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Zapata KA, Devkumar D, Ma Y, Jo CH, Ramo BA. Back pain and disability according to early onset scoliosis etiology in children younger than 10 years. Spine Deform 2024; 12:481-488. [PMID: 37938517 DOI: 10.1007/s43390-023-00783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To determine caregiver-reported back pain prevalence, disability, pain interference, and associations with curve magnitude in early onset scoliosis (EOS) using the Oswestry Disability Index (ODI) and Patient Reported Outcome Measurement Information Systems (PROMIS) measures. METHODS A single-center, retrospective review was performed in children below 10 years of age according to EOS etiology. Caregiver-reported back pain prevalence, ODI, PROMIS Pain Interference, Mobility, and Anxiety measures, and curve magnitude were recorded as part of routine clinic appointments. RESULTS A total of 1212 patients with EOS (588 idiopathic, 295 congenital, 217 neuromuscular, 112 syndromic) ages 6.6 ± 2.7 were included; 23% had caregiver-reported back pain. Neuromuscular EOS patients had the highest prevalence of back pain (29%). ODI scores were higher in neuromuscular (48%) and syndromic (35%) patients than congenital (20%, p < 0.05) and idiopathic (16%, p < 0.01) patients. Neuromuscular patients also had higher PROMIS Pain Interference scores (53.3) compared to idiopathic (41.6, p < 0.001) and syndromic (45.0, p = 0.016) patients. A higher curve was associated with the presence of back pain (39° vs. 30°, p < 0.001) and had positive correlations with ODI scores (r = 0.38, p < 0.001) and PROMIS Pain Interference scores (r = 0.34, p < 0.001). CONCLUSION Approximately one in five children with EOS under the age of 10 have caregiver-reported back pain, with the neuromuscular EOS type exhibiting higher pain prevalence, interference, and disability scores. Larger curve magnitude is associated with an increased prevalence of caregiver-reported back pain, increased disability, and increased pain interference. LEVEL OF EVIDENCE 3 - case-control study.
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Affiliation(s)
- Karina A Zapata
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA.
| | - Devan Devkumar
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Yuhan Ma
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Brandon A Ramo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
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The relationships between physical activity, lumbar multifidus muscle morphology, and low back pain from childhood to early adulthood: a 12-year longitudinal study. Sci Rep 2022; 12:8851. [PMID: 35614086 PMCID: PMC9132932 DOI: 10.1038/s41598-022-12674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
We investigated the longitudinal associations between physical activity (PA), lumbar multifidus morphology, and impactful low back pain (LBP) in young people. Nine-year-old children were recruited from 25 primary schools and followed up at age 13, 16, and 21 years. We measured PA with accelerometers at age 9, 13, and 16; quantified patterns of lumbar multifidus intramuscular adipose tissue (IMAT) change from 13 to 16 years using magnetic resonance imaging; and recorded LBP and its impact with standardised questionnaires and interviews. Associations were examined with crude and adjusted logistic or multinomial models and reported with odds ratios (OR) or relative risk ratios (RRR). We included data from 364 children (mean[SD] age = 9.7[.4] years). PA behaviour was not associated with LBP. Having persistently high IMAT levels at age 13 and 16 was associated with greater odds of LBP (OR[95% CI] = 2.98[1.17 to 7.58]). Increased time in moderate and vigorous intensity PA was associated with a lower risk of higher IMAT patterns (RRR[95% CI] = .67[.46 to .96] to .74[.55 to 1.00]). All associations became non-significant after adjusting for sex and body mass index (BMI). Future studies investigating the relationships between PA behaviour, lumbar multifidus IMAT, and impactful LBP should account for potential confounding by sex and BMI.
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Baronio M, Sadia H, Paolacci S, Prestamburgo D, Miotti D, Guardamagna VA, Natalini G, Bertelli M. Etiopathogenesis of sacroiliitis: implications for assessment and management. Korean J Pain 2020; 33:294-304. [PMID: 32989194 PMCID: PMC7532300 DOI: 10.3344/kjp.2020.33.4.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
The sacroiliac joints connect the base of the sacrum to the ilium. When inflamed, they are suspected to cause low back pain. Inflammation of the sacroiliac joints is called sacroiliitis. The severity of the pain varies and depends on the degree of inflammation. Sacroiliitis is a hallmark of seronegative spondyloarthropathies. The presence or absence of chronic sacroiliitis is an important clue in the diagnosis of low back pain. This article aims to provide a concise overview of the anatomy, physiology, and molecular biology of sacroiliitis to aid clinicians in the assessment and management of sacroiliitis. For this narrative review, we evaluated articles in English published before August 2019 in PubMed. Then, we selected articles related to the painful manifestations of the sacroiliac joint. From the retrieved articles, we found that chronic sacroiliitis may be caused by various forms of spondyloarthritis, such as ankylosing spondyloarthritis. Sacroiliitis can also be associated with inflammatory bowel disease, Crohn’s disease, gout, tuberculosis, brucellosis, and osteoarthritis, indicating common underlying etiological factors. The pathophysiology of sacroiliitis is complex and may involve internal, environmental, immunological, and genetic factors. Finally, genetic factors may also play a central role in progression of the disease. Knowing the genetic pre-disposition for sacroiliitis can be useful for diagnosis and for formulating treatment regimens, and may lead to a substantial reduction in disease severity and duration and to improved patient performance.
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Affiliation(s)
- Manuela Baronio
- Dipartimento di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Fondazione Poliambulanza, Brescia, Italy
| | - Hajra Sadia
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | | | | | - Danilo Miotti
- Cure Palliative e Terapia del Dolore, ICS Maugeri, Pavia, Italy
| | | | - Giuseppe Natalini
- Dipartimento di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Fondazione Poliambulanza, Brescia, Italy
| | - Matteo Bertelli
- MAGI's Lab, Rovereto, Italy.,MAGI Euregio, Bolzano, Italy.,EBTNA-LAB, Rovereto, Italy
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Schwertner DS, Oliveira RANS, Koerich MHAL, Motta AF, Pimenta AL, Gioda FR. Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index. J Back Musculoskelet Rehabil 2020; 33:233-244. [PMID: 31356188 DOI: 10.3233/bmr-170821] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial. OBJECTIVE This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference). METHODS This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted. RESULTS A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI). CONCLUSIONS Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.
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Affiliation(s)
- Debora Soccal Schwertner
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil.,Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Raul A N S Oliveira
- Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Micheline H A L Koerich
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | - Andréa Fontoura Motta
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | | | - Fabiane Rosa Gioda
- Universidade Regional de Blumenau - FURB, Regional University of Blumenau, Blumenau, Brazil
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Implementation of a Classroom Program of Physiotherapy among Spanish Adolescents with Back Pain: A Collaborative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134806. [PMID: 32635363 PMCID: PMC7370067 DOI: 10.3390/ijerph17134806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 01/23/2023]
Abstract
Background: The prevalence of back pain in adolescents is steadily increasing, with negative repercussions on students’ social and academic life. This study sought to improve the ergonomics and musculoskeletal health of adolescents in secondary school by implementing physiotherapy actions within the educational context. Methods: A qualitative collaborative action research approach was used, comprising 49 students, 9 teachers, 11 family members, and 9 physiotherapists. Workshops on ergonomics, stretching, and massage were held. Visual materials were developed to support the assimilation of the information given at the workshops. Data collection included field notes, reflexive diaries, in-depth interviews, and discussion groups. The data were analyzed using the Atlas.ti 6.0 program (Scientific Software Development GmbH, Berlin, Germany). Results: The presence of a physiotherapist in the school context facilitates the acquisition of healthy postural habits. All the adolescents perceived a decrease in back pain after undergoing the program. Conclusions: physiotherapy activities offer students new tools to decrease their back pain and improve their health.
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Keeratisiroj O, Siritaratiwat W. Prevalence of self-reported musculoskeletal pain symptoms among school-age adolescents: age and sex differences. Scand J Pain 2019; 18:273-280. [PMID: 29794297 DOI: 10.1515/sjpain-2017-0150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Non-specific musculoskeletal pain symptoms are common in adolescents and may differ between the sexes, and be related to age and daily activities. It is critical to examine the prevalence and frequency of symptoms in adolescent students who tend to have pain which interferes with their routine activities. This study aimed to explore the prevalence and frequency of self-reported musculoskeletal pain symptoms by age and sex, and we also examined the association of symptoms with routine activities of school-age adolescents by area of pain. METHODS A cross-sectional survey was conducted among Thai students aged 10-19 years. All 2,750 students were asked to report previous 7-day and/or 12-month pain using the Standardized Nordic Questionnaire (Thai version) in 10 body areas. Multivariable logistic regression adjusted for age and sex was used to analyze the association between daily activity and musculoskeletal pain symptoms. RESULTS A total of 76.1% (n=2,093) of students reported experiencing pain in the previous 7 days, 73.0% (n=2,007) reported in the previous 12-month period and 83.8% (n=2,304) reported pain in both 7-day and 12-month periods. The most common pain area was from a headache, with other areas being neck and shoulders, in that order, for both periods of time. The prevalence of musculoskeletal pain was especially higher in older groups and females. Participants reported frequency of pain as "sometimes in different areas" ranging from 78.4% to 88% and severity of pain at 3.82±2.06 out of 10 (95% CI 3.74-3.91). Routine daily activities associated with symptoms of headache, neck, shoulders, and ankles or feet pain were computer use (head, OR=2.22), school bag carrying (neck, OR=2.05), school bag carrying (shoulder, OR=3.09), and playing sports (ankle or foot, OR=2.68). CONCLUSIONS The prevalence of musculoskeletal pain symptoms was high in both the previous 7-day and 12-month periods, especially in females and older adolescents, although most of them sometimes experienced pain. Computer use and school bag carrying were associated with headache, neck and shoulder pain, while playing sports was related to symptoms of the foot and ankle. IMPLICATIONS The prevalence of pain was high, particularly in the older and female groups. Although they experienced mild symptoms sometimes, the related daily activities leading to these symptoms should be closely noticed.
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Affiliation(s)
| | - Wantana Siritaratiwat
- Back, Neck, Other Joint Pain, and Human Performance Research Center (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand, Phone/Fax: +66-4320-2085
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Rahmani N, Mohseni-Bandpei MA, Salavati M, Vameghi R, Abdollahi I. Normal values of abdominal muscles thickness in healthy children using ultrasonography. Musculoskelet Sci Pract 2018; 34:54-58. [PMID: 29274529 DOI: 10.1016/j.msksp.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/07/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022]
Abstract
Abdominal muscles are one of the important elements to support the lumbar spine. Evaluation of muscle thickness using ultrasonography (US) is considered to be a source of information from muscles characteristics. The purpose of this study was to demonstrate normal reference data of abdominal muscles thickness and subcutaneous fat in adolescents using US. A random sample of 160 healthy adolescents (80 boys and 80 girls) at the age range of 15-18 years was recruited. Three abdominal muscles including Transversus Abdominis (TA), Internal Oblique (IO), External Oblique (EO) and subcutaneous fat (SF) were bilaterally measured using US. The range of normal values for TA muscle thickness was between 2.31 and 2.57 mm, for IO muscle thickness was between 4.02 and 5.15 mm and for EO muscle thickness was between 2.81 and 3.17 mm. The normal patterns of abdominal muscles were found as IO > EO > TA at both sides. Boys were taller, heavier with greater body mass index (BMI) and had larger abdominal muscles thickness than girls. A weak negative correlation was found between age and muscles size [r = (-0.06) - (-0.23), p < .05], but a significant positive correlation was found between BMI and muscle size (r = 0.21-0.68, p < .05). It seems that abdominal muscles thickness in adolescents followed the same pattern of muscle size in adults. BMI appeared to be the best predictor of muscle thickness. However, further studies are recommended to support the findings of the present study.
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Affiliation(s)
- Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Mahyar Salavati
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Roshanak Vameghi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Iraj Abdollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Rahmani N, Mohseni-Bandpei MA, Salavati M, Vameghi R, Abdollahi I. Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:905-912. [PMID: 29027682 DOI: 10.1002/jum.14427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/23/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP. METHODS One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography. RESULTS The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P < .05). Patients with LBP had smaller abdominal muscles compared with healthy adolescents. No significant difference was found between the groups in terms of the subcutaneous fat dimension (P > .05). CONCLUSIONS The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.
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Affiliation(s)
- Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran
- Pediatric Neurorehabilitation Research Center and University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Mahyar Salavati
- Department of Physiotherapy , University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran
| | - Roshanak Vameghi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran
| | - Iraj Abdollahi
- Department of Physiotherapy , University of Social Welfare and Rehabilitation Sciences, Evin, Tehran, Iran
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Abstract
Study Design Longitudinal cohort study. Background Spinal pain is responsible for a huge personal and societal burden, but its etiology remains unclear. Deficits in motor control have been associated with spinal pain in adults, and delayed motor development is associated with a range of health problems and risks in children. Objective To assess whether there is an independent relationship between the age at which infants first sit and walk without support and spinal pain at 11 years of age. Methods Data from the Danish National Birth Cohort were analyzed, using the age at which children first sat and first walked without support as predictors. Parents reported the predictors when the children were 6 months and 18 months of age, and also provided information in response to a comprehensive list of covariates, including child sex, birth weight, and cognitive development; socioeconomic indicators; and parental health variables. Outcomes were measured at 11 years of age using the Young Spine Questionnaire, which assesses the presence and intensity of spinal pain. Data were analyzed using multivariable logistic regression models to estimate determinants of neck, thoracic, lumbar, and multisite pain. Results The analyses included data from approximately 23 000 children and their parents. There were no consistent independent associations between the age at first sitting or walking and spinal pain at the age of 11. Odds ratios were between 0.95 and 1.00 for the various pain sites. Conclusion The age at which a child first sits or walks without support does not influence the likelihood that he or she will experience spinal pain in later childhood. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2017;47(10):763-768. doi:10.2519/jospt.2017.7484.
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Chiwaridzo M, Chikasha TN, Naidoo N, Dambi JM, Tadyanemhandu C, Munambah N, Chizanga PT. Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents. Arch Physiother 2017; 7:3. [PMID: 29340198 PMCID: PMC5759913 DOI: 10.1186/s40945-017-0031-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition. METHODS The study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study. RESULTS Twenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89). CONCLUSION Excellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.
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Affiliation(s)
- Matthew Chiwaridzo
- Rehabilitation Department, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare Zimbabwe
- Division of Physiotherapy, University of Cape Town, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Cape Town, South Africa
| | - Tafadzwa Nicole Chikasha
- Rehabilitation Department, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare Zimbabwe
| | - Nirmala Naidoo
- Division of Physiotherapy, University of Cape Town, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Cape Town, South Africa
| | - Jermaine Matewu Dambi
- Rehabilitation Department, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare Zimbabwe
| | - Cathrine Tadyanemhandu
- Rehabilitation Department, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare Zimbabwe
| | - Nyaradzai Munambah
- Rehabilitation Department, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare Zimbabwe
| | - Precious Trish Chizanga
- Department of Tourism and Hospitality, Harare Polytechnic College, P.O Box CY 407, Causeway, Harare Zimbabwe
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The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract Res Clin Rheumatol 2016; 30:1021-1036. [DOI: 10.1016/j.berh.2017.04.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ollier's Disease of the Iliac Bone with Sacroiliac Joint Involvement in an Adolescent Patient. Case Rep Surg 2016; 2016:4893718. [PMID: 27957379 PMCID: PMC5124470 DOI: 10.1155/2016/4893718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022] Open
Abstract
Ollier's disease of the hip bone involving the sacroiliac joint has not yet been reported in the English-language literature in both the mature and immature skeletons. The authors present such a unique case in an adolescent girl that posed a significant diagnostic challenge secondary to the rarity of the lesion and atypical clinical picture.
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Hill J, Keating J. Encouraging healthy spine habits to prevent low back pain in children: an observational study of adherence to exercise. Physiotherapy 2016; 102:229-35. [DOI: 10.1016/j.physio.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/21/2015] [Indexed: 12/12/2022]
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14
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Swain MS, Kamper SJ, Maher CG, Latimer J, Broderick C, McKay D, Henschke N. Short-term Clinical Course of Knee Pain in Children and Adolescents: A Feasibility Study Using Electronic Methods of Data Collection. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 27196524 DOI: 10.1002/pri.1669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/08/2015] [Accepted: 02/28/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders, such as knee pain, are common in children and adolescents, but there is a lack of high quality research that evaluates the clinical course of these conditions. The objective of this study was to evaluate the feasibility of conducting a prospective study of children and adolescents with knee pain using electronic methods of data collection. METHODS Children and adolescents with knee pain that presented to primary care physiotherapy clinics were enrolled and followed-up on a weekly basis via short messaging service (SMS) until their knee pain had recovered (i.e. two consecutive weeks of no pain). Feasibility was assessed in terms of recruitment, retention and response rates to SMS and an online questionnaire. Baseline and 6-month follow-up measures included pain, disability, physical function, physical activity and health related quality of life. Kaplan-Meier survival analysis was used to estimate the median time to knee pain recovery. RESULTS Thirty participants (mean age 13.0 ± 2.2 years, 53% boys) were recruited over 26 months. The overall response rate to weekly SMS follow-up was 71.3% (809 received/1135 sent). One third of participants stopped responding to SMS prior to recovery, and these participants typically had a much lower response rate during the time they remained in the study. At 6-month follow-up, 80% of the cohort completed the final online questionnaire, and 29% of participants still reported current knee pain (≥1/10 VAS). The median time for knee pain recovery was 8 weeks (95%CI: 5, 10). CONCLUSION Electronic data collection alone seems insufficient to track pain recovery in young people and may need to be supplemented with more traditional data collection methods. Researchers should consider further measures to address slow recruitment rates and high attrition when designing large prospective studies of children and adolescents in the future. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Michael S Swain
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Steven J Kamper
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Chris G Maher
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Carolyn Broderick
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Children's Hospital Institute of Sports Medicine, The Sydney Children's Hospitals Network, Sydney, Australia.,School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Damien McKay
- Children's Hospital Institute of Sports Medicine, The Sydney Children's Hospitals Network, Sydney, Australia
| | - Nicholas Henschke
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Institute for Public Health, University of Heidelberg, Heidelberg, Germany
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15
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Functional consequences and health-care seeking behaviour for recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:643-50. [PMID: 26148568 DOI: 10.1007/s00586-015-4105-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study was to investigate the consequences of recurrent non-specific low back pain in Zimbabwean adolescents. Recurrent non-specific low back pain is a common cause of adult disability in low-income countries. However, its impact in adolescents has been a matter of debate in the literature. METHODS A survey was conducted using a cluster sample of 544 school children between the ages of 13 and 19 years. The school children were randomly selected from government-administered secondary schools in Harare, Zimbabwe. RESULTS Parental and students' response rate were 90.3 and 97.8 %, respectively. Almost a third (28.8 %) of school children reported recurrent symptoms (CI 27.8-31.6). However, the majority (84 %) of these cases were unknown to parents. Twenty-seven percent reported having sought medical treatment. On the nine-item Hanover Low Back Pain Disability Questionnaire, 71.2 % of school children had at least one activity of daily living compromised by recurrent NSLBP, especially sports participation. However, severe disability was reported in 28 % of the adolescents. Health-care seeking behaviour was not associated with the level of disability [χ (2)(1) = 0.36, p = 0.55]. CONCLUSION Although most parents are unaware, recurrent NSLBP is common in Zimbabwean school children. However, treatment is rarely sought for the symptoms. A preponderance of adolescents with recurrent NSLBP experiences some degree of functional consequences, although severe disability is rare. There is need to raise awareness of the condition in schools and to parents. Spinal health educational programmes may need to be implemented to avert the functional consequences. Further studies are needed in the future to investigate the coping strategies for pain in adolescents.
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Daily exercises and education for preventing low back pain in children: cluster randomized controlled trial. Phys Ther 2015; 95:507-16. [PMID: 25504487 DOI: 10.2522/ptj.20140273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/25/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Children report low back pain (LBP) as young as 8 years. Preventing LBP in children may prevent or delay adult incidence. OBJECTIVES The purpose of this study was to determine whether education and daily exercise affect LBP episodes in children compared with education alone. DESIGN This was a prospective, multicenter cluster randomized controlled trial. SETTING The study was conducted at 7 New Zealand primary schools. PARTICIPANTS Children (n=708), aged 8 to 11 years, from 7 schools stratified by sample size (36, 114, 151, 168, 113, 45, 83) were randomized and allocated to 2 masked groups: intervention (4 schools, n=469) or control (3 schools, n=239). INTERVENTIONS Participants in the intervention group were taught 4 spinal movements for daily practice. Both groups participated in education that emphasized "back awareness." MEASUREMENTS Low back pain history at baseline was assessed. Children reported episodes of LBP during the previous week on trial days 7, 21, 49, 105, 161, and 270. Analysis was at the individual participant level, with adjustment for school clusters. RESULTS There were no significant differences between groups in the odds of reporting no LBP in the previous week during the study period (odds ratio [OR]=0.72; 95% confidence interval [95% CI]=0.46, 1.14; P=.16). The intervention group reported significantly fewer episodes of LBP (OR=0.54; 95% CI=0.39, 0.74; P<.001) and significantly fewer lifetime first episodes of LBP (n=86 [34%]) compared with the control group (n=58 [47%]) (OR=0.60; 95% CI=0.39, 0.91; P=.02). The odds of an episode of LBP were greater in participants with a history of LBP (OR=4.21; 95% CI=3.07, 5.78; P<.001). Low back pain episodes decreased across the trial period for both groups (OR=0.89; 95% CI=0.84, 0.95; P<.001). Adherence to exercise was poor. LIMITATIONS Replication in other settings is needed. CONCLUSIONS Regular exercise and education appear to reduce LBP episodes in children aged 8 to 11 years compared with education alone.
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Newlands C, Reid D, Parmar P. The prevalence, incidence and severity of low back pain among international-level rowers. Br J Sports Med 2015; 49:951-6. [DOI: 10.1136/bjsports-2014-093889] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/04/2022]
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Chiwaridzo M, Naidoo N. Prevalence and associated characteristics of recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study. BMC Musculoskelet Disord 2014; 15:381. [PMID: 25406690 PMCID: PMC4246475 DOI: 10.1186/1471-2474-15-381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background Until recently, non-specific low back pain (NSLBP) in adolescents was considered a rare phenomenon unlike in adults. The last two decades has shown an increasing amount of research highlighting the prevalence in this age group. Recent studies estimate lifetime prevalence at 7%-80%, point prevalence at 10%-15%, and prevalence of recurrent NSLBP at 13%-36%. In Zimbabwe, there is dearth of literature on the magnitude of the problem in adolescents. Therefore, the aims of the study were to determine the prevalence (lifetime, point, recurrent) and the nature of recurrent NSLBP reported by adolescents in secondary schools. Methods A cross-sectional study was conducted using a questionnaire. A cluster sample of 544 adolescents (age 13–19 years) randomly derived from government schools participated in the study. Lifetime prevalence, point prevalence and prevalence of recurrent NSLBP were presented as percentages of the total population. Exact 95% confidence intervals were given. Chi-square test was used to evaluate the effect of gender and age on prevalence. Results The students’ response rate was 97.8%. The lifetime prevalence was 42.9% [95% confidence interval = 40.8-44.6] with no significant difference between sexes [χ2 (1) =0.006, p = 0.94]. However, NSLBP peaked earlier in female students (13.9 years) than in male students (15 years) [t (226) = 4.21, p < 0.001]. About 10% of the adolescents reported having an episode of NSLBP on the day of the survey. However, female students (14.2%) were more affected on the day [χ2 (1) = 11.2, p < 0.001]. Twenty-nine percent of the adolescents experienced recurrent NSLBP with 78% experiencing at least three episodes in the last 12 months. On average, recurrent NSLBP reported was mild in intensity (4.8 ± 1.9) on the visual analogue scale (VAS) and short in duration. Recurrent NSLBP was associated with sciatica in 20.9% of adolescents. Conclusions NSLBP is a common occurrence among Zimbabwean adolescents in secondary schools. It increases with chronological age and is recurrent in the minority of adolescents. Although much of the symptomatology may be considered benign, the existence of recurrent NSLBP in adolescents before their work-life begins should be a concern to health professionals, teachers and parents. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-381) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew Chiwaridzo
- Department of Rehabilitation, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
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19
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Lardon A, Leboeuf-Yde C, Le Scanff C, Wedderkopp N. Is puberty a risk factor for back pain in the young? a systematic critical literature review. Chiropr Man Therap 2014; 22:27. [PMID: 25328668 PMCID: PMC4200222 DOI: 10.1186/s12998-014-0027-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 07/09/2014] [Indexed: 01/08/2023] Open
Abstract
Background Back pain is a common condition that starts early in life and seems to increase markedly during puberty. A systematic review was performed in order to investigate the link between puberty and back pain, using some Bradford Hill criteria for causality. Objectives We sought to obtain answers to the following questions: 1) Is there an association between puberty and back pain? If so, how strong is this association? And do the results remain unchanged also when controlling for age and sex? 2) Are the results of the studies consistent? 3) Is there a dose-response, showing a link between the increasing stages of puberty and the subsequent prevalence of back pain? 4) Is there a temporal link between puberty and back pain? Design A systematic critical literature review. Methods Systematic searches were made in March 2014 in PubMed, Embase, CINAHL and PsycINFO including longitudinal or cross-sectional studies on back pain for subjects <19 years, written in French or English. The review process followed the AMSTAR recommendations. Interpretation was made using some of the Bradford-Hill criteria for causality. Results Four articles reporting five studies were included, two of which were longitudinal. 1) Some studies show a weak and others a strong positive association between puberty and back pain, which remains after controlling for age and sex; 2) Results were consistent across the studies; 3) There was a linear increase of back pain according to the stage of puberty 4) Temporality has not been sufficiently studied. Conclusion All our criteria for causality were fulfilled or somewhat fulfilled indicating the possibility of a causal link between puberty and back pain. Future research should focus on specific hypotheses, for example investigating if there could be a hormonal or a biomechanical aspect to the development of back pain at this time of life. Electronic supplementary material The online version of this article (doi:10.1186/s12998-014-0027-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnaud Lardon
- EA 4532 CIAMS, Université Paris-Sud, UFR STAPS, Orsay, 91405, France. .,Institut Franco-Européen de Chiropraxie, 24 Bld Paul Vaillant Couturier, 94200, Ivry sur Seine, France.
| | - Charlotte Leboeuf-Yde
- EA 4532 CIAMS, Université Paris-Sud, UFR STAPS, Orsay, 91405, France.,Institut Franco-Européen de Chiropraxie, 24 Bld Paul Vaillant Couturier, 94200, Ivry sur Seine, France.,Research Department Spinecenter of Southern Denmark Hospital, Lillebélt Middelfart, Denmark
| | | | - Niels Wedderkopp
- Sport medicine clinic, orthopedic dep., Hospital of Lillebaelt, Institute of Regional Health, Service Research and Center for Research in Childhood Health, University of Southern Denmark, Odense, Denmark
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20
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Ng L, Perich D, Burnett A, Campbell A, O'Sullivan P. Self-reported prevalence, pain intensity and risk factors of low back pain in adolescent rowers. J Sci Med Sport 2014; 17:266-70. [DOI: 10.1016/j.jsams.2013.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/16/2013] [Accepted: 08/02/2013] [Indexed: 01/11/2023]
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Abstract
BACKGROUND Disability in adults with low back pain (LBP) is associated with negative back pain beliefs (BPBs). Adult BPBs can be positively influenced with education, resulting in reduced LBP disability. By late adolescence, the prevalence of LBP reaches adult levels. The relationship among LBP experience, LBP impact, and BPBs has not been investigated in late adolescence. OBJECTIVE The aim of this study was to document unknown relationships among LBP experience, LBP impact, and BPBs in 17-year-olds. Design A cross-sectional study design was used. METHODS Adolescents (n=1,126) in the Raine Study provided full information on LBP, LBP impact (sought professional advice or treatment, taken medication, missed school or work, interfered with normal activities, interfered with physical activities), BPBs, and a number of covariates. RESULTS Back pain beliefs were more positive in participants with experience of LBP (X=30.2, SD=5.6) than in those without experience of LBP (X=28.5, SD=5.1). Individuals with LBP without activity modification impacts had more positive BPBs than those with activity modification impacts, even after adjustment for mental well-being and sex. The adjusted difference in BPBs between participants with experience of LBP but no activity modification impacts and those reporting all 3 activity modification impacts was 2.9 points (95% confidence interval=1.7 to 4.2). Participants with no activity modification impacts had more positive BPBs than those with no experience of LBP (adjusted difference=2.2 points, 95% confidence interval=1.4 to 2.9). More positive BPBs also were associated with female sex, lower body mass index, higher family income, better 36-Item Short-Form Health Survey (SF-36) Mental Health scale scores, and more positive primary caregiver beliefs. Limitations Cause and effect cannot be ascertained with the cross-sectional design. CONCLUSION Differences in BPBs are associated with different levels of LBP impact at 17 years of age. This finding provides a potential target for intervention early during the life course.
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Stoev I, Powers AK, Puglisi JA, Munro R, Leonard JR. Sacroiliac joint pain in the pediatric population. J Neurosurg Pediatr 2012; 9:602-7. [PMID: 22656249 DOI: 10.3171/2012.2.peds11220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The sacroiliac (SI) joint can be a pain generator in 13%-27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms. METHODS A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits. RESULTS Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations. CONCLUSIONS Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.
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Affiliation(s)
- Ivan Stoev
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Jackson C, McLaughlin K, Teti B. Back pain in children: a holistic approach to diagnosis and management. J Pediatr Health Care 2011; 25:284-93. [PMID: 21867856 DOI: 10.1016/j.pedhc.2010.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/13/2010] [Accepted: 03/14/2010] [Indexed: 11/17/2022]
Abstract
Back pain is a relatively common complaint presenting to the primary care practitioner and is addressed with increasing frequency in the pediatric literature. Back pain is not uncommon in adolescents and often is symptomatic of a relatively benign musculoskeletal etiology. Back pain in children less than 10 years of age and most especially less than 4 years of age can signal a more alarming underlying condition. Evaluation requires a complete history including psychosocial and cultural considerations. Additionally a thorough clinical examination, strategic lab work and judicious imaging are imperative. Management and appropriate referral is specific to the underlying disease process. A holistic, individualized plan of care with inherent involvement of the child and parent/caregiver is essential to ensure safety and enhance outcomes.
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Hill JJ, Keating JL. Risk factors for the first episode of low back pain in children are infrequently validated across samples and conditions: a systematic review. J Physiother 2011; 56:237-44. [PMID: 21091413 DOI: 10.1016/s1836-9553(10)70006-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
QUESTION What risk factors have been identified for the first episode of low back pain in children and adolescents? Have these risk factors been validated? DESIGN Systematic review of prospective studies designed to identify possible modifiable and non-modifiable risk factors for the onset of low back pain in children and adolescents. PARTICIPANTS School children aged up to 18 years without low back pain at enrolment. RESULTS Five studies were included in the review. The included studies varied considerably in methods used to gather data, definitions of low back pain, and recall periods for an episode of low back pain. Forty-seven possible risk factors had been assessed for association with a first episode of low back pain in children. Of these, 13 were significantly associated with a first episode of low back pain. No risk factor was found to be associated with future low back pain in children in more than one study. CONCLUSION Inconsistency in definitions of low back pain, pre-defined recall periods, and methods used to collect and analyse data limit conclusions that can be drawn about factors that identify children at risk of developing low back pain. As no risk factor has been validated in independent investigation, we have no certainty that any factor places children at risk of developing low back pain.
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