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PubMed2001

Lower back pain is reduced and range of motion increased after massage therapy.

STUDY DESIGN: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. OBJECTIVES: Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. SUMMARY OF BACKGROUND DATA: Twenty-four adults (M age=39.6 years) with low back pain of nociceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. METHODS: Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion. RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher. CONCLUSIONS: Massage therapy is effective in reducing pain, stress hormones and symptoms associated with chronic low back pain. PRECIS: Adults (M age=39.6 years) with low back pain with a duration of at least 6 months received two 30-min massage or relaxation therapy sessions per week for 5 weeks. Participants receiving massage therapy reported experiencing less pain, depression, anxiety and their sleep had improved. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.

Adult↗
PubMed1995

Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection.

BACKGROUND: Back pain is a frequent and often ominous clinical sign in patients with ductal pancreatic cancer. METHODS: From 1971 to 1993 a pancreatic carcinoma could be resected in 192 patients, whereas 261 patients underwent either probatory laparotomy alone or palliative bypass procedures. In a retrospective study including uni- and multi-variate survival analysis we have determined the impact of preoperative back pain on both resectability and long-term prognosis after resection. RESULTS: Among the presenting symptoms of patients with ductal pancreatic cancer back pain was a predictive sign of irresectability. In the presence of preoperative back pain the long-term prognosis after resection of the tumour was also significantly impaired. In a multivariate analysis it could be demonstrated that the prognostic impact of back pain was as strong as the influence of residual tumour, tumour grading, and tumour size. CONCLUSIONS: Back pain often indicates irresectability of ductal pancreatic carcinoma and also impairs the long-term prognosis even after curative resection.

Adult↗
PubMed2006

Back and neck pain in triathletes.

OBJECT: As the sport of triathlon has continued to grow, increasing numbers of triathletes have presented in the neurosurgery clinics with various spinal disorders. This epidemiological study was undertaken to establish the lifetime incidence of neck and back pain, to gauge the prevalence of discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado, area. METHODS: A live online questionnaire was developed that was used to collect information about physical characteristics, training habits, athletic status, number of races completed, and back pain among triathletes. The incidence of cervical and/or lumbar discogenic back pain was defined according to the duration of symptoms for the most recent pain episode. The lifetime incidence of low-back pain was 67.8%, with 23.7% of cases possibly being discogenic in origin. The number of triathlons in which the respondents had participated and the presence of previous sports-related injuries were predictive of low-back pain (p = 0.02 and p < 0.00001, respectively). The lifetime incidence of neck pain was 48.3%, with 21.4% of cases being consistent with intervertebral disc involvement. The number of previous sports-related injuries was predictive of neck pain (p < 0.00001), and a strong tendency toward neck pain was observed for athletes with more total years of participation in sports (p = 0.06). CONCLUSIONS: The two main risk factors for long-term spinal problems include sports-related injuries and overuse. The study results definitely support the influence of both mechanisms for low-back pain. Neck pain was associated with an injury event, and a strong (although not statistically significant) tendency toward neck pain was observed in respondents with overuse injuries.

Adolescent↗
PubMed2005

Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain.

OBJECTIVES: To test whether patients with persistent non-specific low back pain, when offered access to traditional acupuncture care alongside conventional primary care, gained more long-term relief from pain than those offered conventional care only, for equal or less cost. Safety and acceptability of acupuncture care to patients, and the heterogeneity of outcomes were also tested. DESIGN: A pragmatic, two parallel group, randomised controlled trial. Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists. The control group received usual care from their general practitioner (GP). Eligible patients were randomised in a ratio of 2:1 to the offer of acupuncture to allow between-acupuncturist effects to be tested. SETTING: Three non-NHS acupuncture clinics, with referrals from 39 GPs working in 16 practices in York, UK. PARTICIPANTS: Patients aged 18-65 years with non-specific low back pain of 4-52 weeks' duration, assessed as suitable for primary care management by their general practitioner. INTERVENTIONS: The trial protocol allowed up to ten individualised acupuncture treatments per patient. The acupuncturist determined the content and the number of treatments according to patient need. MAIN OUTCOME MEASURES: The Short Form 36 (SF-36) Bodily Pain dimension (range 0-100 points), assessed at baseline, and 3, 12 and 24 months. The study was powered to detect a 10-point difference between groups at 12 months post-randomisation. Cost--utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions (EQ-5D) and a preference-based single index measure derived from the SF-36 (SF-6D). Secondary outcomes included the McGill Present Pain Index (PPI), Oswestry Pain Disability Index (ODI), all other SF-36 dimensions, medication use, pain-free months in the past year, worry about back pain, satisfaction with care received, and safety and acceptability of acupuncture care. RESULTS: A total of 159 patients were in the 'acupuncture offer' arm and 80 in the 'usual care' arm. All 159 patients randomised to the offer of acupuncture care chose to receive acupuncture treatment, and received an average of eight acupuncture treatments within the trial. Analysis of covariance, adjusting for baseline score, found an intervention effect of 5.6 points on the SF-36 Pain dimension [95% confidence interval (CI) -1.3 to 12.5] in favour of the acupuncture group at 12 months, and 8 points (95% CI 0.7 to 15.3) at 24 months. No evidence of heterogeneity of effect was found for the different acupuncturists. Patients receiving acupuncture care did not report any serious or life-threatening events. No significant treatment effect was found for any of the SF-36 dimensions other than Pain, or for the PPI or the ODI. Patients receiving acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group. At 24 months, the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief. The acupuncture service was found to be cost-effective at 24 months; the estimated cost per quality-adjusted (QALY) was 4241 pounds sterling (95% CI 191 pounds sterling to 28,026 pounds sterling) using the SF-6D scoring algorithm based on responses to the SF-36, and 3598 pounds sterling (95% CI 189 pounds sterling to 22,035 pounds sterling) using the EQ-5D health status instrument. The NHS costs were greater in the acupuncture care group than in the usual care group. However, the additional resource use was less than the costs of the acupuncture treatment itself, suggesting that some usual care resource use was offset. CONCLUSIONS: Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain. Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits relating to function or disability were identified. GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care (such as massage, chiropractic or physiotherapy), various aspects of cost-effectiveness, value to patients and implementation protocols.

Acupuncture Therapy↗
PubMed1991

Interaction of height and mechanical loading of the spine in the development of low-back pain.

The relation of low-back pain to height and physical activity was examined among 2667 British men and women aged 20-59 years and selected from the general population. Information about occupational activities, height, and lifetime history of low-back pain was obtained from a postal questionnaire. The lifetime prevalence of low-back pain was 58.3%. After allowance for other occupational activities, the onset of low-back pain was strongly associated with heavy lifting at work (men: relative risk (RR) 2.0, 95% confidence interval (95% CI) 1.4-2.8; women: RR 2.2, 95% CI 1.3-3.5). For the men there was also an association with digging (RR 1.6, 95% CI 1.1-2.3). Risk of low-back pain increased with height among the men but not among the women. The risks associated with heavy lifting and digging were greater for the short than for the tall men. Thus the data provide no justification for excluding tall men from heavy manual tasks, despite their greater susceptibility to back problems.

Adult↗
PubMed1997

Sickness absence from back pain, psychosocial work characteristics and employment grade among office workers.

OBJECTIVES: The relation between psychosocial work characteristics, employment grade, and sickness absence due to back pain was studied among office workers. METHODS: Base-line questionnaire data and sickness absence data collected continuously with a mean of 4 years of follow-up were analyzed. The subjects were 6894 men and 3414 women aged 35 to 55 years at recruitment. The main outcome measures were short (< or = 7 days) and long (> 7 days) absences due to back pain. RESULTS: There was a strong inverse association between employment grade and rate of absences due to back pain (P for linear trend < 0.001); for example, the rate ratio for short absences among the men in a comparison of lowest versus highest employment grade was 8.21. The age adjusted rate ratio for the effect of low versus high control over work among the men was 2.22 [95% confidence interval (95% CI) 1.77-2.79] for short and 1.61 (95% CI 1.01-2.58) for long absences due to back pain. For short absences due to back pain among the men in high grades of employment, the rate ratio for low control was 3.42 compared with 0.78 for the lower grades (P for interaction < 0.001). For the women the corresponding rate ratios were 0.80 and 1.35, respectively (P for interaction 0.08). CONCLUSIONS: Absence from work due to back pain was strongly inversely related to employment grade. The effects of psychosocial work characteristics-particularly control-differed by grade and gender in magnitude and direction. The psychosocial work environment represents a potentially reversible cause of ill health.

Adult↗
PubMed1987

Effect of fork-lift truck driving on low-back trouble.

In a population of 240 male fork-lift truck drivers who drove at least 4 h daily, the occurrence of low-back trouble was studied in relation to that of two reference groups. The participation rate of the fork-lift truck drivers was 88%. The responses to a questionnaire concerning low-back trouble were reviewed. Among the fork-lift truck drivers, a statistically significant higher occurrence of low-back trouble was reported for the year preceding the study, in comparison, according to age, to that of a reference group of 399 working men (65 against 47%); however, there was no significantly increased frequency when compared to that of a reference group of 66 unskilled male workers (65 against 51%). The fork-lift truck drivers had a significantly higher rate of absence from work within the previous year due to low-back trouble than the two reference groups (22% compared to 7 and 9%). These findings were confirmed during the follow-up year. A correlation was found between length of employment as a fork-lift truck driver and the occurrence of low-back trouble within the preceding year. It was concluded that fork-lift truck driving may be a contributory cause for low-back trouble.

Adult↗
PubMed1995

Reducing random measurement error in assessing postural load on the back in epidemiologic surveys.

OBJECTIVES: The goal of this study was to design strategies to assess postural load on the back in occupational epidemiology by taking into account the reliability of measurement methods and the variability of exposure among the workers under study. METHODS: Intermethod reliability studies were evaluated to estimate the systematic bias (accuracy) and random measurement error (precision) of various methods to assess postural load on the back. Intramethod reliability studies were reviewed to estimate random variability of back load over time. RESULTS: Intermethod surveys have shown that questionnaires have a moderate reliability for gross activities such as sitting, whereas duration of trunk flexion and rotation should be assessed by observation methods or inclinometers. Intramethod surveys indicate that exposure variability can markedly affect the reliability of estimates of back load if the estimates are based upon a single measurement over a certain time period. Equations have been presented to evaluate various study designs according to the reliability of the measurement method, the optimum allocation of the number of repeated measurements per subject, and the number of subjects in the study. CONCLUSION: Prior to a large epidemiologic study, an exposure-oriented survey should be conducted to evaluate the performance of measurement instruments and to estimate sources of variability for back load. The strategy for assessing back load can be optimized by balancing the number of workers under study and the number of repeated measurements per worker.

Analysis of Variance↗
PubMed1998

Work-related low-back problems in nursing.

This scientific literature review focuses on the relation between nursing work and low-back problems. Its aim was to estimate the risk of physical, psychosocial, and work organizational exposure factors that may lead to low-back problems. In addition this paper reviews and evaluates reported ergonomic intervention, with the object of decreasing the prevalence and incidence of low-back problems among nurses. A considerable number of studies of nursing staff has shown the connection between lifts and transfers of patients on one hand and low-back problems on the other. Factors in nursing work that may be significant in this connection are staff density and work satisfaction. In this review the single individual factor that was indisputably related to low-back problems was "history of back problems". Prevention programs do not show unequivocally positive results. There is a great need to carry out prospective studies with preventive programs.

Adult↗
PubMed1998

Workplace factors and care seeking for low-back pain among female nursing personnel. MUSIC-Norrtälje Study Group.

OBJECTIVES: Low-back pain is common among nursing personnel, and its origin is multifactorial. The present study focused on physical and psychosocial work load. The objectives of the study were to estimate the relative risk for nursing personnel, compared with other occupational groups, to seek health care for low-back pain, and to identify risk factors. METHODS: This study is a part of a population-based case-referent study in the municipality of Norrtälje, situated north of Stockholm. Altogether 333 women served as cases and 733 served as referents. Eighty-one cases and 188 referents were employed in nursing work. The cases had sought health care for low-back pain during the study period, November 1993 to November 1996. The referents were randomly selected from the same population. The subjects filled out 2 questionnaires and participated in interviews about physical exposures and psychosocial factors. RESULTS: When the female nursing personnel were compared with other employed women, no increased risk of consultation for low-back pain was found. According to a multivariate logistic regression, nursing personnel exposed to forward-bending working positions, high energetic work load, perceived physical exertion, or insufficient social support had the highest risk estimates. In univariate analyses, the combination of physical and psychosocial risk factors was associated with a particularly high risk. CONCLUSIONS: In nursing work, physical load seems to be more significant than psychosocial factors when a worker seeks health care for low-back pain. The results of did not support the hypothesis that nursing work is a risk occupation for seeking care for low-back pain when compared with other occupations.

Adult↗
PubMed2001

Vocational rehabilitation of workers with back pain.

This paper concerns the concepts and practices currently in use in occupational health for the rehabilitation of workers with back pain. No conclusive evidence exists for an etiologic model for nonspecific back pain. A difference between acute and chronic back pain is backed up by evidence from the literature. Apart from having the patient stay active and return to ordinary activities as early as possible, there are no significant forms of intervention for acute back pain that effectively decrease the time off work. For chronic back pain multidisciplinary treatment in an occupational setting is effective in enhancing return to work. Clinical practice guidelines consist of diagnostic triage, the assessment of "red flags" for medical emergencies, and guidance in the appropriate application of diagnostic facilities. Occupational health guidelines concentrate on gradual return to work, psychosocial issues, and multidisciplinary rehabilitation facilities.

Back Pain↗
PubMed2006

Is an imbalance between physical capacity and exposure to work-related physical factors associated with low-back, neck or shoulder pain?

OBJECTIVES: This study investigates whether an imbalance between physical capacity and exposure to work-related physical factors is associated with low-back, neck, or shoulder pain. METHODS: Data of the longitudinal study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), with a follow-up of 3 years (N=1789), were used. At baseline, physical capacity (isokinetic lifting strength, static muscle endurance, and mobility of the spine) and exposure to work-related physical factors were assessed. During the follow-up, low-back, neck, and shoulder pain were self-reported annually. "Imbalance" was defined as lower than median capacity combined with higher than median exposure, "high balance" was high capacity and high exposure, and "low balance" was low capacity and low exposure. RESULTS: For both the low-back and neck, imbalance between static endurance and working with flexed postures was a risk factor for pain [relative risk (RR) 1.35, 95% confidence interval (95% CI) 1.08-1.68, and RR 1.36, 95% CI 0.96-1.91, respectively]. Low balance was also associated with low-back pain (RR 1.29, 95% CI 1.04-1.68). Furthermore, low balance between isokinetic lifting strength and lifting exposure was a risk factor for low-back and neck pain [RR between 1.22 (95% CI 0.99-1.49) and 1.35 (95% CI 1.03-1.79)]. No associations were found with shoulder pain. CONCLUSIONS: Some relationship between low-back and neck pain and combined measures of physical capacity with exposure to work-related physical factors seems to exist, but an imbalance between physical capacity and exposure was not found to yield higher risks than high balance or low balance.

Absenteeism↗
PubMed1992

Spinal manipulation for low-back pain.

PURPOSE: To review the use, complications, and efficacy of spinal manipulation as a treatment for low-back pain. DATA IDENTIFICATION: Articles were identified through a MEDLINE search, review of articles' bibliographies, and advice from expert orthopedists and chiropractors. STUDY SELECTION: All studies reporting use and complications of spinal manipulation and all controlled trials of the efficacy of spinal manipulation were analyzed. Fifty-eight articles, including 25 controlled trials, were retrieved. DATA ANALYSIS: Data on the use and complications of spinal manipulation were summarized. Controlled trials of efficacy were critically appraised for study quality. Data from nine studies were combined using the confidence profile method of meta-analysis to estimate the effect of spinal manipulation on patients' pain and functional outcomes. RESULTS OF DATA SYNTHESIS: Chiropractors provide most of the manipulative therapy used in the United States for patients with low-back pain. Serious complications of lumbar manipulation, including paraplegia and death, have been reported. Although the occurrence rate of these complications is unknown, it is probably low. For patients with uncomplicated, acute low-back pain, the difference in probability of recovery at 3 weeks favoring treatment with spinal manipulation is 0.17 (for example, increase in recovery from 50% to 67%; 95% probability limits of estimate, 0.07 to 0.28). For patients with low-back pain and sciatic nerve irritation, the difference in probabilities of recovery at 4 weeks is 0.098 (probability limits, -0.016 to 0.209). CONCLUSIONS: Spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute low-back pain. Data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain.

Back Pain↗
PubMed2005

Meta-analysis: acupuncture for low back pain.

BACKGROUND: Low back pain limits activity and is the second most frequent reason for physician visits. Previous research shows widespread use of acupuncture for low back pain. PURPOSE: To assess acupuncture's effectiveness for treating low back pain. DATA SOURCES: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. STUDY SELECTION: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. DATA EXTRACTION: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. DATA SYNTHESIS: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. The principal [correction] measure of effect size was the standardized mean difference, since the trials assessed the same outcome but measured it in various ways. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. LIMITATIONS: The quantity and quality of the included trials varied. CONCLUSIONS: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

Acupuncture Therapy↗
PubMed1998

[Algorithm in low back pain management in adults].

Currently recommended management for low back pain in adults is presented. The algorithm consists of two phases. In a patient presenting acute low back pain with no previous history thorough clinical evaluation (phase I) should aim at exclusion of cauda equina syndrome, fracture, neoplasm, infection, progressive neurological deficit, or chronic pain syndrome. If none of these condition is responsible for low back pain 4-6 weeks therapy depending on the severity of symptoms should be commenced. Then clinical reevaluation is indicated and if pain persists patient should be referred to a specialist (phase II). Previous diagnosis and treatment should be reviewed critically; if found appropriate the treatment might be repeated during phase II. Primary sources of low back pain as herniated nucleus pulposus, unremitting low back pain (segmental instability), spondylolysis, isthmic spondylolisthesis degenerative spondylolisthesis with spinal stenosis should be identified and appropriate treatment (surgical or conservative) undertaken. Patient education is an important component of phase II. In general, phase II of the algorithm aims at returning the patient to full psychophysical activity and at prevention of low back pain recurrence.

Adult↗
PubMed1999

Are tennis players at increased risk for low back pain and sciatica?

OBJECTIVE: Tennis practiced intensively is generally held to be a risk factor for low back pain. The objective of our study was to evaluate the prevalence of low back pain with or without sciatica during the last week in tennis players versus controls. PATIENTS AND METHODS: During an international tennis competition held in Brest, France, ten physicians or medical students interviewed 633 spectators older than 18 years and divided them into tennis players and controls. The sample size was selected to allow detection of a twofold increase in the risk of low back pain in tennis players (with alpha = 5% and 1-beta = 80%). RESULTS: Of the 633 subjects, 388 were and 245 were not tennis players. There were 421 men with a mean age of 37 +/- 13.7 years and 212 women with a mean age of 34.3 +/- 12.7. Among the men, 49 of the 281 tennis players (17.4%) reported low back pain during the last week versus 26 of the 140 controls (18.6%). Corresponding figures in women were 20 of 107 tennis players (18.7%) and 29 of 105 controls (27.6%). Sciatica was not more common in tennis players (men, 20 of 281 tennis players [7.1%] versus 6 of 140 controls [4.3%]; women, 8 of 107 tennis players [7.5%] versus 10 of 105 controls [9.5%]). None of the differences between tennis players and controls were significant. The number of hours spent playing tennis per week was similar in tennis players with and without low back pain. CONCLUSION: Our interview-based cross-sectional study found no evidence that playing tennis involves a higher risk of low back pain with or without sciatica.

Adolescent↗
PubMed1999

Origin of back pain during bedrest: A new hypothesis.

Back pain during bed rest has frequently been reported. Until recently, studies concentrated mainly on length changes of the spine. Functional aspects such as reduced movements of the back, although anecdotally reported, could neither be quantified nor were they taken into account as a potential cause of back pain. In the present study the geometry of the spinal columns of eight healthy men was continuously recorded over 24 h before, during, and after a seven-day 6 degree head-down tilt period (Series 1). The approach is based on the measurement of skin distances between four pairs of miniaturized ultrasound transmitters and receivers fixed on the back in parallel to the thoracic and lumbar spine. After a four-week break, the entire study was repeated with the same subjects (Series 2). The major findings are: 1. The length increase of the spine segments investigated was virtually identical in both series. 2. During the bedrest period significantly greater pain occurred in Series 1 as compared to Series 2. Pain was generally confined to the lumbar region about 10 cm lateral of the spinous processes. 3. Pain was most prominent when trunk motions were minimal, while movements over the maximal range of the spine transiently reduced the pain remarkably. 4. During bed rest, the amplitude of voluntary movements of the lumbar segment was reduced in particular during Series 1. It is concluded that back pain during bed rest is induced by reduced amplitudes of spine movements rather than by increases in the spine length. It is suggested that isometric muscle contractions of low intensity are a primary course of back pain. Regular, slow, large-amplitude movements of the spine are recommended as a countermeasure.

Adult↗
PubMedDate not supplied

Back pain and spinal alignment abnormalities in schoolchildren.

OBJECTIVES: To study the prevalence of back pain and spinal alignment abnormalities in children aged 10 to 14 years; to define subsets of subjects with similar clinical profiles; and to identify factors associated with pain in the thoracic or lumbar spine. PATIENTS AND METHODS: 972 five- and nine-graders completed a back pain questionnaire at school and were examined by a school physician for spinal alignment abnormalities and for motion range limitation in the spine and/or lower limbs. Multivariate analysis was used to define clinical subsets and to identify factors associated with back pain. RESULTS: The point prevalence of back pain increased with age, from 14.3% in the ten-year-olds to 24% in the 14-year-olds. Girls were more likely than boys to report back pain, which was usually located in the low back. The prevalence of scoliosis increased with age and was higher in the girls. Multivariate analysis identified five clinical profiles: no spinal pain; nonserious spinal pain with no impact on medical service utilization or physical activities; spinal pain unrelated to an injury; injury-related spinal pain not treated by drugs or physical therapy; and injury-related spinal pain treated by drugs and physical therapy. Several factors associated with spinal pain were identified, with variations across the five groups.

Adolescent↗