Low back pain in children and adolescents: a growing problem

Recent research suggests a significant increase in the incidence of low back pain reported among  children  and  adolescents.  Prevalence  increases  with  age,  and  may  be  a  strong indicator of similar issues in adulthood. Causes remain an open question, experts reported at the EFORT Congress in Istanbul.

Istanbul, 6 June 2013  – A recent meta-analysis has suggested that the prevalence rates of low back pain in children and adolescents are higher in more recent studies compared to earlier studies. Dr Teija Lund (ORTON Orthopaedic Hospital, Helsinki), speaking on low back pain  in  this  age  group  at  the  14th   Congress  of  the  European  Federation  of  National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul, said it is still unclear whether these higher reported prevalence rates reflect a true increase in incidence or better recognition of the problem. “However, the past two decades have witnessed an increase in the research performed on this symptom in children and adolescents,” said Dr Lund.

Dr Lund said that in the 1980s it was still believed that children should not have low back pain, and if they did, it was usually due to a severe pathology. “Epidemiological research has  now  shown  that  low  back  pain  in  this  age  group  is  a  common  phenomenon  with reported  prevalence  rates  of  up  to  60%.  The  prevalence  increases  with  age,  and  reaches that seen in adults by late adolescence,” said Dr Lund. Girls have a higher risk to develop back pain than boys.

According to a prospective long-term study carried out by Dr Lund two years ago 59% of healthy  school  age  children  followed  through  maturity  experienced  low  back  pain  by  the time they reached 18 to 19 years old. At the outset of the investigation when they were 7 to 8 years old, 9% of the children had reported experiencing low back pain, showing a clear increase in prevalence.

Modern lifestyle of children and  adolescents: a risk  factor?

Epidemiological studies have investigated the possible associated factors or risk factors for childhood and adolescent low back pain, with conflicting results. “Several studies have addressed the influence of life-style factors, among others overweight, smoking, physical activity, and ‘screen time’. No definite conclusions can be made based on this research,” explained Dr Lund. In fact the studies indicate that care must be taken with what may seem an  obvious  remedy,  i.e.  physical  activity.  “The  studies  suggest  that  both  a  sedentary  life style  and  competitive  sports  would  increase  the  risk  of  low  back  pain,”  said  Dr  Lund. However, she said, as most of these studies are cross-sectional and not longitudinal, they can only assess associations, and not causality.

Looking to the  future: identify causes, develop preventive measures

Dr Lund emphasised the most important recent development is that the medical community has  now  started  to  pay  attention  to  musculo-skeletal  pain  in  children  and  adolescents,  especially low back pain. Since some studies suggest that low back pain in early life is the strongest predictor of adult low back pain, there are clear implications for individual health and health care costs. “If we think of the common nature of low back pain – almost all of us experience  it  at  some  point  of  our  life  –  and  its  financial  implications  to  the  health  care system  and  society  in  general,  preventing  low  back  pain  as  early  as  possible  would  be beneficial from both the individual’s and society’s perspective,” Dr Lund said.

Thus Dr Lund said in the future, more longitudinal studies will be needed to identify possible risk  factors  for  low  back  pain  in  children  and  adolescents  so  that  efforts  can  be  directed toward developing preventive measures for these specific factors.


The   European   Federation   of   National   Associations   of   Orthopaedics   and   Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in  1991 in  the Italian Marentino. Today it  has 42 national member societies from 43 member countries and six associate scientific members.

EFORT   is   a   non-profit   organisation.   The   participating   societies   aim   at   promoting   the exchange  of  scientific  knowledge  and  experience  in  the  prevention  and  treatment  of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.

Source:  EFORT  Speciality  Society  Session:  Low  back  pain  in  children  and  adolescents:  Epidemiology  and  risk factors; Lund et al, Lumbar disc changes on MRI and low back pain. Lumbar Spine Annual Meeting 2011

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