Nonspecific Back Pain

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The majority of back pain found during adolescence does not have an identifiable etiology and falls into the category of nonspecific back pain. Most studies have found that the prevalence of back pain rises during adolescence

(6,14-18), reaching adult levels in late adolescence. Generally, there is a 10% or lower lifetime prevalence of back pain in children 10 years or younger (4,15,16,19). The prevalence starts to rise in the next 1 to 2 years, with some studies reporting a lifetime prevalence of 7% to 30% (15,16,19,20). By 15 to 16 years, the reported lifetime prevalence is as high as 50-69% (15,19,21).

Many studies in several countries have been carried out to investigate the risk factors associated with the development of adolescent back pain and the relationship between back pain at this age versus adults (4,5,22). Most are cross-sectional studies, and are therefore unable to determine if the associated factor is a true marker or risk factor for back pain development (4). Most of the prospective studies involve small groups of subjects, which predispose them to potential subject selection bias. Conflicting results have been found when the same group of subjects is studied first by cross-sectional analysis and then prospectively. Comparison of the results of these different studies has been limited because of the multiple methodologies used. Inaccuracies also arise because of inconsistencies in the recall of back pain episodes by both children and adults.

In reviewing the factors that may be associated with adolescent back pain, we focused on the larger cross-sectional studies (6,14-19,21,23-28), and the six larger prospective studies (26,29-34). In these studies, the factors generally found to be associated with increased prevalence of back pain are older age, psychosocial factors, presence of other somatic symptoms and female gender. Less clear-cut factors include part-time work and smoking. Variable findings have been reported for sports activity. For example, a recent cross-sectional study of Danish adolescents found back pain to be associated with low isometric back extensor muscle endurance, with high isometric endurance being protective; no association was found with aerobic fitness, flexibility, functional strength, or physical activity (27). Factors not shown to be consistently associated with back pain include anthropomorphic factors (height, weight, body mass index), school bag use or weight, spinal or lower body flexibility, scoliosis, family history of back or other pain, and increased sedentary activities such as TV watching and computer use.

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