Abstract
Purpose
To examine the prospective associations of pubertal development and linear growth with spinal pain frequency and duration in children.
Methods
We recruited students from 10 public primary schools. Over 42 months, pubertal development was assessed four times and categorized according to Tanner stages 1–5, and height was measured on seven occasions. Occurrences of spinal pain were reported weekly via text messaging. We constructed variables for spinal pain duration (total weeks with pain) and frequency (number of episodes). Potential associations between pubertal development and growth were examined with generalized estimating equations and reported with incident rate ratios (IRRs). All models were adjusted for potential confounders.
Results
Data from 1021 children (53% female; mean [SD] age = 9.4 [1.4] years), with median participation duration of 39 months, were included. Advancing pubertal development was associated with increased spinal pain duration (IRR [95% CI] = 1.90 [1.45, 2.49] to 5.78 [4.03, 8.29]) and frequency of pain episodes (IRR [95% CI] = 1.32 [1.07, 1.65] to 2.99 [2.24, 3.98]). Similar associations were observed for each 1-cm change in height in 6 months with spinal pain duration (IRR [95% CI] = 1.19 [1.15, 1.23]) and frequency (IRR [95% CI] = 1.14 [1.11, 1.17]). The relations between pubertal development and spinal pain, as well as growth and spinal pain, were largely independent.
Conclusions
In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose–response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1545–1602. https://doi.org/10.1016/S0140-6736(16)31678-6
Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? JAMA 268:760–765
Manek NJ, MacGregor AJ (2005) Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol 17:134–140. https://doi.org/10.1097/01.bor.0000154215.08986.06
van Tulder M, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16:761–775. https://doi.org/10.1053/berh.2002.0267
Disease GBD, Injury I, Prevalence C (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211–1259. https://doi.org/10.1016/S0140-6736(17)32154-2
Stallknecht SE, Strandberg-Larsen K, Hestbaek L, Andersen AN (2017) Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the Danish National Birth Cohort. Eur J Pediatr 176:807–814. https://doi.org/10.1007/s00431-017-2915-y
Kjaer P, Wedderkopp N, Korsholm L, Leboeuf-Yde C (2011) Prevalence and tracking of back pain from childhood to adolescence. BMC Musculoskel Disord 12:98. https://doi.org/10.1186/1471-2474-12-98
Hestbaek L, Leboeuf-Yde C, Kyvik KO (2006) Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskel Disord 7:29. https://doi.org/10.1186/1471-2474-7-29
Kamper SJ, Yamato TP, Williams CM (2016) The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: an overview of systematic reviews. Best Pract Res Clin Rheumatol 30:1021–1036. https://doi.org/10.1016/j.berh.2017.04.003
Dolphens M, Vansteelandt S, Cagnie B, Vleeming A, Nijs J, Vanderstraeten G, Danneels L (2016) Multivariable modeling of factors associated with spinal pain in young adolescence. Eur Spine J 25:2809–2821. https://doi.org/10.1007/s00586-016-4629-7
Hulsegge G, van Oostrom SH, Picavet HS, Twisk JW, Postma DS, Kerkhof M, Smit HA, Wijga AH (2011) Musculoskeletal complaints among 11-year-old children and associated factors: the PIAMA birth cohort study. Am J Epidemiol 174:877–884. https://doi.org/10.1093/aje/kwr205
Janssens KA, Rosmalen JG, Ormel J, Verhulst FC, Hunfeld JA, Mancl LA, Oldehinkel AJ, LeResche L (2011) Pubertal status predicts back pain, overtiredness, and dizziness in American and Dutch adolescents. Pediatrics 128:553–559. https://doi.org/10.1542/peds.2010-2364
Wedderkopp N, Andersen LB, Froberg K, Leboeuf-Yde C (2005) Back pain reporting in young girls appears to be puberty-related. BMC Musculoskel Disord 6:52. https://doi.org/10.1186/1471-2474-6-52
Wheeler MD (1991) Physical changes of puberty. Endocrinol Metab Clin North Am 20:1–14
Tanaka T, Suwa S, Yokoya S, Hibi I (1988) Analysis of linear growth during puberty. Acta Paediatr Scand Suppl 347:25–29
Salminen JJ, Erkintalo M, Laine M, Pentti J (1995) Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine 20:2101–2107 (discussion 2108)
Fairbank JC, Pynsent PB, Van Poortvliet JA, Phillips H (1984) Influence of anthropometric factors and joint laxity in the incidence of adolescent back pain. Spine 9:461–464
Feldman DE, Shrier I, Rossignol M, Abenhaim L (2001) Risk factors for the development of low back pain in adolescence. Am J Epidemiol 154:30–36
Hasler CC (2013) Back pain during growth. Swiss Med Wkly 143:w13714. https://doi.org/10.4414/smw.2013.13714
Lardon A, Leboeuf-Yde C, Le Scanff C, Wedderkopp N (2014) Is puberty a risk factor for back pain in the young? a systematic critical literature review. Chiropr Man Therap 22:27. https://doi.org/10.1186/s12998-014-0027-6
Swain M, Kamper SJ, Maher CG, Broderick C, McKay D, Henschke N (2018) Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review. Br J Sports Med. https://doi.org/10.1136/bjsports-2017-098418
Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, Ogilvie D, Petticrew M, Reeves B, Sutton M, Thompson S (2012) Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health 66:1182–1186. https://doi.org/10.1136/jech-2011-200375
Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidemann M, Christiansen C, Moller NC, Leboeuf-Yde C (2012) Study protocol. The childhood health, activity, and motor performance school study Denmark (the CHAMPS-study DK). BMC Pediatr 12:128. https://doi.org/10.1186/1471-2431-12-128
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243
Tanner JM (1962) Growth at adolescence, with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity. Blackwell Scientific Publications, Oxford
Duke PM, Litt IF, Gross RT (1980) Adolescents’ self-assessment of sexual maturation. Pediatrics 66:918–920
Baranowski T, Smith M, Baranowski J, Wang DT, Doyle C, Lin LS, Hearn MD, Resnicow K (1997) Low validity of a seven-item fruit and vegetable food frequency questionnaire among third-grade students. J Am Diet Assoc 97:66–68. https://doi.org/10.1016/S0002-8223(97)00022-9
Peterson L, Harbeck C, Moreno A (1993) Measures of children’s injuries: self-reported versus maternal-reported events with temporally proximal versus delayed reporting. J Pediatr Psychol 18:133–147
Johansen B, Wedderkopp N (2010) Comparison between data obtained through real-time data capture by SMS and a retrospective telephone interview. Chiropr Osteopat 18:10. https://doi.org/10.1186/1746-1340-18-10
Davis PJ, Williams HJ (2008) The investigation and management of back pain in children. Arch Dis Child Educ Pract Ed 93:73–83. https://doi.org/10.1136/adc.2006.115535
Jakes AD, Phillips R, Scales M (2015) Teenagers with back pain. BMJ 350:h1275. https://doi.org/10.1136/bmj.h1275
Bhatia NN, Chow G, Timon SJ, Watts HG (2008) Diagnostic modalities for the evaluation of pediatric back pain: a prospective study. J Pediatr Orthop 28:230–233. https://doi.org/10.1097/BPO.0b013e3181651bc8
Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075–2094. https://doi.org/10.1007/s00586-010-1502-y
Shah SA, Saller J (2016) Evaluation and diagnosis of back pain in children and adolescents. J Am Acad Orthop Surg 24:37–45. https://doi.org/10.5435/JAAOS-D-14-00130
Franz C, Moller NC, Korsholm L, Jespersen E, Hebert JJ, Wedderkopp N (2017) Physical activity is prospectively associated with spinal pain in children (CHAMPS study-DK). Sci Rep 7:11598. https://doi.org/10.1038/s41598-017-11762-4
Hill AB (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300
Itz CJ, Geurts JW, van Kleef M, Nelemans P (2013) Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 17:5–15. https://doi.org/10.1002/j.1532-2149.2012.00170.x
Pengel LH, Herbert RD, Maher CG, Refshauge KM (2003) Acute low back pain: systematic review of its prognosis. BMJ 327:323. https://doi.org/10.1136/bmj.327.7410.323
Lemeunier N, Leboeuf-Yde C, Gagey O (2012) The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap 20:33. https://doi.org/10.1186/2045-709X-20-33
Hancock MJ, Maher CM, Petocz P, Lin CW, Steffens D, Luque-Suarez A, Magnussen JS (2015) Risk factors for a recurrence of low back pain. Spine J 15:2360–2368. https://doi.org/10.1016/j.spinee.2015.07.007
Ardakani EM, Leboeuf-Yde C, Walker BF (2018) Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review. Chiropr Man Ther 26:1. https://doi.org/10.1186/s12998-017-0172-9
Jones GT, Macfarlane GJ (2005) Epidemiology of low back pain in children and adolescents. Arch Dis Child 90:312–316. https://doi.org/10.1136/adc.2004.056812
Rasmussen AR, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, Hagen CP, Tinggaard J, Mouritsen A, Mieritz MG, Main KM (2015) Validity of self-assessment of pubertal maturation. Pediatrics 135:86–93. https://doi.org/10.1542/peds.2014-0793
Acknowledgements
The authors gratefully acknowledge the valuable work of numerous students who assisted with data collection in the CHAMPS study-DK. We also thank the participating children, their parents, and teachers in the schools involved in the project. We are grateful for the cooperation with The Svendborg Project, Sport Study Sydfyn, and the Municipality of Svendborg. Finally, we wish to acknowledge members of the CHAMPS study-DK not listed as co-authors in this paper: E. Jespersen, M. Heidemann, and C.T. Rexen.
Funding
The TRYG Foundation, University College Lillebaelt, University of Southern Denmark, The Nordea Foundation, The IMK foundation, The Region of Southern Denmark, The Egmont Foundation, The A.J. Andersen Foundation, The Danish Rheumatism Association, Østifternes Foundation, Brd. Hartmann’s Foundation, TEAM Denmark, The Danish Chiropractor Foundation, and The Nordic Institute of Chiropractic and Clinical Biomechanics. The funding sources played no role in the design, conduct, or reporting of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conlict of interest
Prof. Hebert receives salary support from the Canadian Chiropractic Research Foundation and the New Brunswick Health Research Foundation. The authors declare no additional conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hebert, J.J., Leboeuf-Yde, C., Franz, C. et al. Pubertal development and growth are prospectively associated with spinal pain in young people (CHAMPS study-DK). Eur Spine J 28, 1565–1571 (2019). https://doi.org/10.1007/s00586-019-05905-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-019-05905-6