Low back pain in childhood and adolescence: a cross-sectional study in Niigata City

Abstract

A cross-sectional study targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective was to clarify the present incidence of low back pain (LBP) in childhood and adolescence in Japan. It has recently been recognized that LBP in childhood and adolescence is also as common a problem as that for adults and most of these studies have been conducted in Europe, however, none have so far been made in Japan. A questionnaire survey was conducted using 43,630 pupils, including all elementary school students from the fourth to sixth grade (21,893 pupils) and all junior high students from the first to third year (21,737 pupils) in Niigata City (population of 785,067) to examine the point prevalence of LBP, the lifetime prevalence, the gender differences, the age of first onset of LBP in third year of junior high school students, the duration, the presence of recurrent LBP or not, the trigger of LBP, and the influences of sports and physical activities. In addition, the severity of LBP was divided into three levels (level 1: no limitation in any activity; level 2: necessary to refrain from participating in sports and physical activities, and level 3: necessary to be absent from school) in order to examine the factors that contribute to severe LBP. The validity rate was 79.8% and the valid response rate was 98.8%. The point prevalence was 10.2% (52.3% male and 47.7% female) and the lifetime prevalence was 28.8% (48.5% male and 51.5% female). Both increased as the grade level increased and in third year of junior high school students, a point prevalence was seen in 15.2% while a lifetime prevalence was observed in 42.5%. About 90% of these students experienced first-time LBP during the first and third year of junior high school. Regarding the duration of LBP, 66.7% experienced it for less than 1 week, while 86.1% suffered from it for less than 1 month. The recurrence rate was 60.5%. Regarding the triggers of LBP, 23.7% of them reported the influence of sports and exercise such as club activities and physical education, 13.5% reported trauma, while 55.6% reported no specific triggers associated with their LBP. The severity of LBP included 81.9% at level 1, 13.9% at level 2 and 4.2% at level 3. It was revealed that LBP in childhood and adolescence is also a common complaint in Japan, and these findings are similar to previous studies conducted in Europe. LBP increased as the grade level increased and it appeared that the point and lifetime prevalence in adolescence are close to the same levels as those seen in the adulthood and there was a tendency to have more severe LBP in both cases who experienced pain for more than 1 month and those with recurrent LBP.

Fig. 1

Details of Question 1 in the questionnaire

Fig. 2

LBP in each grade. a The point prevalence of LBP: there were no significant differences between the second year and the third year of junior high school students regarding the point prevalence, but the point prevalence tended to be significantly higher as the grade level increased from the fourth grade onward (*P < 0.01, **P < 0.05), reaching 15.2% in the third year of junior high school students. b The lifetime prevalence of LBP: throughout all grades, the lifetime prevalence became significantly higher as the grade level increased (*P < 0.01, **P < 0.05), reaching 42.5% in the third year of junior high students

Fig. 3

Gender differences of LBP in each grade. a The point prevalence of LBP: a point prevalence was seen in 10.1% of males and 9.8% of females. The difference was only significant for the sixth grade of elementary school students (**P < 0.05). b The lifetime prevalence of LBP: there were no differences between genders in elementary school students from the fourth to sixth grades, but from the first year onward the rate was significantly higher in females (*P < 0.01, **P < 0.05)

Fig. 4

The age of first onset of LBP in third year junior high school students. About 90% of them experienced LBP during the first and third year of junior high school

Fig. 5

The duration of LBP. A duration of shorter than 1 week was the most common, accounting for 66.7% of the total, and a duration of less than 1 month accounted for 86.1% of the total

Fig. 6

The presence of recurrent LBP in each grade. Recurrence was found in 60.5% of the students with a lifetime prevalence of LBP, and the recurrence rate of LBP was high even in the lower grades

Fig. 7

The amount of time participating in sports activities for each grade. The amount of time participating in athletic activities significantly increased among students from the fourth of elementary school through the first year of junior high and progressively increased as the grade level increased (*P < 0.001, **P = 0.015), averaging 6.6 h/week for the sixth grade of elementary school students and 12.2 h/week for the first year of junior high school students, increasing approximately twofold between both grades

Fig. 8

The severity of LBP. a The duration of LBP: when the duration of LBP was divided into “less than 1 month” and “more than 1 month”, the severity of LBP was significantly higher in the group of with LBP of more than 1 month (*P < 0.001). b The presence of recurrent LBP: when the presence of recurrent LBP was divided into “without recurrent LBP” and “with recurrent LBP”, the severity was significantly higher in the group with recurrent LBP(*P < 0.001)