Musculoskeletal Lay Summaries

2014

A two-way relationship exists between smoking and spinal pain in adolescents

Keywords: spinal pain, depression, risk factors, smoking

What is already known about this subject:

  • Individuals who begin smoking as adolescents are more likely to be nicotine dependent and/or heavy smokers as adults, and have a greater risk of smoking-related illness or death.
  • Spinal pain is a common health problem in adolescents, and is often associated with poor mental health. Spinal pain that starts in adolescence often continues into adulthood.
  • Cigarette smoking, spinal pain and mental health are important health issues in adolescents. Evidence suggests they may be linked, although the nature of the relationship is still unclear.

What this Raine study adds:

  • Data from Raine participants at 14 and 17 years of age, including information describing smoking history, spinal pain and mental health, revealed that cigarette use, psychosocial problems and spinal pain are correlated in adolescents.
  • The relationship between cigarette smoking and back pain was bi-directional once psychosocial factors were taken into account; back pain at 14 years of age predicted cigarette use at 17 years of age, and cigarette use at 14 years of age predicted back pain at 17 years of age.
  • Awareness of the relationships between back pain, smoking and mental health is an important facet of adolescent health.

Gill, Davinder K, Melissa C Davis, Anne J Smith, and Leon M Straker. 2014. “Bidirectional Relationships between Cigarette Use and Spinal Pain in Adolescents Accounting for Psychosocial Functioning.” British Journal of Health Psychology 19 (1) (February): 113-31. doi:10.1111/bjhp.12039.  [publink]

2013

Spine repositioning in adolescents: the impact of chronic low back pain

Keywords: adolescence, chronic low back pain

What is already known about this subject:

  • The ability to sense the position of the spine in order to reposition it correctly is considered an indicator of spinal health. People with low back pain often have difficulty repositioning their spine correctly, potentially causing further tissue strain and pain.
  • Different patterns of movement control in chronic low back pain in adults have been shown to relate to problems sensing different spinal positions.
  • Adolescent low back pain is a significant health problem, and low back pain that develops during adolescence often persists into adulthood. Problems with the ability to reposition the spine correctly may contribute to the continuation of low back pain from adolescence to adulthood.

What this Raine study adds:

  • 14-16 year olds from the Raine study with chronic low back pain were less able to sense their spinal position and had more difficulty repositioning their lumbar spine correctly, compared to those without back pain.
  • Training of spinal repositioning sense may be a useful treatment for chronic low back pain in adolescents, and this may help to reduce or avoid back pain during adulthood.

Astfalck, Roslyn G, Peter B O’Sullivan, Anne J Smith, Leon M Straker, and Angus F Burnett. 2013. “Lumbar Spine Repositioning Sense in Adolescents with and without Non-Specific Chronic Low Back Pain–an
Analysis Based on Sub-Classification and Spinal Regions.” Manual Therapy 18 (5) (October): 410-7. doi:10.1016/j.math.2013.02.005. [publink]

2012

Relationship between low back pain and other health complaints in teenagers

Keywords: adolescent, low back pain, health status

What is already known about this subject:

  • Disabling chronic low back pain is an important health issue, and low back pain that develops during adolescence can persist into adulthood.
  • Low back pain often occurs with other health problems, often with worse outcomes and higher medical costs.
  • There is very little information available about patterns of health problems that commonly occur with low back pain, particularly in adolescents.

What this Raine study adds:

  • Back pain and other health issues were found to exist in four typical patterns in Raine 17-year-olds: healthy individuals; back pain without other health issues; low back pain with anxiety/depression; and low back pain with behavioural/attention disorders.
  • Anxiety and depression was more likely to co-occur with back pain in girls, and boys were more likely to have back pain co-occurring with behavioural and attention disorders.
  • Understanding the health issues that commonly occur with low back pain in teenagers may help to identify those who are most at risk of chronic or disabling pain and who may benefit most from health interventions.

Beales, Darren John, Anne Julia Smith, Peter Bruce O’Sullivan, and Leon Melville Straker. 2012. “Low Back Pain and Comorbidity Clusters at 17 Years of Age: A Cross-Sectional Examination of Health-Related Quality of Life and Specific Low Back Pain Impacts.” The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine 50 (5) (May): 509-16. doi:10.1016/j.jadohealth.2011.09.017. [publink]

Low back pain is an important health issue in adolescents

Keywords: chronic low back pain, quality of life, public health

What is already known about this subject:

  • Disabling chronic low back pain is an important health issue, and in most cases no specific cause can be identified.
  • Back pain that develops during adolescence may set a course for later life, although some have suggested that it is not an important health issue.
  • The impact of low back pain on quality of life in teenagers is not well understood.

What this Raine study adds:

  • Low back pain in 17-year-olds Raine participants had a substantial negative impact on quality of life and mental health. Chronic low back pain had the greatest impact.
  • Teenagers with low back pain were more likely to seek medical or professional help, use medication, miss work or school, and alter their normal or recreational activities in response to pain.
  • Adolescent low back pain is an important public health issue that requires attention.

O’Sullivan, Peter B, Darren J Beales, Anne J Smith, and Leon M Straker. 2012. “Low Back Pain in 17 Year Olds Has Substantial Impact and Represents an Important Public Health Disorder: A Cross-Sectional
Study.” BMC Public Health 12 (1) (January): 100. doi:10.1186/1471-2458-12-100. [publink]

Genetic variations associated with chronic musculoskeletal pain in teenagers

Keywords: genetic predisposition to disease, musculoskeletal pain, psychology, stress

What is already known about this subject:

  • Severe chronic musculoskeletal pain can be disabling, and can also cause problems with a person’s general health, sleep and mental health.
  • Stress and psychological factors can increase the likelihood of chronic musculoskeletal pain, and variations in genes controlling a person’s stress responses may make them more vulnerable to chronic pain.
  • Musculoskeletal pain disorders become more common during adolescence, however the genetic causes of chronic pain have not been studied in this age group.

What this Raine study adds:

  • Musculoskeletal pain in Raine participants at 17 years of age was associated with genetic variations in DNA samples taken at 14 and 17 years of age.
  • Genetic variations may make some people more vulnerable to pain during times of chronic stress and anxiety.

Skouen, J S, A J Smith, N M Warrington, P B O’Sullivan, L McKenzie, C E Pennell, and L M Straker. 2012. “Genetic Variation in the Beta-2 Adrenergic Receptor Is Associated with Chronic Musculoskeletal
Complaints in Adolescents.” European Journal of Pain (London, England) 16 (9) (October): 1232-42. doi:10.1002/j.1532-2149.2012.00131.x. [publink]

Relationship between beliefs about back pain and the impact of back pain on teenagers

Keywords: low back pain, attitude to health, adolescent

What is already known about this subject:

  • Low back pain can have a serious impact on everyday physical functioning and is disabling for some people. It is also a major health cost to individuals and the community.
  • In most cases of low back pain, no physical cause can be identified. In people with chronic back pain, having more negative beliefs about back pain is often associated with a greater degree of disability.
  • Low back pain frequently develops during adolescence, and low back pain that starts in adolescence will often continue into adulthood.
  • If negative beliefs about back pain also begin during adolescence, it may be possible to target this age group for prevention and management strategies.

What this Raine study adds:

  • Half of the 17-year olds tested had experienced back pain.
  • More negative (or pessimistic) back pain beliefs were found in two groups of Raine adolescents: those whose back pain had significantly affected their lives, and those who had never experienced back pain.
  • Adolescence may be a useful time in which to deliver interventions aimed at preventing and managing back pain before it becomes long-term or disabling. In particular, targeting negative back pain beliefs may be a useful means of reducing the risk of disabling back pain.

Smith, Anne J, Peter B O Sullivan, Darren Beales, and Leon Straker. 2012. “Back Pain Beliefs Are Related to the Impact of Low Back Pain in 17-Year-Olds.” Physical Therapy 92 (10): 1258-1267. doi:10.2522/ptj.20110396. [publink]

2011

Back and neck pain are related to mental health problems in adolescence

Keywords: spinal pain, mental health, adolescence

What is already known about this subject:

  • Mental health problems are common during adolescence, experienced by about 11 to 12 per cent of Australian adolescents.
  • Spinal pain is also common in adolescents, and evidence suggests they may be related.
  • Evidence also suggests that the relationship between pain and mental health differs between boys and girls, but how this relates to back and neck pain is still unknown.

What this Raine study adds:

  • Data describing back and neck pain and mental health in Raine participants at 14 years of age revealed that there was a high prevalence of back and neck pain in this group, and girls were more likely to have mental health difficulties than boys.
  • Mental health and back and neck pain were strongly associated, with the adolescents experiencing mental health issues being more likely to also have back and neck pain.
  • Clinical assessments and treatment of adolescents should consider both physical and emotional pain symptoms.

Rees CS, Smith AJ, O’Sullivan PB, Kendall GE, Straker LM. Back and neck pain are related to mental health problems in adolescence. BMC Public Health. 2011;11:382. [publink]

Gender has an important effect on the relationship between neck and shoulder pain, posture and computer use in adolescents

Keywords: computer use, gender, neck pain, posture

What is already known about this subject:

  • Around one quarter of adolescents experience neck and shoulder pain, and many of these adolescents will continue to do so into adulthood.
  • Rates of neck and shoulder pain in adolescents are increasing, and evidence suggests that this corresponds with increases in computer use and is related to posture.
  • Evidence suggests that males and females sit differently while using computers, and that females are more likely to experience neck and shoulder pain. It is not yet clear how gender influences the relationship between posture, neck and shoulder pain and computer use.

What this Raine study adds:

  • Assessments of neck and shoulder pain, posture and computer use in Raine participants at 14 years of age revealed that computer use, posture and neck and shoulder pain were related, but that the relationships differed between males and females.
  • Males used computers more than females, but females were more likely to have neck and shoulder pain.
  • It is important to consider males and females separately in research and clinical practice aimed at optimising young people’s use of computers.

Straker LM, Smith AJ, Bear NL, O’Sullivan PB, de Klerk NH. Neck/shoulder pain, habitual spinal posture and computer use in adolescents: the importance of gender. Ergonomics. 2011;54(6):539-46. [publink]

2010

Sitting posture differs betweenadolescents with and without chronic low back pain

Keywords: low back pain, movement, muscle, posture, spine

What is already known about this subject:

  • Low back pain commonly develops during adolescence and increases the risk for low back pain in adulthood. Low back pain is chronic and disabling for some people.
  • Adolescents spend a large amount of their time sitting, and sitting, can worsen low back pain.
  • In adults, spinal positions that trigger pain are associated with certain postural patterns and patterns of muscle activation. It is not clear if these postural patterns and patterns of muscle activation are also present in adolescents with chronic low back pain.

What this Raine study adds:

  • In a subgroup of Raine 14-year-olds with and without chronic low back pain, assessment of spinal posture and back and abdominal muscle activation was performed during sitting in their usual position and during sitting in a slumped position.
  • It was found that people with back pain either sat very erect or very slumped but this change was not reflected in patterns of muscle activation.
  • Understanding the factors contributing to chronic low back pain in adolescents will help in the design of useful prevention and treatment strategies that will help reduce the burden of both adolescent and adult chronic low back pain.

Astfalck, R. G., O’Sullivan, P. B., Straker, L. M., Smith, A. J., Burnett, A., Caneiro, J. P., & Dankaerts, W. (2010). Sitting postures and trunk muscle activity in adolescents with and without nonspecific chronic low back pain: an analysis based on subclassification. Spine, 35(14), 1387-95. doi:10.1097/BRS.0b013e3181bd3ea. [publink]

Physical and psychological differences exist between adolescents with and without chronic low back pain

Keywords: low back pain, chronic pain, psychology

What is already known about this subject:

  • Back pain is common in adolescents, and may be influenced by their rapid physical growth and development, as well as the major lifestyle, social and psychological changes that occur during this period.
  • While back pain that starts during adolescence often continues into adulthood, it is not clear whether the physical and psychological factors that have been identified as being important in adults with chronic low back pain are the same as those causing chronic low back pain in adolescents.

What this Raine study adds:

  • Measures of pain experience and clinical assessment in 14-year-old Raine participants revealed that chronic low back pain was an important problem, with adolescents reporting moderate levels of pain and disability over a long period of time.
  • Physical and psychological assessments revealed that when compared to similar Raine participants who were pain-free; those with chronic low back pain had decreased muscle endurance, different sitting posture and a greater number of stressful life events.
  • In contrast to adults with chronic low back pain who commonly avoid physical activity, Raine adolescents with chronic low back pain remained physically active.
  • Chronic low back pain in adolescents is an important problem, addressing both the physical and psychological factors related to its occurrence is essential in its prevention and treatment.

Astfalck, Roslyn G, Peter B O’Sullivan, Leon M Straker, and Anne J Smith. 2010. “A Detailed Characterisation of Pain, Disability, Physical and Psychological Features of a Small Group of Adolescents with Non-Specific Chronic Low Back Pain.” Manual Therapy 15 (3) (July): 240-7. doi:10.1016/j.math.2009.12.007. [publink]

2009

Sitting posture can cause prolonged neck and shoulder pain in adolescents

Keywords: neck pain, shoulder pain, posture

What is already known about this subject:

  • Neck and shoulder pain is a common problem in adolescents.
  • Sitting and computer use are known to contribute to neck and shoulder pain, but it is not known whether an adolescent’s normal sitting posture can contribute to neck and shoulder pain that lasts for a prolonged period of time.

What this Raine study adds:

  • Five percent of Raine participants at 14 years of age had neck and shoulder pain lasting more than three months.
  • Girls were more likely to have neck and shoulder pain than boys, and postural assessment found that girls and boys had different sitting postures.
  • Spinal posture in the pelvic region was the most important determinant of neck and shoulder pain in adolescents. This is contrary to commonly-held clinical beliefs that neck position is the most important factor, and identification and treatment practices should be adjusted accordingly.

Straker, Leon M, Peter B O’Sullivan, Anne J Smith, and Mark C Perry. 2009. “Relationships between Prolonged Neck/shoulder Pain and Sitting Spinal Posture in Male and Female Adolescents.” Manual Therapy 14 (3) (June): 321-9. doi:10.1016/j.math.2008.04.004. [publink]

Physical activity does not account for neck and shoulder pain in adolescents

Keywords: lifestyle factors, neck pain, shoulder pain, risk factors, physical activity, sedentariness

What is already known about this subject:

  • Neck and shoulder pain is a common and increasing problem in adolescents, and can interfere with school and leisure activities. While neck and shoulder pain has been well studied in adults, little is known about its causes in adolescents.
  • Physical activity is important for both general and musculoskeletal health, and there is concern that decreased participation in physical activity and increased time spent using computers and electronic games may be contributing to neck and shoulder pain in adolescents.

What this Raine study adds:

  • Around half of the 14-year-old Raine participants studied reported experiencing neck and shoulder pain.
  • Despite comprehensive assessments of the physical and sedentary activities undertaken by Raine adolescents over a one-week period, no relationship was found between physical activity and neck and shoulder pain.
  • Neck and shoulder pain is an important issue in Australian adolescents, but is not explained by physical activity levels.

Briggs, Andrew M, Leon M Straker, Natasha L Bear, and Anne J Smith. 2009. “Neck/shoulder Pain in Adolescents Is Not Related to the Level or Nature of Self-Reported Physical Activity or Type of Sedentary Activity in an Australian Pregnancy Cohort.” BMC Musculoskeletal Disorders 10 (1) (January): 87. doi:10.1186/1471-2474-10-87.  [publink]