Abstract
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. 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? A systematic critical literature review. 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. 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. 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.
Highlights
Back pain is a common condition that starts early in life and seems to increase markedly during puberty
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
We investigated if associations between puberty and back pain were controlled for possible confounders or modifiers, age and sex
Summary
Back pain is a common condition that starts early in life and seems to increase markedly during puberty. Puberty and back pain The time of puberty is the transition period from childhood to adulthood and over only a few years, both body and soul will undergo many changes. The growth spurt, defined as an average gain of 10 cm per year [9], could be considered a vulnerable period due to sudden mechanical loading changes on the spine. According to a longitudinal study [10], in a healthy population of white girls, the fat mass was shown to increase at the end stage of pubertal development. If this fat replaces active muscle fibers, this too could result in back problems
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