible risk factors.

RESULTS

More than half of the adolescents experienced LBP during the preceding 3 months, and 24.2% reported reduced daily function or care seeking because of LBP. LBP occurrence was not associated with the types or dimensions of the school furniture or body dimensions, but was positively associated with carrying the school bag on 1 shoulder [OR: 2.06 (1.29-3.31)].

CONCLUSION

The present study does not support the hypothesis of different types of school furniture being a causative or preventing factor for LBP. Carrying the school bag in an asymmetric manner may play a role.

Epidemiology of adolescent spinal pain: a systematic overview of the research literature

STUDY DESIGN

Systematic literature review.

OBJECTIVE

To explore the available research literature, and provide an up-to-date synthesis of the epidemiology of idiopathic adolescent spinal pain (IASP).

SUMMARY OF BACKGROUND DATA

IASP and its potential causes have been a concern to researchers for over 2 decades. Because it has been suggested that IASP is related to the incidence of adult spinal pain, it appears important to synthesize what is currently known about IASP.

METHOD

A systematic meta-synthesis approach was used to identify secondary review articles and primary epidemiological studies regarding any type of IASP (neck, upper back, or low back).

RESULTS

A total of 56 primary epidemiological (cross-sectional or longitudinal) studies were identified. Spinal or back pain was the most commonly reported measure, with the lifetime prevalence figures ranging from 4.7% to 74.4%. The lifetime prevalence of low back pain had a similar range, 7% to 72%. The prevalence of pain in other areas of the spine (i.e., thoracic spine and neck) was variably reported, as were incidence rates for all areas of the adolescent spine. IASP is thus a significant problem, and the prevalence figures approach those of adults. There is some evidence that IASP is a risk factor for spinal pain in adulthood. However, there was considerable variation in how back pain was defined, the areas of the spine that were reported on, the manner in which data were collected and reported, thus preventing any significant comparisons of prevalence or incidence rates across studies.

CONCLUSION

Although there is wide discrepancy in the manner in which adolescent spinal pain is reported, it is evident that lifetime prevalence rates increase steadily with age and approximate adult levels by around the age of 18 years. There is an opportunity for further longitudinal research, with standardized methodology, to be undertaken that builds on the findings from this large group of studies.

Recurrent non-specific low-back pain in adolescents: the role of exercise

This study evaluated the efficacy of an exercise programme as an intervention for recurrent non-specific low-back pain (NLSBP) in adolescents. A randomized controlled trial was conducted with an experimental group (n = 27, age 14.6 years) who participated in an 8-week exercise programme and a matched control group (n = 27, age 14.6 years) who continued normal daily activities. All participants suffered from recurrent NSLBP. Pre and post intervention measures of NSLBP status (pain severity and consequences) and daily inactivity (time spent sitting, PC time, TV time) were reported in one week diaries. Two-way mixed ANOVA (independent variables: pre/post and experimental/control) was conducted for each dependent variable, significance was set at P < 0.05. Significant interaction effects were identified for the severity of pain, number of occasions missing sport due to NSLBP and amount of sport participated in. In each case the experimental group benefited from the exercise programme. In contrast, no significant interaction effects were observed for physical inactivity, both groups spent a similar amount of time sitting, watching TV and using a PC pre- and post- intervention. It was concluded that an exercise programme acted as an effective short-term treatment strategy for NSLBP in adolescents. Further evaluation is required to assess the long-term effectiveness.

Study on the relationship between backpack use and back and neck pain among adolescents

A descriptive correlation study was conducted in Hobbs, New Mexico, USA, to find the relationship between backpack use and back and neck pain among adolescent boys and girls. A higher percentage of girls than boys rated their pain as being moderate to extremely strong. The correlation between pain and backpack weight per body mass index among girls was positive and significant, but negative and non-significant among boys. The correlation between pain and backpack weight was positive and non-significant among both boys and girls. The correlation between pain and each of the variables of backpack weight per body weight, backpack weight per height, and backpack weight per body surface area was negative and non-significant among boys, but positive and non-significant among girls. Gender-based research studies with additional variables and safe backpack use education in schools are recommended.

Back education in elementary schoolchildren: the effects of adding a physical activity promotion program to a back care program

Promoting a physically active lifestyle whilst optimizing the spinal load at a young age seems to be advocated within the scope of early back pain prevention efforts. The present study aimed at evaluating the effects of combining a back care program with a physical activity promotion program in elementary schoolchildren. In a pre-post design over two school years, back care knowledge, back care behavior, fear avoidance beliefs and back pain reports were evaluated in children classified into three categories--those who received a back care and a physical activity promotion program (n=190), those who received only a back care program (n=193) and those in a control group (n=172) (mean age at baseline: 9.7 years+/-0.7). Physical activity levels were evaluated in a sub-sample of 26 pupils in each group. The back care program and the physical activity promotion program were both comprehensive ones. In both intervention groups, the scores for back care related knowledge and back care behavior were significantly higher than the control group. The increase in the sum score for back care behavior was significantly higher in the back care group than in the back care plus physical activity promotion group. Significant interaction effects showed an increase in fear-avoidance beliefs between pre- and post-tests in the control group, significantly different from the better scores in both intervention groups. Interaction effects were not significant for pain reports. In the back care plus physical activity promotion group, the daily moderate to vigorous physical activity levels decreased by 8 min per day while a decrease by 31 min per day was found in the back care group and a decrease by 36 min per day in the control group. However, group differences were not significant. The present study findings favor the addition of a physical activity promotion program to a back care program in elementary schools within the scope of early back pain prevention efforts. However, the findings also emphasize the disadvantages of implementing both programs simultaneously in a school curriculum that is already full.

Reproducibility of a low back pain questionnaire in Tunisian adolescents

The objective of this study was to evaluate the reproducibility of a 28-item survey questionnaire for back problems in Tunisian adolescents. A test-retest design was used to investigate the reproducibility of the results obtained using the said 28-item survey questionnaire. Participants were recruited from two schools in Monastir. Seventy-two adolescents from the seventh, eighth, and the ninth grade participated in the inquiry. They have a mean age of 14.01 years (SD 1.67, range 11-19). High levels of reproducibility were found for items that evaluated perceived characteristics of back problems and functional limitation (kappa coefficient=0.71-1.00). The results suggest that the questionnaire used in the present study provided reproducible information and can be used as a survey tool for the investigation of low back problems in adolescents.

Biological risk indicators for recurrent non-specific low back pain in adolescents

OBJECTIVES

A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents.

METHODS

Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schober), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables.

RESULTS

Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (p<0.05). Follow up analysis indicated that symptomatic subjects had significantly reduced lateral flexion of the spine, lumbar sagittal plane mobility, and trunk muscle endurance (p<0.05).

CONCLUSIONS

Hip range of motion, abdominal muscle endurance, lumbar flexibility, and lateral flexion of the spine were risk indicators for recurrent non-specific low back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study

Low back pain (LBP) in children was considered for many years to be a rare condition revealing a serious disease, but in the last two decades, epidemiological studies have shown that the prevalence of nonspecific LBP in children is high. This study was aimed at analyzing the prevalence, severity, consequences and associated factors of LBP in children. A cross-sectional study was undertaken in two preparatory schools in the city of Monastir, Tunisia, in April 2002. This study included a total of 622 children and adolescents--326 females and 296 males--with a mean age of 14 years (range: 11-19 years). They completed the questionnaire in the presence of the physician. For the first 201 questionnaires collected, the corresponding children and adolescents underwent a spine medical examination, with evaluation of pain by visual analog scale if LBP was present. A stepwise logistic regression analysis was carried out to determine the risk factors associated with LBP and chronic LBP. The cumulative lifetime prevalence of LBP was 28.4%. Eight percent of the subjects suffered from chronic LBP. LBP was responsible for 23% of school absenteeism and 29% for sports absenteeism. Medical care requirement was observed in 32.2% and psychological symptoms in 75%. Stepwise logistic regression analysis showed that three factors were associated with LBP: school failure (held back 1 year), odds ratio (OR) =2.6 (95% confidence interval [CI], 1.96-3.44), family history of LBP (parental or sibling LBP), OR=3.80 (95% CI, 2.94-5.92), dissatisfaction with school chair (in height and comfort), OR=3.40 (95% CI, 2.24-5.29). Two factors were associated with chronic LBP: dissatisfaction with school chair, OR=1.62 (95% CI, 1.46-3.32) and football playing, OR=3.07 (95% CI, 2.15-5.10). The prevalence of LBP among Tunisian schoolchildren and adolescents is high. This requires preventive measures and longitudinal studies, which are very important from the standpoint of public health.

Epidemiology of low back pain in children and adolescents

It has been estimated that over 80% of the population will report low back pain (LBP) at some point in life, and each year 7% of the adult population consult their GP with symptoms. Prevalence increases with age, reaching a peak during the sixth decade of life. Until recently little was known about LBP at young ages. Clinically it was perceived to be uncommon-with few children consulting because of LBP in primary care. Large prospective epidemiological studies have shown that, in those free of LBP at baseline, the best predictor of future onset is a previous history of LBP. Therefore, to understand the epidemiology of LBP, and what predisposes someone to a trajectory of LBP in adult life, it is important to examine the condition at young ages, to determine factors responsible for onset of initial episodes, and to examine whether LBP in childhood is related to symptoms in adulthood.

Sitting habits in elementary schoolchildren: a traditional versus a "Moving school"

This study evaluated differences in sitting habits in the classroom between the project "Moving school" and a traditional school in 8-year-old children. Twenty-two children, since 1.5 years involved in the project were compared to 25 children in a traditional school. Making use of the Portable Ergonomic Observation (PEO) method, it was observed that children from a traditional school spend an average of 97% of the lesson time sitting statically, from which one-third with the trunk bend over 45 degrees. In the "Moving school" this posture was replaced by dynamic sitting (53%), standing (31%) and walking around (10%), while trunk flexion over 45 degrees was nearly not observed. Children from the "Moving school" also showed significantly less neck and trunk rotation. Additionally, accelerometric data showed significantly more physical activity in lessons of the "Moving school". Rates of self-reported back or neck pain did not differ significantly between both study groups. Results show that sitting habits are more favourable in a "Moving school". Further research is needed to study the impact of implementing "Moving school" concepts in traditional schools on sitting habits.

The frequency and associated factors of low back pain among a younger population in Turkey

STUDY DESIGN

Open design cross-sectional questionnaire.

OBJECTIVES

The aims of this study are to determine the frequency of low back pains in the younger population and the factors that have an influence on this frequency.

SUMMARY OF BACKGROUND DATA

Low back pain is one of the most important social problems that causes injuries in the younger population. Low back pain frequency is around 30% among adolescents, and 88% of those with low back pain experiences in adolescence have low back pain in later years. Therefore, identifying and, if possible, preventing the associated factors in adolescence and young adulthood is essential for the solution of this social problem.

METHODS

A total of 1,552 students from a total of 8,000 who had come from all parts of Turkey for university registration accepted to participate in the study and were given a questionnaire about low back pain experiences, disability, and possible associated factors.

RESULTS

Low back pain frequency was found to be 40.9%. This rate increases with age. Abandonment of moderate level physical activity and traumas such as slipping on ice and falling down the stairs were identified as associated factors.

CONCLUSIONS

Regular physical activity and the prevention of falls might be ways for decreasing the frequency of low back pain experiences among the youth and significantly influencing the frequency of low back pain in adult population.

Low back pain prevention's effects in schoolchildren. What is the evidence?

Given the high prevalence rates of back pain, as early as in childhood, there has been a call for early preventive interventions. To determine which interventions are used to prevent back problems in schoolchildren, as well as what the evidence is for their utility, the literature was searched to locate all investigations that used subjects under the age of 18 and not seeking treatment. Included investigations were specifically designed as an intervention for low back pain (LBP) prevention. Additionally, a literature search was performed for modifiable risk factors for LBP in schoolchildren. The literature-update search was performed within the scope of the "COST Action B13" of the European Commission, approved for the development of European guidelines for the management of LBP. It was concluded that intervention studies in schoolchildren focusing on back-pain prevention are promising but too limited to formulate evidence-based guidelines. On the other hand, since the literature shows that back-pain reports about schoolchildren are mainly associated with psychosocial factors, the scope for LBP prevention in schoolchildren may be limited. However, schoolchildren are receptive to back-care-related knowledge and postural habits, which may play a preventive role for back pain in adulthood. Further studies with a follow-up into adulthood are needed to evaluate the long-term effect of early interventions and the possible detrimental effect of spinal loading at young age.

Cartable et pathologie rachidienne

Back pain has become a real public health concern both for adults and children. In general, patients complain of moderate pain. While the topic was long ignored by the scientific community, the number of publications has increased over the last three Years. We reviewed the literature to separate real evidence from speculations. Recognized risk factors for spinal pain are: female gender, poor general status, family history of back pain, particular psychological patterns, time spent sitting watching television, history of spinal trauma, intense physical activity, practicing competition sports, and age (more frequent in adolescents than children). Several recent papers have drawn attention to the role of the weight of the school backpack in children, particularly when its weight exceeds 20% of the child's body weight. Many children carry heavy backpacks which for some may weigh 30% to 40% of their body weight. Several groups have estimated that the maximum should be 10% of the body weight. It appears that time spent carrying the backpack as well as its weight is an important factor favoring back pain. Backpacks can injury the head or face, as well as the hands, the elbow, the wrist, the shoulder, the foot and the ankle. Back trauma is observed as the sixth most common injury. The 'weak point' is the shoulder and not the back. A poorly positioned backpack can modify posture and gait. Carrying the backpack with two shoulder straps affects posture and gait less than carrying it on one shoulder. The posture of the spine changes when the weight of the backpack increases. This is probably one of the reasons why many parents who consult believe that there is a relationship between the weight of the backpack and scoliosis or kyphosis, observed in many of their children. It is proven that adolescents who suffer from back pain will probably have chronic back pain as adults, but there is not evidence to our knowledge demonstrating a relationship between the development of spinal deviation and the weight of the backpack. Recent studies have been conducted to design backpacks allowing a better weight distribution and comfort. This type of backpack appears to have a limited benefit. Furthermore, the question of mode must not be ignored for children and adolescents. Backpacks with one sack in front and one in back certainly provide better weight distribution but are they acceptable for children and adolescents?

Back pain in children: no association with objectively measured level of physical activity

STUDY DESIGN

A cross-sectional survey of 481 children aged 8-10 years and 325 adolescents aged 14-16 years obtained through a proportional two-stage cluster sample of children living in Odense, Denmark.

OBJECTIVES

To investigate whether there are any associations between back pain and the level of self-reported physical activity, the level of self-reported physical inactivity, and the level of objectively measured physical activity. In addition, to test the validity of the self-reported physical activity data.

SUMMARY OF BACKGROUND DATA

A sedentary lifestyle in children is believed to be harmful for the back, whereas moderate physical activities are supposed to be beneficial. There is no obvious epidemiologic evidence in favor of this concept. In none of the previous studies has the combined activity/inactivity pattern been investigated, nor has the amount of physical activity been measured objectively.

METHODS

The associations and dose-response connections for back pain, mid back pain, and low back pain in the preceding month were studied in relation to self-reported physical activity and physical inactivity. In addition, an objective and validated method to measure the daily level of physical activity (the accelerometer) was used to establish the associations with the same outcome variables. The association between the level of self-reported activities and the accelerometer was investigated.

RESULTS

The self-reported data resulted in mixed findings, but there were no associations between any of the three pain variables and the readings from the accelerometer, and no changes occurred after adjustment for age, gender, and puberty stage. There was a weak and inconsistent correlation (0.25) between the accelerometer readings and self-reported physical activity that nevertheless tested significantly for trend but none between the accelerometer readings and the level of self-reported physical inactivity.

CONCLUSIONS

There is no obvious association between the objectively measured level of physical activity and back pain in children and adolescents. Simple self-reported levels of physical activity and inactivity cannot be used meaningfully on young people in back pain research.

Children and adolescents with low back pain: a descriptive study of physical examination and outcome measurement

STUDY DESIGN

A retrospective, cohort study of children and adolescents with low back pain (LBP) referred to physical therapy.

OBJECTIVES

To describe the clinical presentation, examination findings, and classification of children and adolescent patients with LBP, and to explore the concurrent validity of the Oswestry questionnaire as a disability measure in this group.

BACKGROUND

Little information is available regarding the clinical presentation, physical examination findings, and outcome assessment in children and adolescents with LOP.

METHODS AND MEASURES

Charts were reviewed for historical, diagnostic, physical examination,and outcome information. Diagnoses given by the referring physicians were recorded. A treatment-based classification was made for each subject. Descriptive statistics were calculated for all variables. The validity of the Oswestry questionnaire was examined.

RESULTS

The children and adolescents included in this study represented 5% (n = 25) of all cases of LOP referred to physical therapy. A greater percentage of patients had difficulty with extension than with flexion range of motion (ROM). Initial pain scores were lower if a specific pathology was present (P = .001). Initial pain and Oswestry scores were poorly correlated (r = 0.16). Forty-four percent (n = 11) of patients scored under the floor value of 12% on the Oswestry.

CONCLUSION

The referral rate of children and adolescents with LBP seems to be low. Compared to adults, children and adolescents appear more likely to have a specific diagnosis given to them by their physician. The physical examination findings appear to indicate that spinal stabilization approaches may be beneficial for many patients. The Oswestry questionnaire may not be a valid tool for documenting changes in disability in these patients. Further research is needed on the conservative management of children and adolescents with LBP.

The association of backpack use and back pain in adolescents

STUDY DESIGN

A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted.

OBJECTIVE

To investigate the relation between backpack use and back pain in adolescents.

SUMMARY OF BACKGROUND DATA

The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain.

METHODS

A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain.

RESULTS

Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights.

CONCLUSION

The use of backpacks during the school day and backpack weights are independently associated with back pain.

Pediatric neurodevelopment and sports participation. When are children ready to play sports?

A fundamental knowledge of normal child and adolescent development is essential to providing a developmentally appropriate sports experience for the child, and to providing guidance to parents regarding their child's sport participation. This article reviews neurodevelopment, normal child and adolescent development relevant to sport participation, and developmental readiness to participate in sports. Neurodevelopmental maturation is a complex, continuous process. The sense of social comparison is not achieved until after 6 years of age, and the ability to understand the competitive nature of sports is generally not achieved until 9 years of age. By about 12 years of age, most children are mature enough to comprehend the complex tasks of sports and are physically and cognitively ready to participate in competitive sports with appropriate supervision.

Back education efficacy in elementary schoolchildren: a 1-year follow-up study

STUDY DESIGN

A control group-designed 1-year follow-up study involving 9 to 11-year-old schoolchildren who followed back education.

OBJECTIVES

To evaluate the efficacy of a back education program, consisting of six sessions of 1 hour each, in elementary school.

SUMMARY OF BACKGROUND DATA

In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. Although several authors advocate the implementation of back education in elementary school, no guidelines exist and little is known about the efficacy of such a program.

METHODS

A total of 198 children (subjected to back education) and 165 controls performed a practical test, evaluating the use of back care principles while sitting, taking off shoes, picking up a pen, and handling a load and a book bag. Post-tests were performed within 1 week after the intervention, after 3 months, and after 1 year. The week prevalence of back and neck pain was evaluated at these test moments in extended samples of intervention children (n = 347) and controls (n = 349). To evaluate habit changes, a limited group of intervention pupils (n = 38) and controls (n = 31) was additionally evaluated in a candid camera observation at the last post-test.

RESULTS

At all post-tests intervention pupils scored significantly higher (P < 0.001) than controls for all practical test items. Candid camera evaluation scores were higher in the intervention group sample compared with the control group sample for four of the eight evaluated items. Following back education significantly decreased the week prevalence of back and neck pain.

CONCLUSIONS

Back education in elementary schoolchildren is efficacious up to 1 year. The role of early back education in preventing back pain at the adult age merits further attention.