Predictors of low back pain hospitalization – A prospective follow-up of 57,408 adolescents

Abstract

Low back pain (LBP) is common among adolescents and it has been estimated that one-fifth of adolescents suffer from recurrent severe LBP. However, longitudinal studies describing the risk factors of LBP are scarce. The purpose of this study was to investigate whether health, physical activity and other health behaviors, socio-demographic background and school success predict LBP hospitalization until early middle age. A cohort of 72,378 adolescents (57,408 respondents, response rate 79%) aged 14-18 years participating in a population survey between 1979 and 1997 was followed for an average of 11.1 years through the national hospital discharge register. We identified 810 (1.1%) persons with LBP hospitalization, 620 males (1.7% of the whole male cohort) and 190 (0.5%) females (HR 3.2; 95% CI: 2.7-3.7). In multivariate Cox's analysis, the strongest risk factors for LBP hospitalization for the whole cohort were weekly health complaints (HR 1.5; 95% CI: 1.2-1.9), daily smoking (HR 1.4; 95% CI: 1.1-1.7), and poor school success (HR 1.4; 95% CI: 1.1-1.9). Late puberty decreased the risk in males (HR 0.7; 95% CI: 0.5-0.9). Among females, participation in organized sports (HR 1.7; 95% CI: 1.1-2.5) was associated with an increased risk for LBP hospitalization. The associations between the risk factors and LBP hospitalization persisted into adulthood. Efforts to reduce adolescent smoking may decrease LBP-related morbidity in males. Coaches should pay special attention to the nature of physical training and personal exercises in females, and physiotherapists and sports physicians to the prevention of LBP hospitalization.

Factors Affecting Low Back Pain in Adolescents

“…18 The prevalence of LBP in the adolescents in our study is within the reported range in recent epidemiological studies that disclosed a lifetime prevalence ranging from 4.7% to 74.4%, 4,7,32-35 that is increasing steadily with age, approximating adult levels by around the age of 18 years and leading to hospitalization after the age of 19 years. 35 The latter seems to be evidence that LBP in adolescents is a risk factor for continuing symptoms in adulthood.…”

“…60 There is a controversy regarding LBP and regular smoking. 18,61 Smoking was not shown to be a risk factor for LBP for 8% of our adolescent smokers who smoked more than 5 cigarettes daily.…”

Low Back Pain and Everyday Functioning of Students

“…Nie któ re ba da nia su ge ru ją, że brak aktyw no ści fi zycz nej jest czyn ni kiem pre dys po nu ją cym do po wsta nia bó lu krę go słu pa [22,24,27,28]. Z drugiej jed nak stro ny, in ne ba da nia wy ka za ły zwięk szone ry zy ko bó lu krę go słu pa lę dźwio we go u osób aktyw nych fi zycz nie [25,29]. Po nad to stwier dzo no wręcz szko dli wy wpływ wy so kie go po zio mu ak tywno ści fi zycz nej [30].…”

“…Certain studies have sug gested that lack of physical activity is a factor pre disposing for back pain [22,24,27,28]. However, other studies have found an increased risk of low back pain in physically active individuals [25,29]. Moreover, a harmful effect of a high level of physical activity was actually noted [30].…”

Orthotic insoles do not prevent physical stress-induced low back pain

“…Low back pain (LBP) is a common clinical entity among adolescents and adults [5,6,9,10]. The prevalence of LBP is highest in middle age, but high occurrence figures of LBP have also been reported among adolescents and young adult populations [1,2,4,14,15].…”