Jouko J. Salminen

Contributing factors to the persistence of musculoskeletal pain in preadolescents: a prospective 1-year follow-up study.

&NA; A 1‐year follow‐up of two preadolescent age cohorts with musculoskeletal pain at least once a week was conducted to analyze predictive factors for the persistence of musculoskeletal pain. Of the 564 children with pain at baseline, representing one third of the sample studied, 515 (91.3%) could be followed and 452 (80.1%) children with complete data were included for the logistic regression analysis. A structured questionnaire included questions on pain and also on several psychosomatic symptoms and amount of exercise. Joint hypermobility together with the questionnaire data were included in the logistic regression analysis. One half of subjects with pain at baseline still reported pain at follow‐up, indicating persistent pain. Boys had a lower risk for the persistence of pain than girls and the risk for the persistence of pain increased 1.2 times per age year. When further adjusted for all the other studied risk determinants, high subjective disability index due to pain (OR 3.2, 95% CI 1.5–6.6) and day tiredness (OR 1.9, 95% CI 1.2–3.0) were the most significant predictors. This might indicate that psychological distress contributes to the persistence of non‐specific musculoskeletal pain of different locations in preadolescents. In clinical work not only pain but its interference with daily activities should be noticed.

Non-specific low back pain in children and adolescents: risk factors

Abstract Low back pain (LBP) among children and adolescents has become the subject of an increasing amount of literature over the last 15 years. This topic, which was considered almost insignificant less than two decades ago, was the focus of a recent international meeting organised in Grenoble (France) in March 1999. This review paper is the result of an literature update search performed by members of three groups which have been active in this field for many years. Current epidemiological data on LBP is summarized as well as the role of the major risk factors according to studies published in the principal peer reviewed journals interested in the topic.

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys

Abstract Objectives: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and2001. Design: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. Setting: Finland. Participants: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. Main outcome measures: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. Results: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boysand 13% of girls in 18 year olds. Conclusion: Pain in the neck, shoulder, and lower back is becoming morecommon in Finnish adolescents. This pain suggests a new disease burden of degenerativemusculoskeletal disorders in future adults.

Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence

&NA; A 1‐year follow‐up study of 1756 third‐ and fifth‐grade schoolchildren was conducted with a structured pain questionnaire to assess the prevalence and persistence of self‐reported musculoskeletal pain symptoms and disability caused by pain. At follow‐up, 1626 (92.7%) children participated in the study. Pain at least once a week persisted in 270 (52.4%) of the 564 children who reported musculoskeletal pain at least once a week in at least one part of the body at baseline. Of the regional pain symptoms, neck pain had highest persistence and, in girls, significantly more than in boys. Persistence of pain was not related to school grade. Widespread pain, determined as in the criteria for fibromyalgia, was found in 132 children (7.5%) and persisted in 35 children (29.7%, 95% CI 21.9–38.4) at follow‐up. Disability was more severe in children with pain symptoms in more than one area. This study showed that about half of the preadolescents complaining of musculoskeletal pain at least once a week at baseline had persistent pain symptoms at follow‐up. The prognosis of widespread pain in preadolescents was almost the same as the previous findings in adults.

Prognosis of non-specific musculoskeletal pain in preadolescents: A prospective 4-year follow-up study till adolescence

&NA; Musculoskeletal pain is common in children but studies on the outcome and predictive factors for persistence/recurrence of these symptoms are scarce. A baseline cross‐sectional survey of 1756 schoolchildren (mean age 10.8) identified 564 (32.1%) children with musculoskeletal pain. At baseline, these children were evaluated using a structured questionnaire and examined for hypermobility and physical fitness. The children were re‐evaluated after one year, and four years (at adolescence) using the same pain questionnaire. At 1‐year follow‐up, 53.8% (95% CI 48.8–58.8) of the children reported pain persistence (persistent preadolescent musculoskeletal pain). At 4‐year follow‐up, 63.5% (95% CI 58.7–68.1) of them had musculoskeletal pain. Neck was the site with most persistent/recurrent musculoskeletal pain. Those with persistent preadolescent musculoskeletal pain had approximately three times higher risk of pain recurrence (OR=2.90 [95% CI 1.9–4.4]). In the univariate analysis, female gender, older age group (11+), hypermobility, co‐existence of psychosomatic symptoms, having high disability index, and reporting combined musculoskeletal pain at baseline predicted pain recurrence at adolescence. In the multivariate analysis, age, headache, hypermobility and having combined musculoskeletal pain were found as independent predictors. Statistically significant sex interactions were found for age, depressive feelings, waking up during nights and hypermobility. More psychosomatic symptoms predicted pain recurrence in girls than in boys, and hypermobility was a strong predictor in females only. Musculoskeletal pain in preadolescents is not a self‐limiting phenomenon and more studies are still warranted to explore its determinants aiming to improve the long‐term outcome of these symptoms.

Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain.

Study Design. This was a prospective 3-year follow-up study of randomized matched subgroups of 15-year-old school children with or without low back pain initially. Objective. In addition to low back pain and leisure time physical activity, spinal mobility, trunk muscle strength, and early degenerative findings of the lumbar spine were evaluated. Summary of Background Data. Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse. Along with several other characteristics, the relationship of these changes to frequent low back pain in young persons is not known. Methods. After a questionnaire-based survey was administered, subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity, anthropometry, spinal mobility, trunk muscle strength, and magnetic resonance imaging findings of the lumbar spine. Results. At baseline and at follow-up, those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function. During follow-up, the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects. Furthermore, disc degeneration at baseline significantly predicted future frequent low back pain. Initial disc protrusion also predicted future frequent low back pain. Conclusion. After the rapid physical growth period, there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects.

Low-back pain in adolescent athletes

In this 3-yr longitudinal study we investigated the occurrence of low-back pain and anatomic changes in the low back in relation to loading and injuries among 98 adolescents: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (17 ice hockey, 17 soccer players), and 31 girl athletes (17 figure skaters, 14 gymnasts). During the 3-yr follow-up, low-back pain lasting longer than 1 wk was reported by 29 (45%; 95% CI, 32%-57%) athletes and by 6 (18%; 95% CI, 7%-35%) nonathletes (P = 0.0099). Acute back injury was reported by 17 of 19 subjects who also reported low-back pain (89%; 95% CI, 67%-99%) and by 2 of 63 of those without prolonged low-back pain (3%; 95% CI, 0%-11%) (P < 0.0001). Among 43 girls participating in baseline and follow-up MRI examinations of the lumbar spine, new MRI abnormalities were found in 6 of 8 reporting acute back injury (75%; 95% CI, 35%-97%) and in 8 of the remaining 35 girls (23%; 95% CI 10% to 40%) (P = 0.018). In conclusion, excessive loading that involves a risk for acute low-back injuries during the growth spurt is harmful to the lower back.

Neck or shoulder pain and low back pain in Finnish adolescents.

The aim of this study was to investigate the prevalence and determinants of self-reported neck or shoulder pain (NSP) and low back pain (LBP) among 12-18-year-olds. A questionnaire was mailed to a nationally representative sample of 11,276 12-, 14-, 16- and 18-year-olds in 1991. The response rate was 77%. NSP was perceived at least once a week by 15% of 12-18-year-olds and LBP by 8%. Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16-18-year-old girls. The strong association of psychosomatic symptoms with NSP and LBP suggests that the latter two pain states could be more psychosomatic than nosiceptive in character.

Spinal mobility and trunk muscle strength in 15-year-old schoolchildren with and without low-back pain

From a population of 1,503 schoolchildren, 38 15-year-old children suffering from low-back pain and 38 asymptomatic controls were selected for testing of spinal mobility and trunk muscle strength. The asymptomatic controls were matched by age, sex, and school class. In the group with recurrent or continual low-back pain (17 boys and 21 girls), the boys were over 4 cm taller than those in the control group. In both sexes sagittal mobility was decreased in lumbar extension and straight leg raising, and increased in lumbar flexion. Endurance strength in the abdominal and back muscles was decreased compared to the control pupils, who reported no back pain at all in the questionnaire collected 1 year before the testing procedure. The pupils reporting sciatica (n = 7) at some time, in addition to recurrent low-back pain, had decreased lumbar flexion and side bending compared to those with recurrent low-back pain (n = 31) without sciatica. The results of the study indicated that in this growing-age population there was a subgroup with recurrent low-back pain having a different spinal mobility pattern as well as decreased trunk muscle strength.

Subject characteristics and low back pain in young athletes and nonathletes

Factors associated with low back pain (LBP) were sought by means of a questionnaire and physical measurements in 138 adolescents. One-hundred athletes and 38 nonathletes, 138 subjects total (58 boys and 80 girls; age range 10.3-13.3 yr), were studied. The questionnaire included questions on physical activity and LBP. Quantitative measurements on anthropometry, flexibility (joint hypermobility and muscular tightness), and strength were performed. There was no significant difference in the occurrence of LBP between athletes and nonathletes. Among the athletes, the duration of training during the past 12 months (min.wk-1) was higher in subjects with the experience of LBP during the past 12 months (N = 23) compared with nonsymptomatic subjects (N = 76) (mean 493 +/- 308 min.wk-1 vs 354 +/- 160 min.wk-1; P less than 0.0001). Similar differences were also seen between subjects with positive lifetime histories of LBP and nonsymptomatic subjects. Various differences were seen in the measurements of anthropometry, flexibility, and strength between boys and girls as well as between athletes and nonathletes. In a multivariate analysis, the cumulative incidence of lifetime history of LBP was associated with tightness of hip flexor muscles only (P = 0.014). LBP during the past 12 months was associated only with the amount of training during the past 12 months (min.wk-1) (P = 0.0066). Our study suggests that high training duration predisposes young athletes to LBP. However, e.g., the flexibility measurements cannot be used to determine athletes at high risk.