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Correlation of low back pain with functional status, general health perception, social participation, subjective happiness, and patient satisfaction.

STUDY DESIGN: A cross-sectional and epidemiologic study investigated low back pain. OBJECTIVE: To assess the correlation among outcome measures for low back pain, including sciatica, according to a proposed low back pain-related model. SUMMARY OF BACKGROUND DATA: Various outcome measures are used in low back pain research: pain, functional status, generic health status, and patient satisfaction. Correlation among these measures has been unclear. METHODS: For this study, 816 subjects (369 men and 447 women; average age, 62 years) who underwent an adult medical examination. The patients were interviewed concerning their personal background, severity of low back pain and sciatica, functional status, general health perception, social participation, subjective happiness, and patient satisfaction. The correlation among these measures was analyzed systematically using path analysis based on a low back pain-related model hypothesizing that low back pain and sciatica worsen functional status and general health perception and then affect social participation, subjective happiness, and patient satisfaction. RESULTS: Restriction of functional status was found to be the most closely correlated with severity of low back pain. A decrease in physical health was most closely correlated with restriction of function. Social participation, subjective happiness, and patient satisfaction were closely correlated with physical health status. There was a significant correlation among outcome measures concerning physical health, which was consistent with a low back pain-related model. CONCLUSIONS: The outcome measures concerning physical health in this study were found to be correlated significantly, consistent with the proposed low back pain-related model.

Adult↗

A controlled randomized study of the effect of training with orthoses on the incidence of weight bearing induced back pain among infantry recruits.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain. SUMMARY OF BACKGROUND DATA: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time. METHODS: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training RESULTS: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001. CONCLUSIONS: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.

Adolescent↗

Back pain claim rates in Japan and the United States: framing the puzzle.

STUDY DESIGN: This is a cross-national comparison of workers' compensation claims for back pain in Japan and the United States (US). OBJECTIVES: The main objective is to juxtapose rates of back pain claims in Japan and Washington state. Because the Washington state rate closely matches rates for other US states as well as the rate for the US as a whole, it is used to represent the US rate. A puzzle is to be framed: Why are back pain claim rates in Japan and the United States so disparate? SUMMARY OF BACKGROUND DATA: Occupational back pain is common among workers in both Japan and the United States. Wage compensation for time off work is also substantial in both countries and potentially induces time off work at least as much in Japan as in the United States. Accordingly, back pain claim rates in Japan seemingly would be on the same order of magnitude as rates in the United States. METHODS: Washington state rates are based on data from its state fund. Both Japan and Washington state rates are composed of the number of workers eligible to file worker compensation claims in a given year (denominator) and the number of back pain claims accepted during that year (numerator). Because rates may fluctuate from year-to-year, 5 years of data on rates are presented, 1995-1999. Central to the comparison are Japanese and Washington state rates of workers' compensation claims for back pain with more than 3 days compensated time loss from work. RESULTS: The back pain claim rate in 1999 was 60 times higher in Washington state than in Japan. The disparity in rates for the other years in the study (1995-1998) was similar. CONCLUSION: Back pain is common among workers both in Japan and the United States, but there is no simple or necessary relationship between that symptom and how it manifests itself in one country or another. Rather, the symptom is protean in its social manifestations. As for what shapes those manifestations-or, more specifically, what causes the startling disparity in back pain claim rates between Japan and the United States-that is a puzzle. Various solutions to the puzzle are discussed, but it remains essentially unsolved.

Back Pain↗

A Cochrane review of superficial heat or cold for low back pain.

STUDY DESIGN: Cochrane systematic review. OBJECTIVE: To assess the effects of superficial heat and cold therapy for low back pain in adults. SUMMARY OF BACKGROUND DATA: Heat and cold are commonly used in the treatment of low back pain. METHODS: We searched electronic databases from inception to October 2005. Two authors independently assessed inclusion, methodologic quality, and extracted data, using the criteria recommended by the Cochrane Back Review Group. RESULTS: Nine trials involving 1,117 participants were included. In two trials of 258 participants with a mix of acute and subacute low back pain, heat wrap therapy significantly reduced pain after 5 days (weighted mean difference [WMD], 1.06; 95% confidence interval [CI], 0.68-1.45, scale range, 0-5) compared with oral placebo. One trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (WMD, -32.20; 95% CI, -38.69 to -25.71; scale range, 0-100). One trial of 100 participants with a mix of acute and subacute low back pain examined the additional effects of adding exercise to heat wrap and found that it reduced pain after 7 days. CONCLUSIONS: The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.

Acute Disease↗

Emotional distress as a predictor for low back disability: a prospective 12-year population-based study.

STUDY DESIGN: A population-based, prospective cohort. OBJECTIVE: To study associations between emotional distress and long-term low back disability in a general population. SUMMARY OF BACKGROUND DATA: In primary and hospital care studies, emotional, cognitive, and personality factors have been associated with low back disability, while the association between distress and novel back pain episodes has been uncertain. METHODS: A randomly drawn cohort of 1152 occupationally active persons aged 20-55 years was interviewed with a comprehensive psychosocial questionnaire in 1990, and was followed for 12 years in national registers over sickness, rehabilitation, and disability benefits. Data on emotional distress, earlier low back pain (LBP), education, life style, psychosocial, and work-related factors were collected at baseline. RESULTS: Long-term benefits due to low back disability were granted to 131 persons (11.4%) in the follow-up period. In multivariate analysis, earlier LBP, emotional distress, low grade of education, and high physical job stress were associated with low back disability. Persons with both emotional distress and earlier back pain were most at risk for disability (hazard ratio 2.91, 95% confidence interval 1.60-5.29). Persons with emotional distress but no earlier episodes of LBP had no increased risk for low back disability (hazard ratio 0.71, 95% confidence interval 0.34-1.45). CONCLUSIONS: Emotional distress is a predictor for low back disability in persons with earlier LBP, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with LBP.

Adult↗

A randomized controlled trial to measure the effectiveness of a sacral wedge in preventing postoperative back pain following trans-urethral resection of the prostate (TURP) in lithotomy position.

BACKGROUND: Postoperative back pain is a common, yet under reported, complication of surgery. Previous studies, although small in number, have indicated that the use of a sacral wedge is effective in reducing the incidence of postoperative back pain. AIM: The aim of the study was to test the hypothesis that the intra-operative use of a sacral wedge would decrease the incidence of postoperative back pain in patients undergoing trans-urethral resection of the prostate in lithotomy position. METHODS: The design of the study was a randomized controlled trial involving the use of a sacral wedge intra-operatively in a male population undergoing trans-urethral resection of the prostate. A total of 236 participants was recruited to the study and allocated to the control or intervention group by block randomization. All patients selected one of three different sized sacral wedges for use during surgery. Data were collected preoperatively, intra-operatively and at postoperative days 2 and 4 and the tools included a structured questionnaire, Oswestry Disability Questionnaire, a visual analogue scale to measure pain intensity and a body map to record its location. RESULTS: Fifty-two per cent of participants reported having a history of back pain and point prevalence on admission to hospital was 27%. Twenty-eight per cent of participants experienced back pain on day 2 postoperatively and this decreased to 14% on day 4. There was no significant difference between the control and intervention groups. The severity of back pain increased after surgery. Postoperatively there were reports of back pain from participants who had not reported a history of back pain before their admission for surgery. CONCLUSIONS: In contrast to other studies we found no evidence to support the use of a sacral wedge intra-operatively to reduce the incidence of postoperative back pain. RELEVANCE TO CLINICAL PRACTICE: Despite the non-significant results, the high level of postoperative back pain stills draws attention to the need to develop strategies to reduce its incidence.

Aged↗

Low back pain and other overuse injuries in a group of Japanese triathletes.

OBJECTIVE: To document the incidence of low back pain and other overuse injuries in a group of triathletes, and to investigate any associations with various physical and triathlon related factors. METHODS: By means of a questionnaire, the physical characteristics, training habits, and the incidences of overuse injuries of 92 Japanese triathletes (70 males, 22 females) were documented. Student's t and chi 2 tests were used to determine the significance of any associations with injury incidence, as well as differences between subjects experiencing or not experiencing low back pain in the previous year. RESULTS: Low back pain was experienced by 32% of subjects in the previous year. The majority (54%) of low back pain episodes lasted under seven days, suggesting mainly soft tissue involvement, and 19% lasted over three months, suggesting involvement of the intervertebral discs. Weekly trunk flexor muscle training frequency was significantly greater (P = 0.035) for the low back pain subjects. Close to significant differences for average weekly cycling time, trunk flexor muscle training time, and low intensity aerobic training, as well near significant associations for weight training and average weekly triathlon training load, were also found. No other factors were significantly associated with low back pain. Low back injuries accounted for 28% of all injuries. Only the knee was a more common single site of injury (33%). CONCLUSIONS: The three most common injuries suffered by the triathletes were of the knee, back and shoulder. The low back pain suffered by many triathletes could be of a potentially serious nature. It is suggested that cycling is a major risk factor for low back pain in triathletes.

Adult↗

Influence of saddle type upon the incidence of lower back pain in equestrian riders.

OBJECTIVE: To investigate the possible influences of saddle type on the incidence of "lower back pain" in a cross section of equestrian riders. METHODS: 108 equestrian riders completed a questionnaire concerning their riding habits and whether they suffered from lower back pain. In particular they were asked whether they used a traditional style/general purpose saddle (GP) or a deep seated/Western style saddle (W). RESULTS: 48% of the riders reported suffering from lower back pain, the incidence being higher in the GP saddle users (66%) than in W saddle users (23%) (P < 0.001). Female riders had a higher incidence of lower back pain than males, 58% v 27% (P < 0.005). When the genders were analysed separately for the effect of saddle type, males using the GP and W saddles had a 33% and 6% incidence of lower back pain respectively, while females using the GP and W saddles had a 72% and 33% incidence. The highest incidence of lower back pain occurred in the GP saddle users who had been riding for more than 15 years (P < 0.07). The data also indicated a possible tendency for there to be more low back pain among riders using a short stirrup length. No other factors were found to affect the incidence of lower back pain. CONCLUSIONS: The difference in the incidence of lower back pain between the users of the two saddle types may be due to the additional comfort, cushioning, postural positioning, and stability offered by the design of the deep seated saddle. The results suggest that, while a deep seated saddle is not suited to all equestrian activities, where possible its use should be considered because of its effect in reducing the risk of lower back pain.

Adolescent↗

Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain.

AIMS: To describe the presence of musculoskeletal co-morbidity of the neck and upper extremities among industrial workers with low back pain, and to examine whether it has an impact on healthcare utilisation and sickness absence for low back pain. METHODS: A self administered questionnaire was used to collect data from 505 industrial workers (response 86%). RESULTS: The 12 month prevalence of low back pain was 50%. Among subjects with low back pain the 12 month prevalence of musculoskeletal co-morbidity of the neck and upper extremities was 68%. Among workers with low back pain, subjects with high pain intensity or disabling low back pain were more likely to have musculoskeletal co-morbidity. In comparison to the subjects who report back pain only, subjects with co-morbidity showed worse general health and health related quality of life. No impact of upper extremity co-morbidity was found on healthcare utilisation, and sickness absence due to low back pain. CONCLUSIONS: This study provides no evidence that musculoskeletal co-morbidity of the neck and upper extremities influences the choice to seek care or take sick leave due to low back pain among industrial manual workers. For occupational health practitioners the finding of a high co-morbidity is important to consider when implementing workplace interventions aimed at the reduction of specific musculoskeletal complaints, since the controls for one musculoskeletal complaint may impact adversely on another musculoskeletal complaint. Researchers who perform low back pain intervention studies using generic health measures, should take into account the impact of musculoskeletal co-morbidity on these measures.

Absenteeism↗

Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up.

OBJECTIVES: To identify risk factors for new episodes of sick leave due to neck or back pain. METHODS: This prospective study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement. The potential risk factors comprised physical and psychosocial work factors, health-related and pain-related characteristics and lifestyle and demographic factors. The response rate at both follow-ups was close to 73%. RESULTS: At the 18-month follow-up, 151 participants reported at least one episode of sick-listing due to neck or back pain during the previous year. Risk factors assessed at baseline for sick leave due to neck or back pain at the follow-up were blue-collar work, back pain one or several times during the previous year, 1-99 days of cumulative sickness absence during the previous year (all causes except neck or back pain), uncertainty of one's own working ability in 2 years' time and the experience of few positive challenges at work. After 3 years, 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow-up. The risk factors for this pain-related sick leave were blue-collar work, several earlier episodes of neck pain, no everyday physical activities during leisure time (cleaning, gardening and so on), lower physical functioning and, for blue-collar workers separately, repetitive work procedures. CONCLUSION: The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow-ups were blue-collar work and several earlier episodes of neck or back pain assessed at baseline. Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures. An evidence-based secondary prevention of neck and back pain including advice to stay active is also warranted.

Absenteeism↗

Changes in the incidence of occupational disability as a result of back and neck pain in the Netherlands.

BACKGROUND: Back pain (including neck pain) is one of the most prevalent health problems for which physicians are consulted. Back pain can decrease the quality of life considerably during a great part of the lives of those who suffer from it. At the same time it has an enormous economic impact, mainly through sickness absence and long-term disability. The objective of this paper is to compare the incidence of occupational disability as a result of back and neck pain in 1980-1985 to 1999-2000 and to explain the findings. METHODS: A descriptive study was performed at population level of changes in incidence of occupational disability as a result of back and neck pain. Statistics from the National Institute of Social Insurance in the Netherlands are used to calculate age and gender specific incidence rates for back pain diagnoses based on the ICD-classification. Incidence rate ratios stratified according to gender and adjusted for age were calculated to indicate changes over time. RESULTS: The incidence of occupational disability as a result of back pain decreased significantly by 37% (95% CI 37%-38%) in men and with 21% (95% CI 20%-24%) in women, after adjustment for age. For overall occupational disability as a result of all diagnoses this was 18% (95% CI 18%-19%) and 34% (95% CI 33%-35%) respectively. Changes were not homogeneous over diagnostic subcategories and age groups. Spondylosis decreased most in men by 59% (95% CI 57%-61%). The incidence of non-specific back pain and neck pain increased most by 196% (95% CI 164%-215%). Post-laminectomy syndrome increased over all age categories both for men (85%, 95% CI 61%-113%) and women (113%, 95% CI 65%-179%). CONCLUSION: The decrease in occupational disability as a result of back pain was larger than the decrease in occupational disability over all diagnoses. However, time trends were not homogeneous over age-, nor over sex- nor back pain categories. Most of this decrease was due to general changes such as legal and economic changes. One of several additional explanations for a decrease is the changed view on management of back pain.

Adult↗

Coping and back problems: analysis of multiple data sources on an entire cross-sectional cohort of Swedish military recruits.

BACKGROUND: As the literature now stands, a bewildering number and variety of biological, psychological and social factors are, apparently, implicated in back problems. However, if and how these have a direct influence on back problems is not clear. Obesity, for example, has in many studies been shown to be associated with back problems but there is no evidence for a causal link. This could be explained by a dearth of suitably designed studies but also because obesity may be but a proxy for some other, truly explanatory variable. Coping has been linked with, particularly, persistent back problems as well as with health in general. The question is, whether coping could be the explanatory link between, for example, these two variables. A cross-sectional study was undertaken using data from the Swedish Army, consisting of the entire cohort of males (N = 48,502) summoned in 1998 to serve in the military. The purpose of the study was to investigate the relation between five independent variables and two dependent variables ("outcome variables"). The independent variables were two anthropomorphic variables (height and body mass index), two psychological variables (intellectual capacity and coping in relation to stress), and one social variable (type of education). The two outcome variables were back problems and ill health. In particular, we wanted to determine whether controlling for coping would affect the associations between the other four independent variables and the two outcome variables. METHODS: Data for the analysis come from a battery of standardized examinations, including medical examinations, a test of intellectual capacity, and a test of coping in relation to stress. Each of these examinations was conducted independently of the others. Unadjusted and adjusted odds ratios were calculated for the outcome variables of back problems and ill health. RESULTS: The associations between height, body mass index, intellectual capacity, type of education and the two outcome variables (back problems and ill health) were weak to moderate. Additionally, there were strong associations between coping and the two outcome variables and when controlling for coping the previously noted associations diminished or disappeared, whereas none of the other variables had a large effect on the association between coping and the two outcome variables. CONCLUSION: Coping emerged as strongly associated with both back problem and ill health and coping had a leveling effect on the associations between the other independent variables and the two outcome variables. This study is noteworthy particularly because the association with coping is so robust. It is a retrospective, cross-sectional study, however, and, as such it raises questions of causality; which - if any - came first, inability to cope or back pain? The results of this study call attention to the need for a prospective study, in which coping is clearly defined. Such a study has been undertaken and will be presented separately. Index terms: back pain, coping, education, height, BMI, intellectual capacity, bio-psycho-social model, epidemiology, cohort, cross-sectional study.

Adaptation, Psychological↗

The effect of a back belt on torso motion--survey in an express package delivery company.

According to the Labor Standard Bureau of Japan, accidental back injuries accounted for about 60% of all occupational injuries and diseases in the last decade. The Ministry of Labor issued guidelines to prevent low back injuries in 1994 to address the problem. The use of back belts is recommended for some special working conditions but details on its proper use were not given. This study was planned to evaluate a newly developed back belt and was done at an express package delivery company where the incidence of low back injury was high. The BackTracker was used to evaluate the effect of the back belt on the range and velocity of torso motion. The results indicated that there were no significant differences in the range of motion (ROM) during flexion/extension, lateral bending, and rotation between with and without the belt. The maximum angular velocity (MAV) of flexion decreased significantly (average decrease: 30 +/- 28.3 degrees/sec) when the back belt was worn. The MAV of extension with belt showed a decreasing tendency though not significant. No notable trends were observed in the MAV, during lateral bending and rotation of the subjects while wearing and not wearing the belt. The results also indicated that the back belt affected differently the torso motion of each subject. This study suggested that this back belt could be useful for tasks with high velocity of flexion/extension and that proper instruction on the use of the back belt is needed for each worker.

Adult↗

Oral contraceptives and low back pain. Attitudes among physicians, midwives and physiotherapists.

BACKGROUND: Only few indications have appeared in the literature concerning a possible relationship between the use of oral contraceptives and low back pain. In our daily work we often meet women who have been recommended to abandon their use of oral contraceptives depending on coexisting low back pain. In order to assess the opinions of a possible relationship between oral contraceptives and low back pain this study was undertaken. METHODS: A validated questionnaire was sent out to physicians, physiotherapists and midwives dealing with either contraceptive counselling or low back pain. A modified questionnaire was sent to medical- and physiotherapist students to assess whether the opinions were a result of the education or the working experience. RESULTS: A total of 225 questionnaires were sent out and 206 (91%) were returned. Sixteen percent thought there was a relationship between the use of oral contraceptives and risk of low back pain. Thirty percent had seen patients with low back pain that was interpreted as being affected by use of oral contraceptives. Twenty-five percent recommended at least some patients with low back pain to change their contraceptive method. Among the students there was a difference in opinion between the first and the last year students indicating that their opinions had been influenced by their education. CONCLUSIONS: Evidently many professionals dealing with oral contraceptives and low back pain believe that there is a relationship between oral contraceptives and low back pain, despite the lack of scientific evidence. These recommendations might influence the contraceptive safety for the individual woman and the possible relationship between use of oral contraceptives and low back pain should therefore be more thoroughly investigated before general recommendations are given.

Adolescent↗

Psychosocial job factors and the one-year evolution of back-related functional limitations.

OBJECTIVES: This 1-year prospective study aimed at assessing the association between some psychosocial job characteristics and back-related functional limitations. METHODS: The participants were 849 workers who sought medical consultation for nonspecific back pain in primary care settings of the Quebec City area. Information on job decision latitude, psychological demands, and social support at work was collected during a telephone interview conducted after the medical consultation. Back-related functional limitations were measured at baseline and 1 year later with the Roland-Morris Disability Questionnaire. The analyses were stratified by gender. Social support at work and the type of back pain were considered potential effect modifiers. Several potential confounders were also considered in the multiple regression analyses that were conducted to isolate the effect of the job psychological demands and decision latitude on the 1-year level of back-related functional limitations. RESULTS: A modest difference in the 1-year Roland-Morris average scores was found only among the women and only for the association between job decision latitude with back-related functional limitations, according to the level of social support at work. This difference was of limited clinical significance. Analyses by type of back pain showed, however, a clinically significant association between the combination of high psychological demands and low decision latitude and back-related functional limitations only for subjects with persistent pain. CONCLUSIONS: Job psychological demands and decision latitude have little influence on the 1-year evolution of back-related functional limitations for one-time and recurrent back-pain problems. However, our results suggest that this association could be important for workers with persistent pain.

Adult↗

Psychosocial factors at work and back pain: a prospective study in office workers.

A prospective one-year follow-up study was carried out among 189 civil servants of a municipal social service department. Its aim was to investigate whether psychosocial factors at work predict back pain prevalence at follow-up. The workers were questioned twice about personal characteristics, psychosocial factors at work, physical workload, back pain experience, and general health and well-being. Back pain was assessed as twelve month prevalence and pain intensity on a visual analogue scale (VAS). In a univariate analysis the variables: high job demands, confinement to the workplace, depression, psychological complaints, and general health complaints, were positively related to back pain prevalence at follow-up. In a multivariate analysis, however, none of the odds ratios for psychosocial stressors differed significantly from one another. Among the back pain variables, pain intensity on the VAS was the best predictor of back pain at follow-up. In a final multivariate logistic regression model none of the above-mentioned variables contributed significantly, except for initial back pain. Initial back pain with low intensity and high intensity significantly predicted the prevalence of back pain at follow-up with odds ratios of 3.0 (90% CI: 1.5-6.0) and 10.3 (90% CI: 4.1-25.5), respectively. In conclusion, the present study does not provide clear evidence that psychosocial factors at work predict back pain.

Adult↗

Low back pain in competitive rhythmic gymnasts.

AIM: It has been reported that rhythmic gymnasts are at risk of suffering from low back injuries, because of repetitive lumbar hyperextensions. On the other hand, this sport requires features of leanness, muscular strength and flexibility that should represent protective factors for back pain. METHODS: This cross-sectional study aimed to assess the prevalence of low back pain in 67 club-level competitive rhythmic gymnasts aged 13-19 years. A standardized questionnaire was used to evaluate back-pain symptoms. Anthropometric measurements, time spent in physical activity, psychological testing results, smoking habits and age of menarche were recorded. One hundred and four age-matched general females served as control group. RESULTS: Low back pain complaints were reported by 7 rhythmic gymnasts and by 27 controls (10.4% vs 26.0%, p<0.05); the prevalent location of back pain was bilateral in gymnasts and central in controls. Gymnasts had lower body weight, body mass index, fat body mass and delayed menarche. The females with low-back pain displayed higher body weight, body mass index, fat body mass, age, a greater smoking habit and more anxious/depressive behaviour, both in the gymnast and in the control group. CONCLUSION: Competitive, club-level rhythmic gymnasts show a reduced prevalence of low back-pain. Being younger in age, having greater leanness, not smoking, displaying less anxious/depressive behaviour, and developing increased muscle strength and flexibility, all can represent preventive factors for low back pain. This study suggests that rhythmic gymnastics is not a discipline at increased risk of low back pain.

Adolescent↗

Back pain, ventilatory function, chest symptoms, and smoking.

Tests of ventilatory function were made and a history of previous back pain was obtained from 909 volunteers (592 men and 317 women). One year later, using postal questionnaires, they were asked about their experience of back pain in the ensuing 12 months and about smoking habits, breathlessness, coughing, and the bringing up of phlegm. From the frequency of their experience of back pain, the population was divided into "nonbacks," "mild backs," and "chronic backs." From their answers to the MRC Questionnaire on respiratory symptoms they were divided first into good, mild, and bad with regard to chest symptoms; and also into smokers, exsmokers, and nonsmokers. Ventilatory function tests were reduced in both smokers and "bad chests" and chest symptoms were significantly worse in smokers. Women with back pain were more likely to be smokers, but men with back pain were not. Chest symptoms were significantly worse in "chronic backs," whether men or women. The results suggest that previous reports of a relation between smoking and back pain arose incidentally from the associations between (a) chest and back symptoms and (b) chest symptoms and smoking.

Back Pain↗