Potential Risk Factors and Triggers for Back Pain in Children and Young Adults  

A 2-Part Scoping Review, plus a Secondary Analysis

Potential Treatment Effect Modifiers for
Manipulative Therapy for Children
Complaining of Spinal Pain.
Secondary Analyses of a
Randomised Controlled Trial
Chiropractic & Manual Therapies 2019 (Dec 10); 27: 59 ~ FULL TEXT
This study was a secondary analysis of data from a randomised controlled trial comparing advice, exercises and soft tissue treatment with and without the years complaining of spinal pain. A text message system (SMS) and clinical examinations were used for data collection (February 2012 to April 2014).Five pre-specified potential effect modifiers were explored: Number of weeks with spinal pain 6 months prior to inclusion, number of weeks with co-occurring musculoskeletal pain 6 months prior to inclusion, expectations of the clinical course, pain intensity, and quality of life.Outcomes were number of recurrences of spinal pain, number of weeks with pain, length of episodes, global perceived effect, and change in pain intensity. To explore potential effect modification, various types of regression models were used depending on the type of outcome, including interaction tests.

Part I: Incident and Episodic Back Pain
Chiropractic & Manual Therapies 2019 (Nov 19); 27: 58 ~ FULL TEXT
The search identified 7,356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age. Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.

Part II: Unclear or Mixed Types of Back Pain
Chiropractic & Manual Therapies 2019 (Nov 19); 27: 61 ~ FULL TEXT
Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain. Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Pubertal Development and Growth are Prospectively
Asociated with Spinal Pain in Young People
(CHAMPS study-DK)
European Spine Journal 2019 (Jul); 28 (7): 1565–1571 ~ FULL TEXT
In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose-response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients.

Change in Young People's Spine Pain Following
Chiropractic Care at a Publicly Funded
Healthcare Facility in Canada
Complement Ther Clin Pract. 2019 (May); 35: 301–307 ~ FULL TEXT
Young people from a socioeconomically disadvantaged, underserved community with spinal pain experienced both statistically and clinically significant improvements in pain severity. A pragmatic course of chiropractic management, that was multimodal in nature, was found to have a favorable outcome as a treatment option for young people suffering with spinal pain of musculoskeletal etiology from a socioeconomically disadvantaged community. Further prospective research is warranted to explore the response of young people with specific diagnoses as the etiology of their spinal pain, and the changes in their functionality and disability, in response to chiropractic management.

The Natural Course of Low Back Pain From
Childhood to Young Adulthood -
A Systematic Review
Chiropractic & Manual Therapies 2019 (Mar 20); 27: 10 ~ FULL TEXT
Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

The Association Between Psychological and Social
Factors and Spinal Pain in Adolescents
European Journal of Pediatrics 2019 (Mar); 178 (3): 275–286 ~ FULL TEXT
This study indicated that psychological and social factors are associated with SP in adolescents with a higher frequency of these reported factors resulting in higher odds of reporting SP, especially “substantial SP”. Psychological factors appear to be more strongly related to SP than the social variables. Together, this reinforces the importance of understanding psychological and social factors in adolescents reporting SP.

Physical Risk Factors for Adolescent Neck and
Mid Back Pain: A Systematic Review
Chiropractic & Manual Therapies 2018 (Sep 24); 26: 36 ~ FULL TEXT
This systematic review could not identify distinct risk factors for adolescent NP and MBP. It could however show a strong need for prospective studies in this field using a consistent definition of NP and MBP, preferably using an illustration. The Young Spine Questionnaire (YSQ) [42] fulfills this requirement and its use is strongly encouraged, although further validation and cross-cultural adaptation is needed. [1] Furthermore, the inconsistency in reporting comparable outcomes should be reduced. This could possibly be achieved through an interdisciplinary consensus conference between stakeholders regarding this research topic and by further investigating the interplay between thoracic and cervical spine. Based on this review, sagittal alignment in sitting and standing should be further investigated as possible risk factors for adolescent NP and MBP using a consistent terminology for the outcomes and longitudinal research designs.

Conservative Care with or without Manipulative
Therapy in the Management of Back and/or Neck
Pain in Danish Children Aged 9-15:
A Randomised Controlled Trial Nested
in a School-based Cohort
BMJ Open. 2018 (Sep 10); 8 (9): e021358 ~ FULL TEXT
The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect.We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1-3) and intervention group 2 (IQR 0-4), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population.

Spinal Manipulation and Exercise for Low
Back Pain in Adolescents:
A Randomized Trial
Pain. 2018 (Jul); 159 (7): 1297–1307 ~ FULL TEXT
For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1–year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.

Spinal Pain and Co-occurrence with Stress and
General Well-being Among Young Adolescents:
A Study Within the Danish National Birth Cohort
European Journal of Pediatrics 2017 (Jun); 176 (6): 807–814 ~ FULL TEXT
Spinal pain in childhood and adolescence is strongly associated with spinal pain and generalized pain in adulthood. [2, 7, 11]. Therefore, it is of great importance to seek to treat and prevent spinal pain in children both to prevent discomfort for the child but also to reduce the individual and social costs of spinal pain in adulthood. If spinal pain among children and adolescents involves psychosocial well-being, then treatment as well as preventive initiatives might include psychosocial approaches, e.g., psycho education and development of appropriate coping strategies.

Spinal Pain in Danish School Children -
How Often and How Long?
The CHAMPS Study-DK
BMC Musculoskelet Disord. 2017 (Mar 27); 18 (1): 67 ~ FULL TEXT
Although rates of spinal pain report were high, for most children the pain was short-lived and did not recur frequently. Of concern though, was the rather substantial number of children who reported either persistent or recurrent pain. In at least a quarter of those with spinal pain, the episodes lasted for more than 4 weeks and/or occurred three times or more during a study year. It is towards this group that a concerted research effort is needed to inform evidence-based prevention and management.

Complementary and Alternative Medicine Use
by Children with Pain in the United States
Acad Pediatr. 2017 (Feb 20).  pii: S1876-2859(17)30063-3
Parents reported that 26.6% of children had pain conditions (e.g. headache, abdominal, musculoskeletal pain) in the past year; of these children, 21.3% used CAM. In contrast only 8.1% of children without pain conditions used CAM (χ²: p<.001). CAM use among children with pain was associated with female sex (adjusted odds ratio (aOR)=1.49, p=0.005), higher income (aOR=1.61, p=0.027), and presence of 4+ comorbidities (aOR=2.01, p=0.013). Among children with pain who used CAM the 2 most commonly used CAM modalities were biologically-based therapies (47.3%) (e.g., special diets and herbal supplements) and manipulative or body-based therapies (46.3%) (e.g., chiropractic and massage). CONCLUSIONS: CAM is frequently used by children with pain in the USA and many parents report benefits for their child's symptoms.

Multivariable Modeling of Factors Associated
with Spinal Pain in Young Adolescence
European Spine Journal 2016 (Sep); 25 (9): 2809–2821 ~ FULL TEXT
Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.

Neck Pain In Children:
A Retrospective Case Series
J Can Chiropr Assoc. 2016 (Sep); 60 (3): 212–219 ~ FULL TEXT
Spinal pain is common amongst the paediatric population (including children and adolescents). It is a significant health issue [1, 2], where 52% of paediatric patients report musculoskeletal (MSK) symptoms over a one-year period.[3] Neck pain is the most common spinal pain in pediatric patients [3, 4] with 60% reporting neck pain persisting at two years after this study began. [5] A survey of Finnish school children reported neck pain experienced at least once during the week.

Whose Pain Is It Anyway? Comparability of Pain
Reports From Children and Their Parents
Chiropractic & Manual Therapies 2016 (Aug 1); 24: 24 ~ FULL TEXT
Percentage agreement between parent and child assessment was around 50% in Sample 1 and 68% in Sample 2. The poor agreement was due to children reporting pain when their parent did not, the reverse very rarely occurred. Pain of greater intensity or longer duration resulted in better agreement between the child and parent. Child age and gender did not influence the likelihood of agreement.

Musculoskeletal Pain in Children and Adolescents
Brazilian Journal of Physical Therapy 2016 (May); 20 (3): 275–284 ~ FULL TEXT
Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research.

Is Back Pain During Childhood or Adolescence
Associated with Muscle Strength, Muscle
Endurance aerobic Capacity: Three
Systematic Literature Reviews
with one Meta-analysis
Chiropractic & Manual Therapies 2015 (Jul 16); 23: 21 ~ FULL TEXT
The present review revealed there to be no association between increased BMS in trunk extension and BP, whereas such an association was clearly present when testing for BME. When adding the results of the meta-analysis for the BME data, the previous findings were confirmed that there is a small but statistically significant protective effect of BME on BP. However, the association between AC and BP requires further studies to evaluate if there is a modifying or confounding link with BME.

Quality of Life, School Backpack Weight, and
Nonspecific Low Back Pain in Children
and Adolescents
J Pediatr (Rio J). 2015 (May); 91 (3): 263–269 ~ FULL TEXT
Girls reported higher disability than boys (p = 0.01), and lower QoL in the domains of physical (p < 0.001) and emotional functioning (p < 0.01), psychosocial health (p = 0.02) and physical health summary score (p < 0.001), and on the total PedsQL score (p < 0.01). School backpack weight was similar in both genders (p = 0.61) and in participants with and without LBP (p = 0.15). After adjustments, participants with LBP reported lower physical functioning (p < 0.01), influencing lower physical health summary score (p < 0.01).

Pain Characteristics of Adolescent Spinal Pain
BMC Pediatrics 2015 (Apr 17); 15 (1): 42 ~ FULL TEXT
Adolescents who suffered from pain in more than one spinal area reported higher pain intensity and frequency than those with pain in only one spinal area. Sleep disorders were a significant predictor for pain in more than one spinal area (p < 0.01) as well as a trend for frequent pain (p = 0.06). Adolescents with frequent pain showed impaired balance on one leg standing with closed eyes (p = 0.02).

Back Pain in Children Surveyed with Weekly
Text Messages - A 2.5 Year Prospective
School Cohort Study
Chiropractic & Manual Therapies 2014 (Nov 18); 22 (1): 35 ~ FULL TEXT
BP does not appear to be a major problem in childhood. Knowledge about the causes of BP in childhood might allow early prevention, however, and the topic is therefore important from a public health viewpoint. It would be productive for further research to study the circumstances surrounding the appearance of back pain in childhood, as well as how various bio-psycho-social factors affect its onset and later recurrence. A better understanding of the severity and consequences of back pain in childhood is also needed. From a clinical viewpoint, health professionals should be vigilant if children present with constant or recurring back pain, as such a pattern appears to be unusual in this population group.

Is Puberty a Risk Factor For Back Pain
in the Young? A Systematic Critical
Literature Review
Chiropractic & Manual Therapies 2014 (Oct 15); 22 (1): 27 ~ FULL TEXT
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.

Adolescent Neck and Shoulder Pain--The Association
with Depression, Physical Activity, Screen-based
Activities, and Use of Health Care Services
J Adolesc Health 2014 (Sep); 55 (3): 366–372 ~ FULL TEXT
Frequent neck and shoulder pain was reported in 20% of Norwegian adolescents. Symptoms of depression and screen-based activities increased the risk of neck and shoulder pain while physical activity was protective. Individuals reporting neck and shoulder pain visited health services more frequently than others.

Spinal Pain in Adolescents: Prevalence, Incidence,
and Course: A School-based Two-year Prospective
Cohort Study in 1,300 Danes Aged 11–13
BMC Musculoskelet Disord. 2014 (May 29); 15: 187 ~ FULL TEXT
Spinal pain is common at the age of 11–15 years, but some have more pain than others. The pain is likely to progress, i.e., to more locations, higher frequency, and higher pain intensity over a two-year period.

Spinal Manipulation and Exercise for Low Back
Pain in Adolescents: Study Protocol for a
Randomized Controlled Trial   NCT01096628
Chiropractic & Manual Therapies 2014 (May 23); 22: 21 ~ FULL TEXT
This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

An International Survey of Pain in Adolescents
BMC Public Health. 2014 (May 13); 14 (1): 447 ~ FULL TEXT
Adolescence marks the transition from childhood to adult life. Pain during adolescence is an important predictor of future pain. [1–3] A Danish twins study [4] found adolescents with persistent low back pain were 3.5 times more likely to have low back pain in adulthood. Co-occurrence of low back pain and headache in adolescence further increases the risk of developing future pain which draws attention to the significance of multiple pains. [4]

High Prevalence of Daily and Multi-site pain --
A Cross-sectional Population-based Study
Among 3000 Danish Adolescents
BMC Pediatrics 2013 (Nov 19); 13: 191 ~ FULL TEXT
In this population-based cohort of school-attending Danish adolescents, nearly two out of three reported current pain and, on average, one out of three reported pain in more than one body region. Female sex, and high level of sports participation were associated with increased odds of having almost daily pain and multi-site pain. The study highlights an important health issue that calls for investigations to improve our understanding of adolescent pain and our capacity to prevent and treat this condition.

Early Adolescent Lumbar Intervertebral
Disc Injury: A Case Study
Chiropractic & Manual Therapies 2013 (Apr 26); 21: 13 ~ FULL TEXT
This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.

Prevalence of Low Back Pain in Children
and Adolescents: A Meta-analysis
BMC Pediatrics 2013 (Jan 26); 13: 14 ~ FULL TEXT
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.

School Children's Backpacks, Back Pain
and Back Pathologies
Arch Dis Child. 2012 (Aug); 97 (8): 730–732
Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The prevalence of school children carrying heavy backpacks is extremely high. Preventive and educational activities should be implemented in this age group.

Effect of Backpack Load Carriage on Cervical
Posture in Primary Schoolchildren
Work. 2012 (Jan 1); 41 (1): 99–108
Subjects demonstrated immediate and statistically significant changes in craniovertebral angle (CVA), indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the walking of 6 minutes, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20% of body weight conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.
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Chronic Idiopathic Pain in Adolescence--
High Prevalence and Disability:
The Young HUNT Study 2008
Pain. 2011 (Oct); 152 (10): 2259–2266 ~ FULL TEXT
This study shows that chronic idiopathic pain in adolescence is common, particularly among girls, and may have a major negative impact on everyday life, with high disability. The disability increases with frequency of pain and number of pain locations; and adolescents with musculoskeletal pain in 3 or more locations, as well as those with daily pain, constitute a group with high subjective disability index. Further studies are needed to analyze pain-associated factors, such as psychosocial and lifestyle factors, in order to suggest appropriate intervention strategies.

Neck and Back Pain in Children:
Prevalence and Progression Over Time
BMC Musculoskelet Disord. 2011 (May 16); 12: 98 ~ FULL TEXT
The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood. Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.

Improving Schoolchildren's Knowledge of Methods
for the Prevention and Management of Low Back
Pain: A Cluster Randomized
Controlled Trial
Spine (Phila Pa 1976). 2011 (Apr 15); 36 (8): E505–512 ~ FULL TEXT
Positive results from this study suggest that it may be advisable to generalize this campaign to larger populations of that age, and that for very young children, a “comic book” format, in which messages are conveyed in simple terms and with drawings that catch the children’s attention, is probably an appropriate way to educate children at such an early age on preventive mechanisms.

Pain in Children and Adolescents: Prevalence,
Impact on Daily Life, and Parents' Perception,
A School Survey
Scand J Caring Sci. 2011 (Mar); 25 (1): 27–36
Sixty per cent of the children and adolescents reported pain within the previous 3 months. Pain increased with age, where girls aged 16–18 years reported the most pain. Total prevalence of chronic pain was 21%. Children reported impact on social life; inability to pursue hobbies, disturbed sleep, absence from school, and inability to meet friends because of pain. The girls reported significantly more frequently disturbed sleep, loss of appetite, and use of medication, compared to the boys. There was little agreement between parents and children regarding pain.

Chiropractic and Children:
Is More Research Enough?
Chiropractic & Osteopathy 2010 (Jun 2); 18: 11 ~ FULL TEXT
In evidence-based (informed) practice, one takes into account not only research-based evidence but also clinical expertise and the patients' perspectives. In this paper, we briefly discuss how this should be handled in clinical practice is briefly discussed, using the concept of "traffic lights" (red, yellow, green). We explain how the combination of evidence and plausibility can be used to reach a decision as to whether a treatment or diagnostic procedure is suitable, possible, or unsuitable.

Children and Chiropractic Care:
A Window of Opportunity
J Manipulative Physiol Ther. 2009 (Oct); 32 (8): 603–605 ~ FULL TEXT
Health and lifestyle early in life have profound impact on health and quality of life in later years. Common public health problems such as musculoskeletal disorders, cardiovascular disease, and depression tend to cluster in individuals, and this pattern is established early. At present, no health care profession has convincingly assumed the responsibility of spinal and musculoskeletal health for children. Considering the magnitude of the challenges ahead for both researchers and clinicians, this may be a good opportunity for doctors of chiropractic to take responsibility and engage in a determined effort to bring forward evidence-based strategies for prevention of spinal pain and other musculoskeletal problems.

A Description of Children and Adolescents in
Danish Chiropractic Practice: Results from
a Nationwide Survey
J Manipulative Physiol Ther. 2009 (Oct); 32 (8): 607–615 ~ FULL TEXT
For the older children, musculoskeletal problems were the most dominant complaint, ranging from 33% among the preschool children to 75% among the teenagers. These complaints were often chronic and about a third of the children older than 2 years had experienced symptoms for more than 1 year before seeing the chiropractor. Among the older children and the adolescents, musculoskeletal complaints were most common and mostly of a chronic nature. The large number of pediatric patients in chiropractic practices and the paucity of evidence of treatment effectiveness indicate the need for further research in these age groups.

Chronic Muloskeletal Pain in Children:
Assessment and Management
Rheumatology (Oxford). 2009 (May); 48 (5): 466–474 ~ FULL TEXT
Pediatricians and pediatric rheumatologists review a large number of children with ongoing pain (disease and non-disease related). A small number of these develop chronic pain conditions that are complex and distressing. Over recent years studies of the epidemiology, aetiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention. Medication has a role when part of a multidisciplinary framework, although there is little evidence for or against the effectiveness of most pharmacotherapy. There is strong evidence to support early targeted psychological and physical intervention, and an understanding that parental education and involvement is essential if progress is to be maintained. In this review, an overview of the assessment is presented and management of childhood chronic musculoskeletal pain conditions with reference to main research findings to date.

Medical Doctors Likely to Encounter Children
With Musculoskeletal Complaints Have Low
Confidence in Their Clinical Skills
J Pediatrics 2009 (Feb); 154 (2): 267–271
Questionnaires, filled out by a broad spectrum of medical providers in England [Primary Care (n = 75), Pediatrics (n = 39), Emergency (n = 39), Orthopedics (n = 40), and experienced doctors in Primary Care (n = 93), and Pediatrics (n = 60).], revealed that 74% of them scored their personal confidence in pediatric musculoskeletal clinical assessment as "no" to "low".

Non-specific Neck Pain in Schoolchildren:
Prognosis and Risk Factors for Occurrence
and Persistence. A 4-year Follow-up Study
Pain. 2008 (Jul 15); 137 (2): 316–322 ~ FULL TEXT
In conclusion, neck pain in schoolchildren tends to fluctuate, but there also seems to exist a subgroup (5%) with persistent NP already in pre-/early adolescents, or even earlier. Co-occurrence of frequent other musculoskeletal symptoms and/or markers of psychological stress with frequent NP are risk indicators for a more persistent course, at least within next few years. Since adult chronic NP problems might originate in childhood, further studies are needed, including preventive interventions.

Epidemiology of Adolescent Spinal Pain:
A Systematic Overview of the Research Literature
Spine (Phila Pa 1976). 2007 (Nov 1); 32 (23): 2630–2637 ~ FULL TEXT
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.

Neck and Shoulder Pains in Relation to Physical
Activity and Sedentary Activities in Adolescence
Spine 2007 (Apr 20); 32 (9): 1038–1044
Almost half of the girls and one third of the boys reported mild neck or occipital pain, or shoulder pain, and 3% of girls and 2% of boys reported severe neck or occipital pain, or shoulder pain during the past 6 months. High-level physical activity associated with an increased prevalence of both severe neck or occipital pain and severe shoulder pain in girls, but not in boys. Prolonged sitting was associated with a high prevalence of neck or occipital pain and shoulder pain in girls, and neck or occipital pain in boys. Of various sedentary activities, television watching and reading books associated with neck or occipital pain in girls, whereas playing or working with a computer associated with neck or occipital pain in boys. In girls, television watching also associated with mild shoulder pain.

Back and Pelvic Pain in an Underserved
United States Pregnant Population:
A Preliminary Descriptive Survey
J Manipulative Physiol Ther. 2007 (Feb); 30 (2): 130–134 ~ FULL TEXT
Low back pain (LBP) in the general population is recognized as a major health concern, and left untreated, this malady can lead to chronic, disabling morbidity. [1, 2] Accordingly, chronic pain is a major health care expense in the United States, and LBP is responsible for the majority of chronic musculoskeletal pain. [3] Low back pain and pelvic pain (PP) in pregnancy, however, are frequently viewed as transient conditions that are anticipated to subside after childbirth. In fact, recent studies have identified that women who do have LBP/PP during pregnancy receive little recommendations and/or treatment for their complaints. [4, 5]

Is Comorbidity in Adolescence a Predictor for
Adult Low Back Pain? A Prospective Study
of a Young Population
BMC Musculoskelet Disord 2006 (Mar 16); 7: 29 ~ FULL TEXT
Your chiropractic care may be working out “kinks” in your lower back that have been around a lot longer than you realize. This new study of 10,000 Danish residents shows a link between adolescent and adult low back pain (LBP). Researchers studied twins born between 1972 and 1982 by sending out questionnaires in 1994 and again in 2002. The outcomes showed that a high percentage of those who had LBP in 1994 still suffered from LBP in 2002. They also found that those with persistent LBP were 4.5 times more likely than the average person to have future LBP episodes!

The Course of Low Back Pain from Adolescence
to Adulthood: Eight-year Follow-up
of 9600 Twins
Spine 2006 (Feb 15); 31 (4): 468–472 ~ FULL TEXT
High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1–7, 8–30, >30). Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain.

An Epidemiologic Study of MRI and Low
Back Pain in 13-year-old Children
Spine (Phila Pa 1976). 2005 (Apr 1); 30 (7): 798–806
In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference. Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.

Persistence and Change in Nonspecific Low
Back Pain Among Adolescents: A 3-year
Prospective Study
Spine (Phila Pa 1976). 2004 (Nov 1); 29 (21): 2452–2457
Our findings indicate that reports of LBP in midadolescence are strong predictors of future LBP in late adolescence, although half of those reporting LBP at baseline did not report LBP at follow-up and one fourth had forgotten minor previous episodes. The data confirm the general trend that LBP, often provoked by manual work and prolonged sitting, is common, and the results indicate a consistent, but changeable, pattern of juvenile LBP. Future research should study the significance of reports of LBP provoked by manual work and sitting during adolescence for future LBP and disability in adulthood.

Evaluation of Chiropractic Management of
Pediatric Patients with Low Back Pain:
A Prospective Cohort Study
J Manipulative Physiol Ther 2003 (Jan); 26 (1): 1–8 ~ FULL TEXT
Fifteen chiropractors provided data on 54 consecutive pediatric patients with LBP. The average age of the patients was 13.1 years, 57% were male, 61% were acute, with 47% attributing onset to a traumatic event (most commonly sports-related); 24% reported an episode duration of greater than 3 months. Almost 90% of cases presented with uncomplicated mechanical LBP, most frequently diagnosed as lumbar facet dysfunction or subluxation.

Back, Neck, and Shoulder Pain in Finnish
Adolescents: National Cross Sectional Surveys
British Medical Journal 2002 (Oct 5); 325 (7367): 743–745 ~ FULL TEXT
To study changes in the prevalence of pain in the back or neck in adolescents between the years 1985 and 2001, the authors compared biennial nationwide postal surveys, between 1985–2001, and annual classroom surveys, from 1996–2001. They found that pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders for future adults. Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 43% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds.

Back Pain Reporting Pattern in a Danish
Population-based Sample of Children
and Adolescents
Spine (Phila Pa 1976). 2001 (Sep 1); 26 (17): 1879–1883
The 1-month prevalence of back pain was 39%. Thoracic pain is most common in childhood, whereas thoracic pain and lumbar pain are equally common in adolescence. Neck pain and pain in more than one area of the spine are rare in both age groups. No gender differences were found. Of those who had back pain, 38% also reported some type of consequence, usually either visits to a medical physician or diminished physical activities.

Neck or Shoulder Pain and Low Back Pain
in Finnish Adolescents
Scand J Public Health. 2000 (Sep); 28 (3): 164–173
Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16–18-year-old girls.

Prolonged Low-Back Pain in Young Athletes:
A Prospective Case Series Study
of Findings and Prognosis
European Spine Journal 1999 (Dec); 8 (6): 480–484 ~ FULL TEXT
We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series.

Why the Back of the Child?
European Spine Journal 1999; 8 (6): 426–428 ~ FULL TEXT
An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP).

At What Age Does Low Back Pain Become a
Common Problem? A Study of 29,424
Individuals Aged 12–41 Years
Spine (Phila Pa 1976). 1998 (Jan 15); 23 (2): 228–234
The prevalence of the various definitions of low back pain increased greatly in the early teen years (earlier for girls than for boys), and by the ages of 18 years (girls) and 20 years (boys) more than 50% had experienced at least one low back pain episode. The pattern for the 1-year period prevalence of low back pain was very similar to that for the lifetime prevalence; both started at 7% (95% confidence interval, 5–9%) for the 12-year-old individuals and reached 56% (95% confidence interval, 53–59%) and 67% (95% confidence interval, 62–71%), respectively, for the 41-year-old individuals.

ABC of Sports Medicine: Musculoskeletal
Injuries in Child Athletes
British Medical Journal 1994 (Jun 11); 308: 1556–1559
The growing skeletons of children may be injured more easily than the mature skeletons of adults because the bones are more porous and the long bones are further weakened by the epiphysical plates at their proximal and distal ends.