Non-specific Low Back Pain in Children and Adolescents
At the turn of the century, adolescent low back pain was considered uncommon.1 In 2016, this bulletin reported the prevalence at 5%.2
Regretfully, current studies estimate the prevalence of non-specific low back pain (LBP) between ages 9 and 16 to be 39%.3,4 Worse yet, a 25-year, prospective follow-up study finds that adolescent low back pain predicts adult back pain, increased morbidity, and decreased working capacity.5
The now common nature of the problem underscores the importance of knowing that physiotherapy referrals will be effective. Peer-reviewed journals have published a number of studies and a collection of systematic reviews and meta-analyses to determine the most effective physiotherapy approaches in childhood and adolescent LPB.
The latest of these is a systematic review and meta-analysis published last April.6 José Manuel García-Moreno and colleagues from the University of Murcia analysed the results of fifty trials, with an eye toward effects that would prevent recurrence and adult LBP. They found that, with medium to large effect sizes, physiotherapy effectively:
- Improved patient knowledge
- Improved hamstring flexibility
- Corrected posture
- Improved postural hygiene
Moderators Shown to Improve the Effectiveness of Physiotherapy for Childhood and Adolescent LBP:
- Greater than 8 weeks. This is according to previous studies and a 2014 consensus opinion.7,8,9 In the current meta-analysis, length of care only ranged between 7 and 9 weeks, which limited the ability to evaluate this moderator.
- Treatments that increase intensity and magnitude progressively—emphasizing the importance of professional supervision.
- Therapeutic exercise plus physical activity proves more effective than therapeutic exercise alone.
References
1. Jones G, Macfarlane G. Epidemiology of low back pain in children and adolescents. Arch Dis Child. 2005; 90: 312-316.
2. Jeffries L, Milanese S, Grimmer-Somers K. Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine. 2007; 32: 2630-7.
3. Hwang J, Louie PK, Phillips FM, An HS, Samartzis D. Low back pain in children: a rising concern. European Spine Journal. 2019 Feb 5;28:211-3.
4. Minghelli B. Low Back pain in childhood and adolescent phase: consequences, prevalence and risk factors–a revision. J Spine. 2017 Jan;6(1):6.
5. Harreby M, Neergaard K, Hesselsoe G, et al. Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children. Spine. 1995; 20: 2298-302.
6. García-Moreno JM, Calvo-Muñoz I, Gómez-Conesa A, López-López JA. Effectiveness of physio[1]therapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2022 Apr 2;23(1):314.
7. Lloyd RS, Faigenbaum AD, Stone MH, Oliver JL, Jeffreys I, Moody JA, Brewer C, Pierce KC, McCambridge TM, Howard R, Herrington L. Position statement on youth resistance training: the 2014 International Consensus. British Journal of Sports Medicine. 2014 Apr 1;4
8(7):498-505. 8. Calvo-Muñoz I, Gómez-Conesa A, Sánchez-Meca J. Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis. BMC Musculoskeletal Disorders. 2012 Dec;13:1-9.
9. Behringer M, Vom Heede A, Matthews M, Mester J. Effects of strength training on motor perfor[1]mance skills in children and adolescents: a meta-analysis. Pediatric Exercise Science. 2011 May 1;23(2):186-206.