Back Pain in Youth – Occurrence and Risk Factors

Abstract

Research shows that a majority of people will experience back pain (BP) during their lifetime. Low back pain (LBP) in youth has a tendency of increasing the odds for LBP in adulthood, and it is commonly concurrent with other musculoskeletal (MSK) complaints, but also other factors such as sleep problems, reduction of physical activity and school absenteeism. Some studies have suggested that youth taking part in sports are at increased risk for LBP. Therefore, the main objective of this thesis was to investigate the prevalence of BP in youth and explore the association between LBP incidence and plausible risk factors in youth basketball and floorball players. The prevalence of back pain (BP) was first investigated in youth based on their participation in organized sports club activities. Twenty-four percent of boys and 35% of girls reported BP. BP was associated with other musculoskeletal complaints. In boys, being a sports club member the odds for LBP were increased compared to non-members. On the other hand, frequent neck and shoulder pain (NSP) was less common among sports club members than it was among non-members. In addition, BP prevalence, incidence and risk factors for LBP were investigated in youth basketball and floorball players using a prospective design. At the beginning of every study year, the players participated in baseline tests that measured muscle strength and flexibility, general joint hypermobility, ground reaction force (GRF) during vertical drop jump and movement control during movement tests. During the follow-up of one to three years, individual training and game hours and back pain resulting in at least 24-hour time-loss were recorded. We found that, LBP was common among young team sport players: 45% and 64% of basketball and floorball players reported having experienced LBP, respectively. The onset of the symptoms seemed to be mostly gradual without any identifiable trauma and LBP was most prevalent during the playing season. The longitudinal analysis revealed that 13% of the players reported time-loss LBP during the follow-up with median time-loss of 14 days. The incidence of BP was 0.4 per 1,000 hours of training and games. In the risk factor analyses, we found an association between hip-pelvic control during single-leg vertical drop landing and LBP. We did not observe a similar association in standing knee lift test and hip-pelvic control. No associations were found between LBP and impact force of landing, lower extremity maximal strength nor flexibility or hypermobility. LBP is a common complaint among youth and youth athletes and is concomitant with other MSK complaints. LBP hampers sports participation in youth athletes. Decreased hip-pelvic control in single-leg landing task was associated with increased risk for LBP incidence in youth floorball and basketball players. In the future, the association between movement and position control and LBP incidence in youth athletes should be investigated further using prospective and intervention designs.