Low Back Pain In Adulthood Research Articles

Adverse Childhood Experiences and Chronic Low Back Pain in Adulthood: The Role of Emotion Regulation

Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in a substantial burden at the individual, community, and health care system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation (DER), depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = .15 [95% CI {.06–.25}]) and with movement (indirect effect = 1.50 [95% CI {.69–2.57}]). Findings suggest ACEs are linked to cLBP severity in adulthood through DER. This aligns with research demonstrating that childhood maltreatment can lead to DER, which perpetuate over the lifespan to impact adult health outcomes. PerspectiveThis study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to cLBP in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention. Trial RegistrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ClinicalTrials.gov ID: NCT03338192).

Relationship between low-back pain and flexibility in children: A cross-sectional study.

Low-back pain is common among school-aged children. Decreased trunk flexibility in childhood influences low-back pain in adulthood. Previous studies examining the association between low-back pain and trunk flexibility in children are insufficient. Examining this association among elementary school children may help to better understand trunk flexibility in children with low-back pain and to modify the management of inflexibility. Therefore, this study aimed to identify the prevalence of low-back pain and its relationship with physical function among elementary school students. School-aged children aged 6-12 years were recruited in Japan between May 2018 and March 2023. Fingertip-to-floor distance, back muscle strength, pelvic tilt angle during gait, and the visual analog scale for low-back pain were measured. In addition, factors independently related to low-back pain were determined through logistic regression analysis. Low-back pain was reported in 9.6% of the 394 participants (boys, 191; girls, 203). All children with low-back pain presented with back pain when they moved; however, the pain was non-specific. Logistic regression analysis showed that the fingertip-to-floor distance was an independent risk factor for low-back pain (odds ratio, 0.921; p = 0.007). The odds ratios calculated in the logistic regression analysis confirmed that low-back pain frequency increased as the fingertip-to-floor distance decreased. The risk of low-back pain was associated with inflexibility, regardless of sex and muscle strength. These findings suggest that children with low-back pain must increase their trunk and lower extremity flexibility.

Lower Back Pain in Adolescents with an Osteopathic Component

Low back pain (LBP) is a common complaint in adolescents and has been increasingly reported in recent years. Affecting roughly 40% of adolescents, it leads to negative overall health, higher incidence of LBP in adulthood, and greater utilization of health care resources over one’s lifetime. LBP in adolescents differs from adult populations due to variations in structural anatomy, which contribute to differing approaches in diagnosis and treatment of this condition. The differential diagnosis of LBP in this population is extremely broad and can be attributed to many underlying etiologic factors. Clinicians must conduct a thorough history and physical examination and consider the appropriate diagnostic testing to accurately diagnose adolescents early on in their conditions to provide the most effectivetreatment. Treatment for this condition ranges from rest and rehabilitation, to oral medications, OMT, bracing, and rarely, surgery. Physicians must also be able to recognize clear risk factors and symptoms for serious underlying pathology that can be causing LBP. This article will focus on diagnosis and treatment of the most common causes of LBP in adolescents.

The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies.

Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.

Persistent muscle hyperalgesia after adolescent stress is exacerbated by a mild-nociceptive input in adulthood and is associated with microglia activation

Non-specific low back pain (LBP) is a major global disease burden and childhood adversity predisposes to its development. The mechanisms are largely unknown. Here, we investigated if adversity in young rats augments mechanical hyperalgesia and how spinal cord microglia contribute to this. Adolescent rats underwent restraint stress, control animals were handled. In adulthood, all rats received two intramuscular injections of NGF/saline or both into the lumbar multifidus muscle. Stress induced in rats at adolescence lowered low back pressure pain threshold (PPT; p = 0.0001) and paw withdrawal threshold (PWT; p = 0.0007). The lowered muscle PPT persisted throughout adulthood (p = 0.012). A subsequent NGF in adulthood lowered only PPT (d = 0.87). Immunohistochemistry revealed changes in microglia morphology: stress followed by NGF induced a significant increase in ameboid state (p < 0.05). Repeated NGF injections without stress showed significantly increased cell size in surveilling and bushy states (p < 0.05). Thus, stress in adolescence induced persistent muscle hyperalgesia that can be enhanced by a mild-nociceptive input. The accompanying morphological changes in microglia differ between priming by adolescent stress and by nociceptive inputs. This novel rodent model shows that adolescent stress is a risk factor for the development of LBP in adulthood and that morphological changes in microglia are signs of spinal mechanisms involved.

A Study on Neck Pain and Iow Back Pain among the Undergraduate Students of a Medical College in Bhopal, India

Introduction: Development of at a younger age is a potential risk of developing chronic low back pain in adulthood. The study was planned with the purpose to know the extent of the less studied musculoskeletal disorders as a health problem among Indian medical students. The study was conducted to assess the prevalence of low back and neck pain among medical students, find the associations of low back and neck pain with quality-of-life issues, self-perceived stress and lifestyle.&#x0D; Methods: A cross-sectional study was conducted at the Bhopal, India from May to July 2019, total 220 medical students were randomly selected. A questionnaire including the pre-validated instruments viz. Oswestry Disability Index, Visual Analog Scale and Perceived Stress Scale-10 were used to collect the data. Data entry was done in Microsoft Excel and was analyzed on statistical package SPSS version 23.&#x0D; Results: The overall prevalence of Low Back and Neck Pain were 49.1% and 56.4% respectively. A significant association of female gender was found with Neck and Low Back Pain. A significant negative correlation was found between body mass index and Visual Analogue Scale neck &amp; back (p=0.003).&#x0D; Conclusion: There was a high prevalence of low back pain and neck pain in medical students at Bhopal. Females were affected more than males. Complaint of lower back pain was more than neck pain. Playing outdoor sports and weightlifting was found to be having protective effect on low back pain and neck pain.

Adverse Childhood Experiences and Chronic Low Back Pain in Adulthood: Role of Emotion Regulation

Adverse childhood experiences (ACEs) can have profound deleterious effects on subsequent physical health and psychological functioning in adulthood. Commonly studied ACEs include childhood emotional, physical, sexual abuse, parental psychopathology, substance abuse, and early parental loss due to death/abandonment, or parental incarceration. Recent evidence suggests that ACEs represent a likely social determinant of chronic pain development in adulthood; however, little research to date has investigated the psychological processes that might underlie the link between ACEs and chronic pain. The current study examined emotion regulation as a potential mediator of the relationship between ACEs and pain severity in adults with chronic low back pain (cLBP). Study participants included 209 adults (54% women, 58% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants retrospectively reported childhood experiences of abuse and neglect on the Adverse Childhood Experiences (ACEs) questionnaire. Higher ACEs scores are indicative of greater exposure to adverse childhood events. Participants also completed the Difficulties in Emotion Regulation Scale (DERS), and the Brief Pain Inventory – Short Form (BPI-SF) to assess cLBP severity. Sociodemographic data (e.g., sex/gender, ethnicity/race, age, social status) were also collected. In data analytic models, sociodemographic variables were included as covariates. Results revealed that emotion regulation mediated the relationship between ACEs and cLBP severity (indirect effect = .160, 95% percentile bootstrap CI [.071 to .270]). More specifically, ACEs were linked to greater difficulty with emotion regulation (p < .001), which, in turn, was associated with greater cLBP severity (p < .001). Results suggest ACEs may be linked to cLBP severity in adulthood though difficulties in emotion regulation. This aligns with research demonstrating that childhood maltreatment can lead to maladaptive emotion regulation strategies (heightened emotional reactivity, rumination, attentional bias to threats) which can exacerbate and perpetuate poor physical and mental health over the lifespan. Grant support from R01MD010441.

The Psychosocial Risk Factors of Low Back Pain in 10–13-Year-Old Children

Research background. Even 70% of population in industrialized countries report low back pain (LBP). LBP usually appears in early adolescence, and it is as common in late adolescence as in adulthood. Low back pain reported in childhood is a predictor of LBP in adulthood. It is widely accepted that back pain is a multidimensional disorder with physical, lifestyle and psychosocial factors related to the development and maintenance of adolescent back pain. So far, no definitive conclusion has been made on the nature and interaction of these factors. The aim of the research was to measure the prevalence of LBP and define the relationship among psychosocial factors and back pain. Research methods. The study included 193 respondents: 103 girls and 90 boys aged from 11 to 13 years of age. We conducted a cross-sectional study using Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) to assess psychosocial factors. The prevalence of back pain was assessed by a questionnaire. Research results. The life time prevalence of back pain is 38.9%. Girls (46.6%) experience back pain more often than boys (30%). The assessment of psychosocial factors identified that majority of children 73.6% had no difficulties. Psychosocial difficulties were more common among boys (18.8%) than girls (7.8%). Emotional problems were assessed in 15% of respondents and peer problems in 31.6%. Conclusions. Less than half of children have experienced low back pain at least once in their life. Girls experienced back pain more often than boys. The prevalence of back pain is increasing with age. Reliable evidence was obtained that children who experience, or are likely to experience, psychosocial problems suffer from back pain more frequently.Keywords: children, low back pain, psychosocial factors.

Cross-sectional associations between the diversity of sport activities and the type of low back pain in adulthood

Leisure-time physical activity has a complex relationship with low back pain (LBP). Thus, we aimed to investigate whether the diversity of sport activities is associated with the type of LBP. In the FinnTwin16 study, 4246 (55% females) Finnish twins at mean age 34.1 years replied to a health behaviour survey in 2010–2012. Based on the participation in different sport activities, we created two measures of diversity: quantity (i.e. the number of sport activities: 1, 2, 3, 4 and ≥5) and quality (i.e. the type of sport activity: endurance, strength, body care, etc.). Based on the frequency, duration and type of LBP, we created three groups: no history of LBP lasting more than one day, radiating LBP and non-radiating LBP. The associations between the quantity and quality of sport activities and the type of LBP were investigated with logistic regression analyses. Participation in ≥5 sport activities associated with less radiating and non-radiating LBP in analyses pooled across sex (odds ratio 0.46, 95% CI 0.30–0.69 and 0.66, 0.44–0.99, respectively). However, the associations attenuated after adjusting for several confounders. Participation in endurance sports was associated with less radiating (0.58, 0.43–0.76) and non-radiating (0.60, 0.44–0.81) LBP, whereas strength sports and body care only with less radiating LBP (0.76, 0.58–1.00 and 0.26, 0.09–0.74, respectively) adjusted for all sport types. On a sport-specific level, running and cycling were associated with less radiating and non-radiating LBP. In adulthood, the diversity of sport activities, particularly participation in endurance sports, may be associated with less radiating and non-radiating LBP.

Effectiveness of Dry Needling and Low-Level Laser Therapy in Nonspecific Low Back Pain

Introduction: Musculoskeletal spinal disorders are an immense problem in industrialised societies resulting in tremendous personal and economic costs. Younger adults (30 to 60-year-old) are more likely to experience Low Back Pain (LBP) from the disc space or from back muscle strain or other soft tissue strain. Experiencing it earlier in life may lead to recurrent and chronic LBP in adulthood. Dry Needling (DN) which are utilised to treat low back torment in current patterns. Low Level Laser Treatment (LLLT) is utilised to treat LBP by concentrating on the trigger focuses. Aim: To identify the effectiveness of DN and LLLT in the management of selected outcome variables among patients with nonspecific LBP. Materials and Methods: The Quasi experimental study was conducted among a total of 30 subjects who met the inclusion criteria. The subjects were divided into 15 each as group A (DN) and group B (LLLT). The Numerical Pain Distress Scale (NPDS), Quebec Back Pain Disability Scale (QBPDS) and lumbar flexion range of motion were assessed, before and after two weeks of intervention program to identify the effectiveness. Data analysis was done through SPSS and graph pad, using paired t-test and independent t-test. Results: Both groups have shown improvement after two weeks of intervention treatment program. Both groups showed significant difference in relieving pain, reducing disability and improving lumbar range of motion on nonspecific LBP individually. However, there was no significant difference found between the groups, thus null hypothesis was accepted and rejecting the alternate hypothesis. Conclusion: Both the techniques are equally effective in reducing the pain, disability level and improving range of motion individually after two weeks of intervention.

Predicting Factors at Skeletal Maturity for Curve Progression and Low Back Pain in Adult Patients Treated Nonoperatively for Adolescent Idiopathic Scoliosis With Thoracolumbar/Lumbar Curves: A Mean 25-year Follow-up.

A retrospective, long-term follow-up study. We aimed to clarify the predicting factors at skeletal maturity for future curve progression and low back pain (LBP) in adolescent idiopathic scoliosis (AIS) with thoracolumbar/lumbar (TL/L) curve. TL/L curves are likely to progress after skeletal maturity and cause LBP. Of 147 patients treated nonoperatively for AIS with TL/L curve, 56 (55 females; average age at the time of survey, 39.5 ± 7.1 years; average follow-up duration after maturity, 24.9 ± 6.9 years) completed questionnaires, including the visual analogue scale (VAS) for LBP and Oswestry disability index (ODI). Forty-nine patients underwent a radiological examination, and 48 underwent lumbar magnetic resonance imaging (MRI). The mean Cobb angle of the TL/L curve increased from 37.3° ± 7.5° to 47.8° ± 12.6° (0.41° ± 0.39° per year). The factors at skeletal maturity that were associated with the annual progression of the TL/L curve included a cranially located apical vertebra, and great apical vertebral translation and L3 tilt. In addition, the VAS for LBP was positively correlated with L4 tilt, and the ODI was positively correlated with L4 tilt and apical vertebral rotation. Multivariate analyses and receiver-operating characteristic curves demonstrated that L3 tilt at skeletal maturity independently predicted a curve progression ≥0.5° per year (odds ratio [OR], 1.17), while L4 tilt at skeletal maturity independently predicted a VAS ≥3 cm (OR, 1.20) and ODI ≥21% (OR, 1.25) in adulthood, with a cutoff value of approximately 16° for each factor. Moreover, lumbar disc degeneration on MRI was associated with L4 tilt at skeletal maturity and LBP in adulthood. Great L3 and L4 tilt at skeletal maturity, especially those >16°, are predictors of future curve progression and LBP in adulthood, respectively. For adolescent patients with these risk factors, periodic follow-ups into adulthood should be considered. 4.

Influence of a dynamic seating habit on lumbar motor control in schoolchildren.

Adequate motor control is considered important for spinal stability and the prevention of low back pain in adulthood and in childhood. Given that the sitting position can affect proprioception, this study aimed to evaluate the influence of using at school a triangular and dynamic cushion on schoolchildren's trunk motor control. Thirty 8-year-old schoolchildren were randomized into a control group (n= 15) and a "cushion group" (n= 15), in which the children used the cushion for one year and a half. At the end of this period, a 3D-analysis was used to assess lumbar spine proprioception by means of a trunk repositioning task performed blindfolded in a seated position in two conditions (on a stable and on an unstable surface). The schoolchildren in the cushion group performed better at the trunk repositioning task (p= 0.02) and hold their lumbar lordosis (p= 0.03) better than the control children, in both conditions (stable and unstable). This preliminary study suggests that daily use of a triangular dynamic cushion has a beneficial impact on children's lumbar proprioception. Further studies are needed to confirm these results and investigate the effectiveness of its use to prevent low back pain in adulthood.

Association between Pain in Adolescence and Low Back Pain in Adulthood: Studying a Cohort of Mine Workers.

Purpose. To study the association of self-reported pain in adolescence with low back pain (LBP) in adulthood among mine workers and, also, study associations between the presence of LBP over 12-month or one-month LBP intensity during a health examination and daily ratings of LBP three and nine months later. Methods. Mixed design with data collected retrospectively, cross-sectionally, and prospectively. Data was collected using a questionnaire during a health examination and by using self-reported daily ratings of LBP three and nine months after the examination. Results. Pain prevalence during teenage years was 55% and it was 59% at age 20. Pain during teenage years had a relative risk of 1.33 (95% confidence interval 1.03–1.73) of LBP 12 months prior to the health examination, but with no associations with LBP intensity or LBP assessed by text messaging. Pain at age 20 years was not associated with any measure of LBP in adulthood. Daily ratings of LBP were associated with LBP during the health examination three and nine months earlier. Conclusions. There were no clear associations between self-reported pain in adolescence and LBP in adulthood. Self-reported daily ratings of LBP were associated with LBP from the health examination. Possible limitations for this study were the retrospective design and few participants.

Low Back Pain in Adolescent Athletes; Evaluation and Rehabilitation

Low back is a problem on the rise in adolescents which can be specific or non specific type. The risk increases in adolescents with their participation in sports activities that place a high amount of stresses on the lumbar spine. This not only leads to increased absenteeism from school but also increases the risk to have low back pain in adulthood, hence it is important to do proper evaluation and rehabilitate these adolescents at the beginning. An accurate and comprehensive history goes far in establishing the differential diagnosis. The red flags have to be cleared and proper physical and functional evaluation has to be done. Rehabilitation has to be comprehensive with the aim to facilitate the return of the athlete back to sports. The purpose of this review is to outline the assessment and management methods available for adolescent athletes with low back pain.

Role of overweight and obesity in low back disorders among men: a longitudinal study with a life course approach

ObjectivesTo assess the association between being overweight or obese with low back pain (LBP) and clinically defined low back disorders across the life course.DesignA longitudinal and cross-sectional study.SettingA nationwide health...

Adolescent low back pain among secondary school students in Ibadan, Nigeria.

Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available. The study's objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalence's association with some socio-demographic variables. Participants were adolescent students from 15 secondary schools in Ibadan. Data was collected using a respondent-administered, validated questionnaire on low back pain in adolescents. Participants (Female: 298; Male: 273) aged 14.23 ±2.27 years (range 10-19) were recruited through multi-stage random sampling. Five hundred and seventy-one (83.97%) of the 680 copies of the questionnaire administered were returned. Data was analysed using mean, standard deviation, frequency, percentages, and Chi-square test with alpha level at 0.05. Lifetime, twelve-month, one-month and point prevalence rates of ALBP were 58.0%, 43.8%, 25.6% and 14.7% respectively. Age at first experience of ALBP was 11.86 ± 2.36 years. Gender was not significantly associated with any rate (p ≥0.317). Age (p ≤ 0.043) and engagement in commercial activities (p ≤ 0.025) were significantly associated with all period prevalence rates while injury to the back was significantly associated with all period prevalence rates except point prevalence (p = 0.087). Adolescent low back pain is common among secondary school students in Ibadan and its prevalence is significantly associated with age and engagement in commercial activities, but not with gender.

Sitting Postures and Trunk Muscle Activity in Adolescents With and Without Nonspecific Chronic Low Back Pain

A preliminary cross-sectional comparative study of adolescents with nonspecific chronic low back pain (NSCLBP) and healthy controls. To investigate whether differences in spinal kinematic and trunk muscle activity exist in both usual and slump sitting in adolescents with NSCLBP. Evidence suggests that low back pain commonly develops in adolescence and increases the risk for low back pain in adulthood. Sitting is an important consideration in adolescents with NSCLBP: currently there are no reports investigating their motor control strategies in sitting. Twenty-eight adolescents (14 female) with NSCLBP and 28 matched pain-free controls were recruited from a large cohort study. Pain subjects were subclassified based on O'Sullivan's classification system. Three-dimensional lumbo-pelvic kinematic data and the activation of 3 back and 2 abdominal muscles were recorded during usual and slump sitting. The flexion-relaxation phenomenon in sitting was also investigated. Spinal posture in usual and slump sitting were similar for adolescents with and without NSCLBP. However, differences were identified in both sitting conditions when those with NSCLPB were subclassified and compared with controls. Muscle activation differences were not consistently identified, with only lower levels of internal oblique activation in usual sitting in NSCLBP compared with pain-free controls showing significance. Flexion relaxation was observed in both iliocostalis and thoracic erector spinae in the NSCLBP group but not controls. This study provides preliminary results. Differences with sitting posture are only seen when adolescents with NSCLBP are classified. Trunk muscle activation is not a sensitive marker for discriminating subgroups of NSCLBP during adolescence.

Brace treatment for patients with Scheuermann's disease - a review of the literature and first experiences with a new brace design

BackgroundIn contemporary literature few have written in detail on the in-brace correction effects of braces used for the treatment of hyperkyphosis. Bradford et al. found their attempts effective, treating Scheuermann's kyphosis with Milwaukee braces, but their report did not specifically focus on in-brace corrections. White and Panjabi's research attempted to correct a curvature of > 50° with the help of distraction forces, but consequently led to a reduction in patient comfort in the application of the Milwaukee brace. In Germany they avoid this by utitlising braces to treat hyperkyphosis that use transverse correction forces instead of distraction forces. Further efforts to reduce brace material have resulted in a special bracing design called kyphologic™ brace. The aim of this review is to present appropriate research to collect and evaluate possible in-brace corrections which have been achieved with brace treatment for hyperkyphosis. This paper introduces new methods of bracing and compares the results of these with other successful bracing concepts.Materials and methods56 adolescents with the diagnosis of thoracic Scheuermann's hyperkyphosis or a thoracic idiopathic hyperkyphosis (22 girls and 34 boys) with an average age of 14 years (12-17 yrs.) were treated with the kyphologic™ brace between May 2007 and December 2008. The average Stagnara angle was 55,6° (43-80). In-brace correction was recorded and compared to the initial angle using the t-test.ResultsThe average Stagnara angle in the brace was 39°. The average in-brace correction was 16.5° (1-40°). The verage percentage of in-brace correction compared to the initial value was 36%. The differences were significant in the t-test (t = 5.31, p < 0,001). To make these results comparable to other studies, the kyphosis angle of 25° was set to 0 for our sample in order to achieve a norm value adapted (NVA) percentage of in-brace correction. By doing this a correction of 54.1% was achieved. There was no correlation between the percentage of in-brace correction and the age of the patient, but a highly significant correlation between percentage of in-brace correction and the initial Stagnara angle.DiscussionIf we assume that outcome of brace treatment positively correlates with in-brace correction, the treatment should be initiated before the curvature angle exceeds 50 - 55° in a growing adolescent. In scoliosis bracing, if the average in-brace correction equals > 15°, then it is predicted that the result will lead to a final correction. Applying this to hyperkyphosis patients, the average in-brace correction with this brace was also > 15°. We therefore estimated to achieve a favourable outcome using this brace type (once compliance was attained) especially when comparing the correction effects achieved with this new approach to the correction effects reported upon using the Milwaukee brace. The latter brace has been shown to lead to beneficial outcomes in long-term studies with comparable in-brace corrections.ConclusionConservative treatment of Scheuermann's hyperkyphosis in international literature is generally regarded as an effective treatment approach. Physiotherapy and bracing are the first-line treatments for this condition.An average in-brace correction of > 15° as was achieved using the kyphologic™ brace predicts a favourable outcome.The kyphologic™ brace leads to in-brace corrections comparable to those of the Milwaukee brace, which has previously been shown to provide beneficial outcome in the long-term.A prospective follow-up study seems desirable before final conclusions can be drawn.Future studies should focus more on thoracolumbar and lumbar curve patterns, because these patterns may predict chronic low back pain in adulthood with reduced quality of life of the patients and high costs with respect to medical care and occupational sickness leave.Surgery according to international literature is rarely necessary in this condition.

Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4,771 Danish adolescents

Social and economic disadvantage is associated with general poor physical health. This relationship has been recognised for centuries, but it is unknown whether socioeconomic factors have a specific influence on low back pain (LBP). Furthermore, it is unknown how social and economic disadvantages in youth affect adult health. Therefore, the specific objectives of this study are to explore (1) the cross-sectional association between socioeconomic status (SES) and LBP in adolescence and (2) the longitudinal association between SES in adolescence and LBP in early adulthood. A database containing LBP data from 4,771 twins was merged with their parents' social and economic data, available from Statistics Denmark. Low back pain data ['any low back pain' and 'persistent low back pain (more than 30 days)'] were collected in 1994, when the subjects were 12-18 years of age, and collected again eight years later. Socioeconomic data of the parents (education, income, social class and long-term illness, all for both mother and father) were collected in 1994. Logistic regression analyses were used to estimate the associations between each parameter of parental SES in adolescence and LBP at baseline as well as at follow-up. Finally, the influence of a variable combining the different socioeconomic parameters was established. All estimates were controlled for smoking, alcohol consumption and body mass index at baseline. In the logistic regression models, only three of the 32 estimates were statistically significant. When merging the socioeconomic variables into a combined score, the results indicated that a good social background had a protective effect against the persistent LBP, while there was no association with any LBP. However, the statistical significance of this effect was unclear. We found no or very weak indications of possible relationships between social factors in adolescence and LBP at baseline and at follow-up.

Prevalence and Characteristics of Low Back Pain in Secondary School Children (Mazandaran- Iran)

Introduction: Approximately, 30-40% of general population experience at least one episode of Low Back Pain (LBP) annually. Research on LBP in adolescents is of great value, as it seems to be a major contributing factor for LBP in adulthood. This study was designed to assess LBP characteristics and its disability in Mazandaran Province secondary school children in 2004. Materials and Methods: This cross-sectional study was carried out on secondary school children aged 11-14 years old. Random multistage sampling was performed and 5000 questionnaires were distributed among schoolchildren. The assessment of LBP characteristics and its related disability were assessed using two questionnaires. A 100 mm Visual Analogue Scale (VAS) was applied for measuring pain intensity and LBP disability was measured by the nine activities using the modified Hanover LBP Disability Questionnaire. Results: Of the original sample, 4813 (96.2%) children returned the questionnaires. Results showed that point prevalence of LBP was 15% and with 95% confidence interval for similar communities was estimated to be 14 to 16 %. 7.7% of students suffered from radiating pain to their legs. Among those with LBP, 60.4% reported that symptoms lasted 1-12 hours. 19.3% of children reported at least one episode of LBP in their life. The mean pain intensity on VAS was 32.8±20.48 mm. Of those with LBP, 100% also reported having difficulty with at least one of the nine activities on the modified Hanover LBP disability questionnaire. Sitting on a chair lasting for 45 minutes in classroom (33%) and standing up from armchair at home (5.8%) were the most and the least disabling factors respectively. Conclusion: The results suggested that the prevalence and disability rate of LBP in secondary schoolchildren is high. Therefore, further studies looking at the effect of different preventive strategies at home and school is recommended.