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PubMed1998

Methodologic issues in low back pain research in primary care.

STUDY DESIGN: Narrative review and discussion of the selected literature. OBJECTIVES: To discuss some important methodologic challenges in low back pain research in primary care. SUMMARY OF BACKGROUND DATA: Many methodologic problems must be confronted when conducting low back pain research. Some of these problems are back pain specific or specific to the primary care setting. METHODS: Methodologic problems related to four research issues will be discussed: study designs, definition of low back pain, determinants of low back pain, and outcome assessment. RESULTS: Two fundamentally different study designs are frequently used in low back pain research, namely observational studies and experimental studies. The definition of low back pain is typically restricted to a highly variables self-reported symptom, the sensation of pain in the back. There clearly is a need for an evidence-based classification system for low back pain. Because a tenable theoretical framework is lacking, it is difficult to know which determinants of low back pain should be quantified. Low back pain studies focus usually on health-related quality-of-life outcome parameters. The identification of the minimum clinically relevant changes for the most important outcome instruments needs further consideration. CONCLUSIONS: In years to come, low back pain researchers are challenged to overcome some of these (and other) problems to enhance the quality of low back pain research in primary care.

Clinical Trials as Topic↗
PubMed1999

Is occupational low back pain on the rise?

STUDY DESIGN: A retrospective analysis of back pain claim data from two sources, a workers' compensation provider and Washington State Department of Labor and Industries. The Workers' Compensation Provider claim data were examined over a 9-year period, 1987-1995, and the Washington claim data were examined over a 5-year period, 1991-1995. In addition, a third source of data, reports of back pain from the the Bureau of Labor Statistics, was examined over a 4-year period, 1992-1995. OBJECTIVES: To characterize occupational low back pain trends in the United States. More specifically, trends in back pain rates and costs as well as back injury rates from the Bureau of Labor Statistics were discerned. SUMMARY OF BACKGROUND DATA: The literature often refers to a recent rise in occupational low back pain. However, the question is: Do empirical data support this notion? METHODS: Retrospective analysis of workers' compensation provider, Washington State, and Bureau of Labor Statistics data. RESULTS: The U.S. estimate of the annual low back pain claim rate decreased 34% between 1987 and 1995, although the trend was not monotonic. There was a sharper decrease in the U.S. estimate of the annual low back pain claim costs during this time (58%). In 1995, however, occupational low back pain remained a major problem in the U.S.: an estimated $8.8 billion was spent on low back pain claims, and the rate of filing low back pain claims was 1.8 per 100 workers. CONCLUSIONS: Evidence of a rise in occupational low back pain was not discerned for the 8-year period studied. Data from three sources support this finding. However, occupational back pain remains a major problem in the U.S.

Costs and Cost Analysis↗
PubMed1999

Low back pain and lifestyle. Part II--Obesity. Information from a population-based sample of 29,424 twin subjects.

STUDY DESIGN: A cross-sectional postal survey of 29,424 twin subjects aged 12-41 years obtained from a population-generated panel. OBJECTIVES: To determine whether obesity is associated with low back pain. SUMMARY OF BACKGROUND DATA: Despite a large number of epidemiologic studies in this area, it is unclear whether obesity and low back pain are positively associated, and if so, whether there is a causal association. METHODS: The association and dose-response connection between body mass index and nonspecific low back pain experienced by subjects in the preceding year were studied. Possible modifying effects of age, gender, type of work, and smoking were investigated. The prevalence of nonspecific low back pain was also studied in monozygotic twin pairs who were dissimilar in body mass index. RESULTS: There was a modest positive association between body mass index and low back pain that increased with the duration of low back pain. The underweight subjects consistently reported lower prevalence of low back pain (odds ratios < 1) than did those higher in weight. The dose-response curve was usually A-shaped. A positive monotonic dose response was apparent mainly in those with long-lasting or recurrent low back pain. The positive association between body mass index and low back pain disappeared when monozygotic twins who were dissimilar in body weight classification were studied. CONCLUSIONS: Obesity is modestly positively associated with low back pain, in particular with chronic or recurrent low back pain. However, because the association is weak, because there is no consistent positive monotonic dose response, and because the link disappears in monozygotic twins who are dissimilar in body mass index, it is unlikely that this association is causal. It is possible, however, that obesity plays a part in the chronicity of simple low back pain. Therefore, those with recurring or long-term low back pain deserve further attention.

Adolescent↗
PubMed1999

Recurrent low back pain and early disc degeneration in the young.

STUDY DESIGN: A prospective 9-year follow-up study involving randomized matched subgroups of 15-year-old schoolchildren with or without low back pain at baseline. OBJECTIVES: To evaluate the long-term persistence of initially reported recurrent low back pain, and to examine the significance of abnormalities found in magnetic resonance imaging of lumbar discs in individuals 15 and 18 years of age as possible contributors to persistently recurrent low back pain. SUMMARY OF BACKGROUND DATA: In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. The current results, in accordance with previous findings, indicate that there is a subgroup of adolescents with more chronic symptoms which, in the authors' opinion, deserves more attention. Disc disease accompanying low back pain is a key issue both in research and clinical practice. The significance of early degenerative findings in the lumbar discs is not known. METHODS: In the survey of 14-year-olds (n = 1503), a subgroup (7.8%) with recurrent low back pain was found. A random sample of individuals with recurrent low back pain (n = 40) and an equal number of completely asymptomatic control subjects were selected for a comparative study. The selected groups were examined by magnetic resonance imaging at 15 and 18 years of age. The participation rate of youth at 14, 18, and 23 years of age for all three questionnaires was 82% (29 boys and 33 girls). Imaging data were interpreted by two blinded radiologists experienced in low-field-strength magnetic resonance imaging. In calculations of relative risks, the participants reporting recurrent low back pain in all phases of the study were compared with participants who had no persistently recurrent pain. RESULTS: Eleven participants (35%) in the original group with low back pain persistently reported recurrent pain. In 15-year-old participants with disc degeneration, the relative risk of reporting recurrent low back pain up to the age of 23 years was 16 (95% confidence interval 2.2-118) compared with those having no disc degeneration. In addition, disc protrusion and Scheuermann-type changes at 15 years contributed to the risk of persistently recurrent low back pain. CONCLUSIONS: The authors' earlier findings already favored the hypothesis of a causal relation between the early evolution of a degenerative process of lower lumbar discs and recurrent low back pain in the near future. The current results further strengthen this hypothesis, indicating that individuals with disc degeneration soon after the phase of rapid physical growth not only have an increased risk of recurrent low back pain at this age, but also a long-term risk of recurrent pain up to early adulthood.

Adolescent↗
PubMed2002

Episodes of low back pain: a proposal for uniform definitions to be used in research.

STUDY DESIGN: Literature review and group discussions. OBJECTIVE: To propose uniform definitions for low back pain episodes to be used in research. BACKGROUND: Different definitions of episodes have been used in low back pain studies. This hampers comparison of study results. Definitions are proposed for episodes of low back pain, care for low back pain, and work absence because of low back pain. METHODS: In a Medline search, we identified about 1200 papers, of which 81 possibly contained a definition of episodes. In group discussions, we decided which definitions to propose and discussed their applicability. RESULTS: We found few definitions in the literature. In the group discussions we decided to define an episode of LBP as a period of pain in the lower back lasting for more than 24 hours, preceded and followed by a period of at least 1 month without low back pain. An episode of care for low back pain was defined as a consultation or a series of consultations for low back pain, preceded and followed by at least 3 months without consultation for low back pain. An episode of work absence due to low back pain was defined as a period of work absence due to low back pain, preceded and followed by a period of at least 1 day at work. CONCLUSIONS: In many studies, episodes of low back pain are mentioned without a clear definition. We consider our proposed definitions of episodes to be arbitrary but well considered. We advise that they be tested for use in future research.

Absenteeism↗
PubMed2004

Estimates and patterns of direct health care expenditures among individuals with back pain in the United States.

STUDY DESIGN: Secondary analysis of the 1998 Medical Expenditure Panel Survey. OBJECTIVE: To estimate total health care expenditures incurred by individuals with back pain in the United States, calculate the incremental expenditures attributable to back pain among these individuals, and describe health care expenditure patterns of individuals with back pain. SUMMARY OF BACKGROUND DATA: There is a lack of updated information on health care expenditures and expenditure patterns for individuals with back pain in the United States. METHODS: This study used data from the 1998 Medical Expenditure Panel Survey, a national survey on health care utilization and expenditures. Total health care expenditures and per-capita expenditures among individuals with back pain were calculated. Multivariate regression models were used to estimate the incremental expenditures attributable to back pain. The expenditure patterns were examined by stratifying individuals with back pain by sociodemographic characteristics and medical diagnosis, and calculating per-capita expenditures for each stratum. RESULTS: In 1998, total health care expenditures incurred by individuals with back pain in the United States reached 90.7 billion dollars and total incremental expenditures attributable to back pain among these persons were approximately 26.3 billion dollars. On average, individuals with back pain incurred health care expenditures about 60% higher than individuals without back pain (3,498 dollars vs. 2,178 dollars). Among back pain individuals, at least 75% of service expenditures were attributed to those with top 25% expenditure, and per-capita expenditures were generally higher for those who were older, female, white, medically insured, or suffered from disc disorders. CONCLUSIONS: Health care expenditures for back pain in the United States in 1998 were substantial. The expenditures demonstrated wide variations among individuals with different clinical, demographic, and socioeconomic characteristics.

Adolescent↗
PubMed2004

Prevalence, incidence, and recurrence of low back pain in scaffolders during a 3-year follow-up study.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To describe the natural history of low back pain by its prevalence, incidence, and recurrence during a 3-year period and identify risk factors for cumulative incidence and recurrence of low back pain in scaffolders. SUMMARY OF BACKGROUND DATA: Although some studies have described prevalence, incidence, or recurrence of low back pain, few studies have assessed two or more of these outcome measures simultaneously. Furthermore, little is known about the association between individual, physical, psychosocial, and health-related risk factors and cumulative incidence and recurrence of low back pain in scaffolders. METHODS: Between 1998 and 2001, a cohort of 288 scaffolders (response 85%) completed a questionnaire at baseline and at three yearly follow-ups during 3 years. RESULTS: At baseline 60% of the study population had had an episode of low back pain in the past 12 months of which 22% was of chronic nature. During follow-up, the yearly incidence of low back pain varied between 20% and 28%, while yearly recurrence rates were 64% to 77%. Only few workers consistently reported the presence (20%) or absence (26%) of low back pain each year. Weak significant associations were present for the following: age 35 to 44 years, moderate general health, high strenuous arm movements, and body mass index with the cumulative incidence of low back pain. Significant associations were found between high manual handling of material and high job demand and low job control and the cumulative recurrence of low back pain, while moderate general health only showed a weak significant association with this outcome measure. CONCLUSIONS: Low back pain was a dynamic process with high rates for incidence, recurrence, and recovery. General health and work-related physical and psychosocial factors influenced both the incidence and recurrence of low back pain. The incidence and recurrence of low back pain depend strongly on the recall period of low back pain and the time-window of investigation.

Adult↗
PubMed2006

The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins.

STUDY DESIGN: Prospective study with 8-year follow-up. OBJECTIVE: To describe the evolution of low back pain from adolescence into adulthood. SUMMARY OF BACKGROUND DATA: 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. It is important to understand the nature of such a link if effective preventive programs are to be established. METHODS: 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). RESULTS: 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. Twenty-six percent of those with low back pain for more than 30 days during the baseline year also had more than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample. CONCLUSIONS: Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.

Adolescent↗
PubMed2006

A population-based survey of back pain beliefs in Canada.

STUDY DESIGN: Population-based survey. OBJECTIVES: To assess the back pain beliefs in 2 provinces in Canada to inform a population-based educational campaign. SUMMARY OF BACKGROUND DATA: Beliefs, attitudes, and recovery expectations appear to influence recovery from back pain, yet prevailing public opinions about the condition have been little studied. METHODS: Telephone surveys were conducted with 2400 adults in 2 Canadian provinces. Surveys included the Back Beliefs Questionnaire, and additional questions concerning age, gender, recent and lifetime back pain, coping strategies for back pain, and awareness and persuasiveness of media information concerning back pain. RESULTS: A high prevalence of back pain was reported, with a lifetime prevalence of 83.8%, and 1-week prevalence of 34.2%. Generally, a pessimistic view of back pain was held. Most agreed that back pain makes everything in life worse, will eventually stop one from working, and will become progressively worse with age. Mixed opinions were observed regarding the importance of rest and staying active. A significant minority (12.3%) reported taking time off from work for their last back pain episode. Those individuals taking time off from work held more negative back pain beliefs, including the belief that back pain should be rested until it gets better. CONCLUSIONS: Public back pain beliefs in the 2 Canadian provinces sampled are not in harmony with current scientific evidence for this highly prevalent condition. Given the mismatch between public beliefs and current evidence, strategies for reeducating the public are needed.

Adolescent↗
PubMed2005

Back pain reporting in young girls appears to be puberty-related.

BACKGROUND: There is a large increase in back pain reporting in the early teens. In no previous study has the prevalence of low back pain been investigated in relation to the onset of puberty. The objective of this study was to establish whether the onset of puberty is associated with back pain reporting in young girls. METHODS: A subsample of 254 girls aged 8-10 years and 165 girls aged 14-16 years from a cross-sectional survey of 481 children aged 8-10 years and 325 adolescents aged 14-16 years of both sexes. Main outcome measures were back pain defined as low back pain, mid back pain, and/or neck pain in the past month. Other variables of interest were Puberty (five different stages), age, body mass index, and smoking. Independent information on onset of puberty was obtained through a physical examination and on back pain through an individual structured interview. The association was studied between onset of puberty and the outcome variable (the one month period prevalence of back pain), controlling for overweight, and smoking. Odds ratios with 95% confidence intervals were used to describe bivariate associations, logistic regression with robust standard errors was used for multivariate analyses. RESULTS: There is a highly significant trend for increased back pain reporting with increasing level of puberty until maturity is reached. The biggest leap appears between the second level (beginning of puberty) and the third level (mid puberty) and the findings remain after controlling for the covariates. These results emanate from the low back, whereas pain in the mid back and neck do not seem to be linked with pubertal stage. CONCLUSION: In girls, the reporting of low back pain increases in frequency during puberty until maturity, regardless of age. Why some girls are susceptible to back pain in the early stage of puberty is unknown.

Adolescent↗
PubMed2005

Prevalence of low back pain in alpine ski instructors.

STUDY DESIGN: Mailed survey to random sample of a specific population. OBJECTIVES: To examine the lifetime and point prevalence of low back pain among alpine ski instructors. BACKGROUND: The lifetime prevalence for back pain is up to 60% among some athletes. Published literature documents back pain among athletes participating in many sports. However, the prevalence of low back pain among alpine ski instructors has not been established. METHODS AND MEASURES: Surveys were mailed to 500 randomly selected members of the Professional Ski Instructors of America. The lifetime and point prevalence were determined by respondents' report regarding history of low back pain and current back pain. RESULTS: Two hundred four (75% of the 272 respondents) reported a history of low back pain. Eighty-five of those who responded (31%) reported current back pain. Over 9% of respondents missed 10 or more days of work because of back pain. CONCLUSIONS: The lifetime prevalence of back pain among respondents was similar to the general population. The respondents reported more lifetime prevalence of back pain than athletes of many other sports. The high prevalence of back pain among ski instructors may increase cost and decrease revenue for the employer. Prevention training in this population may decrease the prevalence of back pain and lessen costs to the employer and the alpine ski instructor.

Adolescent↗
PubMed1991

Theories of back pain and health care utilization.

Because most people in the United States have occasional back pain, demand for the treatment of back pain is widespread. Yet, few treatments have proven to be more effective than placebo therapy. We examine patterns of treatment that have emerged in the absence of definitive treatment. We concentrate on high-cost users of back pain treatment (i.e., chronic pain patients) and high-cost treatments (i.e., surgical and non-surgical hospitalization for low back pain). The small minority of back pain patients whose disability persists into chronicity (90 days or more) accounts for a disproportionate amount of all back pain costs. Interventions have been developed to prevent back pain but, once back pain has already occurred, little is done to prevent it from becoming chronic. Drug therapy may be used to treat the symptom of chronic pain, the cause of which may not be thereby affected. Regarding high-cost treatments, surgical and nonsurgical hospitalizations for low back pain are common practices in the United States. Pain specialists for the past 15 years have advocated a conservative approach to back pain, but the rate of surgery for low back pain increased during this time. Average lengths of stay for surgical and nonsurgical low back pain hospitalizations decreased. We explore why, in the instance of low back pain surgery, change was resisted, whereas, in the instance of average lengths of stay, change was accepted. In view of why change may be resisted or accepted, we discuss interventions designed to change physicians' practice style.

Back Pain↗
PubMed1998

Back pain in Australian military helicopter pilots: a preliminary study.

BACKGROUND: Several studies have highlighted the problem of back pain among helicopter pilots, but few have controlled for potential confounding factors in their analyses, or sought to examine the effects of back pain on operational readiness and flying performance. There have been no previous studies of the prevalence of back pain among Australian military pilots. METHODS: The prevalence, risk factors, and consequences of low back pain were assessed in a cross-sectional survey of 200 Australian military helicopter pilots by self-completion questionnaire. RESULTS: Responses were received from 131 (66%) of available pilots. The overall prevalence of reported back pain was 64% (95% CI 56%-72%), with a further 28% of pilots describing back discomfort while flying. More than half the pilots (55%) indicated that back pain had interfered with their concentration while flying, with 16% reporting that they had hurried flying missions because of pain. A minority of pilots (7%) had refused to fly because of back problems. After adjusting for age, education, BMI, posture and numbers of hours flown, multiple logistic regression modelling indicated that a prior history of back injury was the most significant predictor of back pain among rotary wing pilots (OR 2.63, 95% CI 1.11-6.23). CONCLUSIONS: We conclude that the prevalence of back pain in Australian military helicopter pilots is unacceptably high and may be limiting operational readiness, pilot performance, flying safety, and pilot health. Urgent attention needs to be given to improved ergonomic design in aircraft, and both back pain prevention and back injury rehabilitation programs.

Adult↗
PubMed2002

Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain.

The present study was carried out to examine possible mechanisms of back muscle dysfunction by assessing a stabilising and a torque-producing back muscle, the multifidus (MF) and the iliocostalis lumborum pars thoracis (ICLT), respectively, in order to identify whether back pain patients showed altered recruitment patterns during different types of exercise. In a group of healthy subjects (n=77) and patients with sub-acute (n=24) and chronic (51) low back pain, the normalised electromyographic (EMG) activity of the MF and the ICLT (as a percentage of maximal voluntary contraction) were analysed during coordination, stabilisation and strength exercises. The results showed that, in comparison with the healthy subjects, the chronic low back pain patients displayed significantly lower (P=0.013) EMG activity of the MF during the coordination exercises, indicating that, over the long term, back pain patients have a reduced capacity to voluntarily recruit the MF in order to obtain a neutral lordosis. In contrast, during the stabilisation exercises, no significant differences between patients and controls were found for the normalised EMG activity of the two muscles. These findings indicated that, during low-load exercises, no insufficiencies in back muscle recruitment were evident in either subacute or chronic back pain patients. During the strength exercises, the normalised activity of both back muscles was significantly lower in chronic low back pain patients (P=0.017 and 0.003 for the MF and ICLT, respectively) than in healthy controls. Pain, pain avoidance and deconditioning may have contributed to these lower levels of EMG activity during intensive back muscle contraction. The possible dysfunction of the MF during coordination exercises and the altered activity of both muscles during strength exercises may be of importance in symptom generation, recurrence or maintenance of low back pain.

Acute Disease↗
PubMed1991

Low-back injuries in a heavy industry. I. Worker and workplace factors.

The costs and circumstances of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of an offshore petroleum drilling company, 1979-1985, were compared. The objectives were to identify worker and workplace factors associated with low-back injuries, to identify factors differentially associated with lost-time injuries, and to formulate recommendations for the control of low-back injuries. Low-back-impact injuries resulted largely from falls. Efforts to prevent falls would have a potential to reduce other serious consequences as well as back injuries. Workers performing the heaviest physical labor were at highest risk of low-back strains. Based on activities precipitating the injury, modifications of work site, equipment, and procedures to help reduce low-back strains are recommended. Only job was a predictor of whether a low-back strain was likely to be associated with lost time. Even this association was lacking for low-back impact injuries. Cost control by preventing the small proportion of high cost injuries may not be feasible. Rather, subsets of low-back injuries defined, for example, by work site or activity can suggest options for intervention.

Accidental Falls↗
PubMed2002

Back education efficacy in elementary schoolchildren: a 1-year follow-up study.

STUDY DESIGN: A control group-designed 1-year follow-up study involving 9 to 11-year-old schoolchildren who followed back education. OBJECTIVES: To evaluate the efficacy of a back education program, consisting of six sessions of 1 hour each, in elementary school. SUMMARY OF BACKGROUND DATA: In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. Although several authors advocate the implementation of back education in elementary school, no guidelines exist and little is known about the efficacy of such a program. METHODS: A total of 198 children (subjected to back education) and 165 controls performed a practical test, evaluating the use of back care principles while sitting, taking off shoes, picking up a pen, and handling a load and a book bag. Post-tests were performed within 1 week after the intervention, after 3 months, and after 1 year. The week prevalence of back and neck pain was evaluated at these test moments in extended samples of intervention children (n = 347) and controls (n = 349). To evaluate habit changes, a limited group of intervention pupils (n = 38) and controls (n = 31) was additionally evaluated in a candid camera observation at the last post-test. RESULTS: At all post-tests intervention pupils scored significantly higher (P < 0.001) than controls for all practical test items. Candid camera evaluation scores were higher in the intervention group sample compared with the control group sample for four of the eight evaluated items. Following back education significantly decreased the week prevalence of back and neck pain. CONCLUSIONS: Back education in elementary schoolchildren is efficacious up to 1 year. The role of early back education in preventing back pain at the adult age merits further attention.

Back Injuries↗
PubMed2006

Association between back pain and physical fitness in adolescents.

STUDY DESIGN: A cross-sectional study of 9413 adolescents. OBJECTIVES: To study the associations between back pain, physical activity, and physical fitness. SUMMARY OF BACKGROUND DATA: A high physical fitness level, and especially muscle endurance in the back muscles, is associated with lower risk of back pain, but little is known about other types of physical fitness and back pain in adolescents. METHODS: A cross-sectional study of 3956 boys and 5457 girls 17 years of age. The associations between self-reported back pain and different types of physical fitness and self-reported physical activity were analyzed in high schoolchildren in Denmark. RESULTS: Back pain was reported by 43% of the girls and 37% of the boys. Back pain was associated with low isometric muscle endurance in the back extensors, and the highest quartile had a lower risk of back pain (odds ratio = 0.71; 95% confidence interval, 0.62-0.82) within the last month. No associations were found to aerobic fitness, functional strength, flexibility, or physical activity level after adjustment for muscle endurance. More girls than boys experienced back pain, and it was more common in taller adolescents. CONCLUSION: Children with high isometric muscle endurance were less likely to report back pain. No other measures of physical fitness or level of self-reported physical activity were linked to back pain reporting.

Adolescent↗
PubMed1984

The adolescent back. A field survey of 370 Finnish schoolchildren.

In this study, dealing with the early diagnosis and prevention of back pains, adolescent postural faults especially in the sagittal plane were examined with a standardized physical examination technique suitable for use in schools; the strength and flexibility of muscles affecting the back were investigated; neck and/or back symptoms were screened; and the association of background factors and the findings of the physical examination with symptoms was evaluated. The material consisted of a total of 370 11, 13, 15 and 17-year-old comprehensive and senior secondary school pupils from a small suburban municipality, selected by random sampling. The subjects were quite evenly distributed in terms of different age and sex groups. The physical examination of the back, with evaluation of symptoms, took place in the autumn of 1981 in the premises of school health care, and 58 of the examined subjects were referred on the basis of symptoms and/or findings to an X-ray examination of the thoracic and/or lumbar spine. The X-rays were taken in the spring of 1982. 1 Back pain history. Relation between present neck and/or back symptoms, background variables and findings in physical examination. 7.6% of the subjects reported previous neck and/or back symptoms that had interfered with their school work or leisure activities. Present, mainly mild neck and/or back symptoms were reported by 19.7%. Girls reported symptoms more often than boys (p less than 0.05), and the occurrence of symptoms increased with age (p less than 0.001). Roughly one third of the subjects had frequent symptoms. Pains were most often localized in the low back (p less than 0.001) and were most frequently associated with sitting or physical activities. Most subjects who had suffered from previous symptoms also reported symptoms at the time of the study. These more chronically symptomatic subjects accounted for 6.2% of the total material. 2.9% of siblings under 11 years, 8.0% of siblings 11-17 years, and 13.7% of siblings over 17 years of age had at some time prior to the study complained of recurrent neck and/or back symptoms. Of mothers, 19.0% and of fathers, 15.4% reported neck and/or back symptoms that were continual and/or reduced working ability. The mother (p less than 0.01) and/or the father (p less than 0.05) of a subject reporting frequent symptoms, also reported neck and/or back symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗