Still unclear what causes of high prevalence of low back pain among adolescents and children


A recent meta-analysis suggested that the prevalence of low back pain among adolescents and children has increased. However, delegates at annual meeting of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT; 5–6 June, Istanbul, Turkey were told, whether this increased prevalence is a true increase or is actually more a reflection of better recognition of the problem of low back pain in this age group is still unknown.

Teija Lund (ORTON Orthopaedic Hospital, Helsinki), said: “The past two decades have witnessed an increase in the research performed on this symptom in children and adolescents.”

She reported that in the 1980s, it was still believed that children should not have low back pain, and if they did, it was usually due to a severe pathology. However, Lund added: “Epidemiological research has now shown that low back pain in this age group is a common phenomenon with reported prevalence rates of up to 60%. The prevalence increases with age, and reaches that seen in adults by late adolescence.” Girls have a higher risk to develop back pain than boys.

According to a prospective long-term study carried out by Lund two years ago, 59% of healthy school age children followed through maturity experienced low back pain by the time they reached 18 to 19 years old. At the outset of the investigation when they were seven to eight years old, 9% of the children had reported experiencing low back pain, showing a clear increase in prevalence.

Epidemiological studies have investigated the possible associated factors or risk factors for childhood and adolescent low back pain, with conflicting results. “Several studies have addressed the influence of life-style factors, among others overweight, smoking, physical activity, and ‘screen time’. No definite conclusions can be made based on this research,” explained Lund. In fact the studies indicate that care must be taken with what may seem an obvious remedy, ie. physical activity. “The studies suggest that both a sedentary life style and competitive sports would increase the risk of low back pain,” said she reported. However, according to Lund, as most of these studies are cross-sectional and not longitudinal, they can only assess associations, and not causality.

Lund emphasised the most important recent development is that the medical community has now started to pay attention to musculoskeletal pain in children and adolescents, especially low back pain. Since some studies suggest that low back pain in early life is the strongest predictor of adult low back pain, there are clear implications for individual health and health care costs. “If we think of the common nature of low back pain – almost all of us experience it at some point of our life – and its financial implications to the health care system and society in general, preventing low back pain as early as possible would be beneficial from both the individual’s and society’s perspective,” Lund said.

She said that, therefore, in the future, more longitudinal studies will be needed to identify possible risk factors for low back pain in children and adolescents so that efforts can be directed toward developing preventive measures for these specific factors.