Back Pain In Adolescents Research Articles

‘Back on Track’ – development of a school-based back care education programme

There is a high prevalence of back and neck pain among school children,1 with estimations that 50% of 14-year-olds have experienced back pain.2 Adolescent back pain sufferers are more likely to experience back pain as an adult, and problems can begin at primary school age.3,4 It is widely understood that the risk for back pain in young people is mul- tifactorial; however, the school environ- ment is an important consideration as children spend 30% of their time there.5,6Abertawe Bro-Morgannwg University Health Board serves a population of 500,000 individuals in South Wales. The percentage of paediatric referrals to physiotherapy for back and neck pain increased from 2.1% in September 2011 to 4.5% in March 2012. A project was introduced to ascertain whether local school children's backs are 'fit for the future'. The aims of the project were to investigate the prevalence of back and/or neck pain in school children in the Neath/ Port Talbot locality, identify the possible contributing risk fac- tors and raise awareness of the importance of applying practical back care education in the school environment.In June 2012, a questionnaire-based study was undertaken with a purposive sample of 204 young people from two primary schools (n = 78) and one senior school (n = 126) in the local area, spanning pupils aged from 7 to 15 years. The questionnaire addressed some key risk factors predisposing young people to back and neck pain and included school bag weight, school furniture, general lifestyle, and previous back pain.7,8 It is recognised that psychosocial factors may play a significant role in the development of back pain in young people;5,6 however, investigating such issues was beyond the scope of this physiotherapy-led initiative, and attempting to discuss sensitive subject matter with pupils could be seen as inappropriate within the school environment.Results of the questionnaire found that a total of 72% of the primary school sample reported back and/or neck pain in the past year and 36% within the last week prior to the questionnaire taking place. A total of 64% of the secondary school-aged pupils reported back and/or neck pain in the past year and 33% in past week. A total of 89% of pupils ques- tioned had not reported their back/neck pain to anyone, but 78% wanted teach- ing on how to keep their backs healthy.A number of questions addressed some of the school activity-related risk factors associated with back and neck pain in young people. For primary school children, sitting in assembly and sitting on the floor were the most problematic activities reported. For secondary school children, it was carry- ing their school bag; 15% of 11- to 12-year-olds carried a bag that weighed 10% of their body weight or greater. The literature recommends no more than 10%-15% of body weight.9These results may suggest that grow- ing spines are being affected, and back and neck pain in young people is a prob- lem which needs further investigation. The information obtained also supports the knowledge that many possible risk factors for back/neck pain in children are school-related, such as bag weight, uncomfortable seating and prolonged periods of sitting.10These results led to several local and national press releases along with a BBC Radio Wales live interview during August 2012 in time with pupils' return to school. There was also the opportunity to pre- sent the findings to Neath/Port Talbot primary and secondary school teachers during the Autumn term of 2012. Following on from this, a resource pack entitled 'Back on Track - a school-based back care education programme' evolved as a collaborative with a physio- therapist in England.A comprehensive school in Port Talbot was willing for 'Back on Track' to be piloted with Year 8 pupils aged 12/13 years who had participated in the initial questionnaire. In the spring/summer term 2013, paediatric physiotherapists delivered 'Back on Track' to 106 pupils as part of their pastoral care curriculum. …

Web-based survey usefulness for studying the influence of school bags and backpacks on back and neck pain in children and adolescents - pilot study in a medium-sized town

A total of 380 questionnaires were submitted with no logical errors and highly probable answers from 220 girls (average age 13.4 years old) and 160 boys (average age 13.7 years old). The back and neck pain was mentioned by 49% of adolescents (51% of girls and 46% of boys). Thoracic and lumbar pain was mentioned by 39 girls (10%) and 100 boys (26%). The reported pain occurred intermittently (72.5%), mostly during the day (63%). Some respondents mentioned that pain occurs when they carry their bags on their shoulders (7%) or when they carry their backpacks (19%). Girls more likely carry bags (youth style), and boys prefer backpacks or rucksacks. Girls usually carry bags on the same shoulder. Of the total respondents, 65% were pain-free while being physically active 2-4 hours per week outside of the school physical education program (p<0,01).

Associations of Body Mass Index and Body Height With Low Back Pain in 829,791 Adolescents

Body mass index (BMI) (calculated as weight (kg)/height (m)²) and height are linked to the pathogenesis of low back pain, but evidence-based confirmation is lacking. We examined the prevalence of low back pain in adolescents and its association with BMI and height. Disability clauses (official military limitations related to a person's health status) indicating low back pain severity were divided according to symptoms of low back pain alone and symptoms of low back pain with objective corroborating findings. All 829,791 males and females undergoing mandatory premilitary recruitment examinations since 1998 were included. Logistic regression models assessed the relationships of BMI and height with low back pain. Prevalence of low back pain was 0.2% for both males and females with objective findings and 5.2% for males and 2.7% for females without objective findings. Higher BMI was significantly associated with low back pain in males (for overweight, odds ratio = 1.097, P < 0.001; for obese, odds ratio = 1.163, P < 0.001) and in females (for overweight, odds ratio = 1.174, P < 0.001; for obese, odds ratio = 1.211, P < 0.001). Height was associated with increased risk of low back pain in both genders. Odds ratios for low back pain in the tallest group compared with the shortest group were 1.438 (P < 0.001) for males and 1.224 (P < 0.001) for females. Low back pain with or without objective findings was associated with overweight and obesity as well as with height.

Spondylolysis is frequently missed by MRI in adolescents with back pain

Magnetic resonance imaging (MRI) is often used in the evaluation of lower back pain in adolescents. The purpose of our study is to report on the frequency of MRI missing spondylolysis in adolescents with back pain in a pediatric orthopaedic practice. A retrospective review of all patients with a diagnosis of spondylolysis who presented from January 2000 to March 2010 was performed. All patients were evaluated at a single institution by the senior author. Inclusion criteria were patients with spondylolysis confirmed on computed tomography (CT) or plain film that also received an MRI. Eleven patients with spondylolysis had an MRI performed. The mean age of the study patients was 14.2years (range 10-17). The diagnosis of spondylolysis was missed in the MRI radiology reading in 7 out of 11 (64%) studies. MRI missed a spondylolysis in over half of the adolescents in this consecutive series. In patients with a history or physical findings suggestive of spondylolysis, such as localized pain of the lumbar spine with back extension, further radiographic evaluation should be considered, even if an MRI is negative. III, retrospective review.

Determinants of Health Care Use for Low Back Pain in Adolescence

Introduction Recent studies have indicated that LBP is already common in adolescence, but only a few studies have evaluated the factors that determine LBP-related health care use at this age. Materials and Methods The study population included 1987 adolescents aged 18 from the Oulu Back Study (OBS), a subcohort of the 1986 Northern Finland Birth Cohort (NFBC 1986). We used logistic regression to evaluate whether enabling resources need factors; personal health habits or psychological problems are associated with seeking health care for LBP, among adolescents reporting LBP during the last year. Results Of the 1987 respondents, 50% of the women and 42% of the men reported having had LBP during the previous year. Of the 921 respondents with LBP, 89 (16%) women and 59 (16%) men had consulted a health care professional. In both the genders, pain intensity was strongly associated with seeking care (VAS 8–10 vs. VAS 0–3; men: OR 16.6, 95% CI, 3.8–72.5, women: OR 18.8 95% CI, 6.3–56.1). In addition, LBP-related daily activity limitations (impairment index 4–6 vs. 0 OR 15.7 95% CI, 1.7–142.5) were associated with care seeking among males. Student status was also associated with care-seeking among males (OR 2.34 95% CI, 1.02–5.36). (Fig. proportion of adolescents seeking medical care for LBP according to pain intensity in VAS.) Conclusion Approximately one out of six adolescents with LBP seeks medical care. Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared

Determinants of Health Care Use for Low Back Pain in Adolescence

IntroductionRecent studies have indicated that LBP is already common in adolescence, but only a few studies have evaluated the factors that determine LBP-related health care use at this age.Materials and MethodsThe study population included 1987 adolescents aged 18 from the Oulu Back Study (OBS), a subcohort of the 1986 Northern Finland Birth Cohort (NFBC 1986). We used logistic regression to evaluate whether enabling resources need factors; personal health habits or psychological problems are associated with seeking health care for LBP, among adolescents reporting LBP during the last year.ResultsOf the 1987 respondents, 50% of the women and 42% of the men reported having had LBP during the previous year. Of the 921 respondents with LBP, 89 (16%) women and 59 (16%) men had consulted a health care professional. In both the genders, pain intensity was strongly associated with seeking care (VAS 8–10 vs. VAS 0–3; men: OR 16.6, 95% CI, 3.8–72.5, women: OR 18.8 95% CI, 6.3–56.1). In addition, LBP-related daily activity limitations (impairment index 4–6 vs. 0 OR 15.7 95% CI, 1.7–142.5) were associated with care seeking among males. Student status was also associated with care-seeking among males (OR 2.34 95% CI, 1.02–5.36). (Fig. proportion of adolescents seeking medical care for LBP according to pain intensity in VAS.)ConclusionApproximately one out of six adolescents with LBP seeks medical care. Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence.I confirm having declared any potential conflict of interest for all authors listed on this abstractYesDisclosure of InterestNone declared

Experiences of low back pain in adolescents in relation to physiotherapy intervention

The aim of this study was to generate a substantive theory, based on interviews with children and adolescents with low back pain (LBP), explaining how they manage their main concerns in daily life. Tape-recorded open interviews were conducted with 14 boys and girls with LBP, aged 12–18 years, who participated in a 12-week physical therapy intervention. The grounded theory was used for analyzing the transcribed interviews. A core category, mobilizing own resources, emerged from the analysis, describing how adolescents with LBP succeed in managing their main concern, gaining body confidence, in daily life. The core category was divided into four categories labelled: coaching from the physiotherapist, seeking for information, compliance with physiotherapy and gaining energy from pain-free moments. The categories formed a substantive theory, illuminating how young people with LBP experienced physical therapy intervention. The theory explains and provides a deeper understanding of the main concerns of these adolescents and their strategies in managing their life situation.

Prevalence and risk factors associated with spinal pain in adolescent computer users: a systematic review.

Increased computer use has been suggested as a contributing factor for a rapid increase in the prevalence of neck and back pain in adolescents in the late 1990s and the beginning of 2000. The overall objective of this review was to synthesise the best available evidence on the estimates of prevalence of, and risk factors associated with, spinal discomfort in adolescent computer users. This review considered cross-sectional, case-control, or cohort studies. Studies were considered for inclusion if they reported either prevalence or risk factors associated with spinal pain in adolescents aged between 13 and 18 years using computer in school or at home. The search included The Cochrane Library, JBI Library of Systematic Reviews, PEDro, MEDLINE, CINAHL, Web of Science, ERIC, PsycINFO, EMBASE, and CEPS. The grey literature was also searched. The search was limited to English and Chinese language papers, and spanned from the inception of each database to May 2011. Two review authors independently evaluated the methodological quality of the included studies using the standardised Joanna Briggs Institute instruments. Data was extracted using the standardised Joanna Briggs Institute data extraction form. Meta-analysis was not appropriate because there was considerable heterogeneity between studies. The findings were summarised in tables and in narrative form. Seven studies were included in this review: three studies were carried out in Finland, two in the USA, one in Sweden, and one in South Africa. There was marked variability in the period prevalence data across different studies: 15-60% for cervical pain and 12-53% for lumbar pain. None of the reviewed studies reported the confidence intervals for prevalence estimate. Four studies investigated the association between the duration of computer use and cervical pain, two studies for lumbar pain and none for thoracic pain. Positive associations between the duration of computer use and cervical pain were found in three out of four studies, with the odds ratio ranged from 1.3 (95% CI 1.1 to 1.6) to 2.3 (95% CI 1.5 to 3.6). One study found that weekly internet use greater than 42 hours predicted the occurrence of lumbar pain, and the odds ratio was 1.9 with 95% CI of 1.1 to 3.4. The other study reported non-significant association without providing statistical evidence. This systematic review suggests a relatively high prevalence of spinal pain in adolescents. The cervical spine region appears to be more prone to musculoskeletal pain than the lumbar or thoracic regions. Cervical spine pain was statistically significantly associated with duration of computer use, however the odds ratio may be too small to be considered clinical significant. There is conflicting evidence on the association with duration of computer use and lumbar pain and no evidence for thoracic spine. The relatively high prevalence of spinal pain in adolescents highlights the need for preventative and treatment strategies. Further research, preferably prospective cohort studies utilising physical examination, is required to more rigorously investigate the issue of computer use and spinal pain among adolescents. There is a need to conduct more research in Asian or developing countries to reflect any cultural or socioeconomic differences that may influence the amount of computer exposure and its potential impact on musculoskeletal health in adolescent computer users.

Physical workload and risk of low back pain in adolescence

ObjectivesTo evaluate the role of physical workload in low back pain (LBP) among adolescents.MethodsWorking history and physical workload factors at 18 years were assessed for 1984 members of the Northern...

Pubertal Status Predicts Back Pain, Overtiredness, and Dizziness in American and Dutch Adolescents

Functional somatic symptoms, symptoms for which no organic pathologic basis can be found, are more prevalent in girls than in boys, and this difference tends to increase during adolescence. This might be explained, at least in part, by pubertal development. We hypothesized that pubertal maturation predicts the development of most functional somatic symptoms and that this especially is true for girls. We used 2 longitudinal population-based studies to examine our hypotheses: the Longitudinal Study of Pain in Adolescents in Seattle (n = 1996 [49.7% girls]) and the Dutch Tracking Adolescents' Individual Lives Survey (n = 2230 [51.0% girls]). Two assessment waves of each study were used. American adolescents were younger than Dutch adolescents at the first (11.6 vs 13.6) and second (14.5 vs 16.2) assessment waves, but they were in about the same pubertal development stage. Functional somatic symptoms were measured by pain questions, the Symptom Checklist-90, and the Youth Self-report. The Pubertal Development Scale was used to assess pubertal development on a continuous scale in both cohorts. Ordinal logistic regression analyses revealed that American and Dutch adolescents at a later pubertal status at baseline were more likely (odds ratios ranged from 1.24 to 1.61) to report back pain, overtiredness, and dizziness but not stomach pain and headache 2 to 3 years later. Although these relationships were not equally strong for boys and girls, no significant gender differences were found. Pubertal status predicted the frequency of some, but not all, functional somatic symptoms at follow-up.

Prevalência e fatores associados à dor lombar em escolares

The objective was to determine the prevalence of lower back pain in adolescents and its relationship to sports and sedentary activities. We conducted a cross-sectional study of 5th to 8th-grade students (n = 1,236) in Bauru, São Paulo State, Brazil. We used a structured protocol and the Nordic questionnaire for musculoskeletal symptoms. The analysis was performed using a descriptive approach and bivariate and multivariate binary logistic regression. Prevalence of lower back pain was 19.5% (7% in boys and 12.5% in girls), with statistically significant differences according to gender (p < 0.00001), age (p = 0.0057), and sports (p = 0.0001). Bivariate and multivariate analyses showed independent associations between lower back pain and female gender, time watching TV, and sports. Lower back pain in schoolchildren can persist as chronic pain in adults. Understanding the relationships between variables should provide useful measures for maintaining, improving, and promoting students' wellbeing.

Pubertal Status Predicts Back Pain, Overtiredness, and Dizziness in American and Dutch Adolescents

Pubertal Status Predicts Back Pain, Overtiredness, and Dizziness in American and Dutch Adolescents

Back and neck pain are related to mental health problems in adolescence

BackgroundThere is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents.MethodsOne thousand five hundred and eighty participants (mean age 14.1 years) from the Western Australian Pregnancy (Raine) Study provided cross-sectional spinal pain and CBCL data.ResultsAs predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain.ConclusionsThese findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.

Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Sato T, Hirano T, Ito T, et al. Eur Spine J 2011;20(2):274–9. Epub 2010 Dec 17

Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Sato T, Hirano T, Ito T, et al. Eur Spine J 2011;20(2):274–9. Epub 2010 Dec 17

Association of Biopsychosocial Factors With Degree of Slump in Sitting Posture and Self-Report of Back Pain in Adolescents: A Cross-Sectional Study

Conflicting evidence exists regarding relationships among sitting posture, factors that influence sitting posture, and back pain. This conflicting evidence may partially be due to the presence of multiple and overlapping factors associated with both sitting posture and back pain. The purpose of this study was to determine whether the degree of slump in sitting was associated with sex and other physical, lifestyle, or psychosocial factors. Additionally, the relationship between the report of back pain made worse by sitting and the degree of slump in sitting and other physical, lifestyle, or psychosocial factors was investigated. This was a cross-sectional study. Adolescents (n=1,596) completed questionnaires to determine lifestyle and psychosocial profiles and the experience of back pain. Sagittal sitting posture, body mass index (BMI), and back muscle endurance (BME) were recorded. Standing posture subgroup categorization was determined. Multivariate analysis revealed that the most significant factor associated with the degree of slump in sitting was male sex, followed by non-neutral standing postures, lower perceived self-efficacy, lower BME, greater television use, and higher BMI. Multivariable analysis indicated poorer Child Behaviour Checklist scores were the strongest correlate of report of back pain made worse by sitting, whereas degree of slump in sitting, female sex, and BME were more weakly related. Causality cannot be determined from this cross-sectional study, and 60% of sitting posture variation was not explained by the measured variables. Slump in sitting was associated with physical correlates, as well as sex, lifestyle, and psychosocial factors, highlighting the complex, multidimensional nature of usual sitting posture in adolescents. Additionally, this study demonstrated that a greater degree of slump in sitting was only weakly associated with adolescent back pain made worse by sitting after adjustment for other physical and psychosocial factors.

Children in Pain: Recurrent Back Pain, Abdominal Pain, and Headache in Children and Adolescents in a Four-Year-Period

To analyze the development of recurrent pain in 3 body locations in children and adolescents (baseline age, 9 to 14 years) in a 4-year period. In a large population-based longitudinal epidemiological study data was collected through annual postal questionnaires (longitudinal, n = 2025). Descriptive statistics and generalized estimating equations were used. Girls were more likely to report recurrent pain, demonstrated a steeper development during the 4-year period, and reported multiple pain more often than boys. Younger children reported less recurrent pain, but displayed a steeper trend of increasing prevalence rates as they grew older. Older children illustrated a more stable development of recurrent pain and reported multiple pain more often. Disability experienced because of recurrent pain was related strongest to pain intensity. Stable patterns of pain were related to higher intensity and disability reports. The children experienced headache as the most disabling of the 3 pains. The results show that boys and girls report recurrent pain in different patterns in the years. To identify risk factors, analysis should be performed separately for boys and girls. Furthermore, it is recommended to include children before the age of 9 years in a prevention study.

Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan

There have been a few studies regarding detail of back pain in adolescents with idiopathic scoliosis (IS) as prevalence, location, and severity. The condition of back pain in adolescents with IS was clarified based on a cross-sectional study using a questionnaire survey, targeting a total of 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067), Japan. 32,134 pupils were determined to have valid responses (valid response rate: 73.7%). In Niigata City, pupils from the fourth grade of elementary school to the third year of junior high school are screened for scoliosis every year. This screening system involves a three-step survey, and the third step of the survey is an imaging and medical examination at the Niigata University Hospital. In this study, the pupils who answered in the questionnaire that they had been advised to visit Niigata University Hospital after the school screening were defined as Scoliosis group (51 pupils; 0.159%) and the others were defined as No scoliosis group (32,083 pupils). The point and lifetime prevalence of back pain, the duration, the recurrence, the severity and the location of back pain were compared between these groups. The severity of back pain was divided into three levels (level 1 no limitation in any activity; level 2 necessary to refrain from participating in sports and physical activities, and level 3 necessary to be absent from school). The point prevalence was 11.4% in No scoliosis group, and 27.5% in Scoliosis group. The lifetime prevalence was 32.9% in No scoliosis group, and 58.8% in Scoliosis group. According to the gender- and school-grade-adjusted odds ratios (OR), Scoliosis group showed a more than twofold elevated odds of back pain compared to No scoliosis group irrespective of the point or lifetime prevalence of back pain (OR, 2.29; P = 0.009 and OR, 2.10; P = 0.012, respectively). Scoliosis group experienced significantly more severe pain, and of a significantly longer duration with more frequent recurrences in comparison to No scoliosis group. Scoliosis group showed significantly more back pain in the upper and middle right back in comparison to No scoliosis group. These findings suggest that there is a relationship between pain around the right scapula in Scoliosis group and the right rib hump that is common in IS.

Factors Affecting Low Back Pain in Adolescents

Prospective multifactorial study on low back pain (LBP) in adolescents. Most studies on LBP have focused on adults although many investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical, and behavioral factors have been associated with nonspecific LBP in adolescents. To investigate the effect of all previously reported parameters together with psychological and psychosocial factors using advanced statistics, on LBP in adolescents aged 15 to 19 years. Six hundred and eighty-eight students aged 16±1 years from 5 randomly selected high schools participated in this study and completed a questionnaire containing questions on daily activity, backpack carrying, psychological and psychosocial behavior. Anthropometric data as well as biplane spinal curvatures together with questionnaire results were included in the analysis using advanced statistics. LBP reported 41% of the participants. Generally, statistically significant correlations were found between LBP (0.002), physical activity (P<0.001), physician consultation (P=0.024), and depression (P<0.001). Sex-related differences were shown regarding LBP intensity (P=0.005) and frequency (P=0.013), stress (P<0.03), depression (P=0.005), and nervous mood (P=0.036) in favor of male students. Male adolescents had continuous energy (P=0.0258) and were calm (P=0.029) in contrast with female counterparts. LBP was sex-related and was less common in adolescents with frequent activity. Adolescent girls with stress, depressive mood, and low energy have more LBP than boys, which makes physician consultation for LBP more common in female adolescents. Systematic physical activity and control of psychological profile should decrease LBP frequency and intensity.

Low back pain in junior Australian Rules football: a cross-sectional survey of elite juniors, non-elite juniors and non-football playing controls

BackgroundLow back pain in junior Australian Rules footballers has not been investigated despite findings that back pain is more prevalent, severe and frequent in senior footballers than non-athletic controls and findings that adolescent back pain is a strong predictor for adult back pain. The aim of this study was to determine the prevalence, intensity, quality and frequency of low back pain in junior Australian Rules footballers and a control group and to compare this data between groups.MethodsA cross-sectional survey of male non-elite junior (n = 60) and elite junior players (n = 102) was conducted along with a convenience sample of non-footballers (school children) (n = 100). Subjects completed a self-reported questionnaire on low back pain incorporating the Quadruple Visual Analogue Scale and McGill Pain Questionnaire (short form), along with additional questions adapted from an Australian epidemiological study. Linear Mixed Model (Residual Maximum Likelihood) methods were used to compare differences between groups. Log-linear models were used in the analysis of contingency tables.ResultsFor current, average and best low back pain levels, elite junior players had higher pain levels (p < 0.001), with no difference noted between non-elite juniors and controls for average and best low back pain. For low back pain at worst, there were significant differences in the mean pain scores. The difference between elite juniors and non-elite juniors (p = 0.040) and between elite juniors and controls (p < 0.001) was significant, but not between non-elite juniors and controls. The chance of suffering low back pain increases from 45% for controls, through 55% for non-elite juniors to 66.7% for elite juniors. The chance that a pain sufferer experiences chronic pain is 16% for controls and 41% for non-elite junior and elite junior players. Elite junior players experienced low back pain more frequently (p = 0.002), with no difference in frequency noted between non-elite juniors and controls. Over 25% of elite junior and non-elite junior players reported that back pain impacted their performance some of the time or greater.ConclusionsThis study demonstrated that when compared with non-elite junior players and non-footballers of a similar age, elite junior players experience back pain more severely and frequently and have higher prevalence and chronicity rates.

Low Back Pain in Adolescents: A Comparison of Clinical Outcomes in Sports Participants and Nonparticipants

Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined. To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes. Observational study. Outpatient physical therapy clinics. Fifty-eight adolescents (age = 15.40 +/- 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation. Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician's discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis. Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests. Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P = .013), attended more sessions (mean difference = 1.40, 95% confidence interval [CI] = 0.21, 2.59, P = .022) over a longer duration (mean difference = 12.44 days, 95% CI = 1.28, 23.10, P = .024), and experienced less improvement in disability (mean Oswestry difference = 6.66, 95% CI = 0.53, 12.78, P = .048) than nonparticipants. Overall, the pattern of clinical outcomes in this sample of adolescents with LBP was similar to that of adults with LBP. Adolescents with LBP due to sports participation received more treatment but experienced less improvement in disability than nonparticipants. This may indicate a worse prognosis for sports participants. Further research is required.