Appendix 1 Summary of Adolescent Spinal Pain Studies

Author Country Number Age Study Methodology

Pain Results
and year of range type Design Recall
type
subjects
Balague et Switzerland 1715 7-17 years Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence Lifetime prevalence
al (1988) sectional Younger students 1 week prevalence Spinal pain: 46% 8 years 16%
answered at home Low back pain : 35% 9 years 10.3%
with parents Neck pain 3% 10 years 9.9%
Older students Thoracic pain: 9.5% 11 years 19.9%
answered in school 1 week prevalence 12 years 29.9%
Spinal Pain : 16% 13 years 52.8%
Low back pain : 11% 14 years 67.9%
Disabling pain 15 years 71.3%
Spinal pain 10% 16 years 65.6%
Balague et Switzerland 117 11-15 years Cross Interview Lifetime prevalence Spinal Pain Lifetime prevalence 1 week prevalence Disabling pain
al (1993) sectional 1 week prevalence Spinal pain: 44% Spinal pain: 13% Spinal pain 5%
Low back pain : 33% Low back pain : 9.5%
Neck/thoracic 12% Neck/thoracic 3.5%
Balague et Switzerland 1608 8 – 16 Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence Lifetime prevalence
al (1994) years sectional 8-12 years with 1 week prevalence pain Spinal pain: 34.2%
parents help Neck/ Low back pain : 21% 8 years 9.3% 12 years 13.4%
>12 years answered Thoracic Neck/thoracic: 13.2% 9 years 5.8% 13 years 21.3%
in school pain 1 week Prevalence 10 years 9.8% 14 years 27.2%
Spinal Pain : 12% 11 years 14.6% 15 years 39.1%
16 years 50%

Balague et Switzerland 615 12-17 years Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence 1 month prevalence
al (1995) sectional ? answered in school 1 month prevalence Spinal pain: 74% Low back Pain : 24.3%
Low back pain : 51% Referred pain
Neck pain only 8% Low back to legs 18%
Thoracic only 21% Neck to arms 23%
Brattberg Sweden 1245 8-17 years Longitudinal Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence 2 year cumulative incidence
(1994) Answered in school M F Age
7 9 8 year 20%
olds
15 24 11 year 16%
olds
22 47 13 year 22%
olds
39 58 17 year 22%
olds
Brattberg Sweden 335 8-14 years Longitudinal Questionnaire Lifetime incidence Spinal pain Cumulative incidence
(2004) Mailed to participants (including 1989-2002 cohort: 31%
headache) 1991-2002 cohort: 43%
Burton et al England 216 11-16 years Longitudinal Interview Age 11/12 Lifetime prevalence Low back Lifetime prevalence 1 week prevalence
(1996) Questionnaire Age 1 week prevalence pain 11 years 11.6% 11 years 3.2%
13/14/15 12 years 21.4% 12 years 3.9%
13 years 28.8% 13 years 6.4%
14 years 38.5% 14 years 10%
15 years 50.4% 15 years 12.9%

Cakmak et Turkey 1552 University Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence 21 years 51%
al (2004) students sectional Administered by pain 17 years 33% 22 years 48%
Female 43%
specialist 18 years 32% 23 years 65%
Male 39%
19 years 32% 24 years 62%
20 years 36% 25 years 61%
Ebrall Australia 610 (boys) 12-19 years Cross Questionnaire Lifetime prevalence Low back LBP history
(1994) sectional Administered Point prevalence pain Age Current Past Never
individually and in 12 years 12.2% 19.5% 68.3%
small group situations 13 years 11.6% 30.2% 58.1%
14 years 18.7% 41.1% 40.2%
15 years 18.9% 43.2% 37.9%
16 years 18.9% 41.4% 39.6%
17 years 15.9% 46.3% 37.9%
18 years 17.1% 54.3% 28.6%
19 years 0% 66.6% 33.3%
Total 16.7% 40.3% 42.9%
Fairbank et England 446 13-17 years Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence
al (1984) sectional Answered in school Point prevalence pain Spinal pain: 26%
Thoracic Low back pain : 8.5%
pain Thoracolumbar 5%
Thoracic 3%
Non-specific 8.5%
Feldman et Canada 502 Mean age Longitudinal Questionnaire Substantial Low Low back Percent Disabling Lifetime
al (2001) 13.8, 14.1 over 18 No information on back pain (at least pain Hazard back pain prevalence
and 14.6 months where they were once per week over Low back pain 17.2 % 13.5 % 38%
6 month completed previous 6 months)
intervals Disabling Back pain
Percent hazard
Feldman et Canada 502 Grades 7-9 Longitudinal Questionnaire Cumulative annual Neck and Cumulative incidence
al (2002) over 12 No information on incidence upper limb 6 months 12 months
months where they were pain Neck 10.5% 8.5%
6 month completed Upper back 10.5% 7%
intervals Shoulder 8% 5%
Arm 9% 6.5%
Upper limb 20% 13%
* Please note figures estimated from bar graph
Ghandour United States 8370 6th to 10th Cross Questionnaire 6 month prevalence ‘Backache’ Point prevalence
et al (2004) of America Females grade sectional Answered at home Backache 23.6%
Grimmer et Australia 1269 12-18 years Cross Questionnaire 2 week prevalence Low back 2 week prevalence
al (2000) sectional Answered at school pain Low back pain 15.2-44.3%
Groholt et 5 Nordic 6230 7-17 years Cross Questionnaire Lifetime prevalence Back pain By Nationality By age
al (2003) Countries sectional Answered at home by (no further Sweden 3.3% 7-9 years 0.9%
biological mother or information Iceland 6.8% 10-12 years 3.0%
father reported) Norway 5.1% 13-15 years 7.0%
Finland 2.9% 16-17 years 10.4%
Denmark 8.3%
Hakala et al Finland 189,894 12-18 years Cross Questionnaire 6 months Low back 6 months prevalence
(2002) sectional Answered at home prevalence pain
Back pain Neck pain
Neck pain
M F M F
14 yrs 7% 8% 14 yrs 12% 24%
16 yrs 11% 14% 16 yrs 16% 38%
18 yrs 17% 13% 18 yrs 19% 45%
Harreby et Denmark 640 16 years Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence 1 month prevalence Point prevalence
al (1993) sectional 1 month prevalence pain Low back pain 9% Low back Pain 8% Low back pain 2.5%
Point prevalence
Harreby et Denmark 640 School Longitudinal Baseline: body height, Lifetime prevalence Low back Lifetime 1 year Point
al (1997) Children over 25 XR of lumbar/thoracic 1 year prevalence pain prevalence prevalence prevalence
years spine and history of Point prevalence LBP in school 84% 75% 22%
LBP
25 year follow up: XR abnormal T11-L5 85% 81% 27%
questionnaire
XR abnormal T5-T10 73% 70% 21%

Total 70% 63% 19%

Harreby et Denmark 1389 13-16 years Cross Questionnaire Lifetime prevalence Low back Prev Lifetime 1 year 1 month 1 week Point
al (1999) sectional Completed in school 1 year prevalence pain LBP 58.9% 50.8% 30.6% 13.9% 5.3%
1 month prevalence
1 week prevalence
Point prevalence
Hestbaek et Denmark 9569 12-22 years Longitudinal Questionnaire 1 year Low back 1994 2002
al (2006) Mailed to home Prevalence pain 1 year 1 year
Lifetime prevalence prevalence prevalence
12-15 yrs (in 1994) 16 36
16-19 yrs (in 1994) 40 38
20-22 yrs (in 1994) 50 43
male 32 35
female 38 42

Iwamoto et Japan 171 High school Longitudinal Reporting to coach 1 year prevalence Low back 1 year prevalence
al (2004) footballers pain Low back pain + radiographic changes 54.1%
Low back pain - radiographic changes 37.1%
Jones et al England 500 10–16 Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence 1 Week prevalence
(2004) years sectional ?? Completed in 1 week prevalence pain M F M F
school 10 yrs 17.6% 18.8% 10 yrs 5.9% 9.4%
11 yrs 21.2% 23.7% 11 yrs 9.1% 10.5%
12 yrs 28.6% 33.3% 12 yrs 11.4% 12.8%
13 yrs 35.9% 50% 13 yrs 12.8% 16.7%
14 yrs 50% 55.9% 14 yrs 18.4% 20.6%
15 yrs 54.2% 57.6% 15 yrs 22.9% 21.2%
16 yrs 57.1% 59% 16 yrs 22.9% 23.1%
Korovessis Greece 3441 9-15 years Cross Subjects asked about Lifetime prevalence Thoracic Thoracic pain Low back pain
et al (2004) sectional thoracic and LBP pain Boys Girls School class Boys Girls
experiences while Low back 14% 9% 4 8% 9%
carrying backpack pain 38.5% 72% 5 23% 54%
Surface back contour
14% 31% 6 11% 78%
analysis: scoliometer
and kyphometer 26% 38% 7 6% 20%
11% 39% 8 15% 29%
15% 40.5% 9 29% 32%
* Please note figures estimated from bar graphs
Kristensen Norway 316 15 years Cross Adolescent Lifetime prevalence Low back Lifetime prevalence
et al (2001) sectional questionnaire: 1 year prevalence pain Non-specific LBP 63%
answered at school 1 year prevalence
Parent questionnaire: LBP which had influenced leisure time activity 22%
distributed in class LBP which had influenced schoolwork 7%
LBP resulting in stopping one or more leisure activity 2%
LBP resulting in being excused from phys ed 19%
LBP resulting in taking pain medication 11%
Kristjans- Iceland 2173 11-12 years Cross ?? ?Lifetime Headache, Monthly pain 78.2%
dottir (1997) 15-16 years sectional prevalence stomach One or more pains weekly 40.4%
pain and Two or three pains weekly 15.6%
back pain
Kujala et al Finland 138 10-13 years Cross Questionnaire 1 year Disabling Spinal Pain 1 year Disabling spinal pain prevalence
(1992) sectional Answered at home pain prevalence Low back pain 21%
Lifetime prevalence Neck pain 13%
Lifetime prevalence
Spinal Pain 28%
Kujala et al Finland 98 10-16 years Longitudinal Questionnaire 1 year Disabling Low back 1 year Disabling pain prevalence
(1994) Answered at home pain prevalence pain Low back pain + athlete 12% - 38%
Low back pain + non-athlete 3% - 9%
Kujala et al Finland 698 10-17 years Cross Questionnaire 1 year Disabling Spinal Pain 1 year Disabling spinal pain prevalence
(1999) sectional Answered at school pain prevalence Low back pain 10.7%
Neck pain 18.6%
Thoracic pain 7.6%
Lebkowski Poland 3316 17 years Cross Unknown (Published Lifetime prevalence Low back Lifetime prevalence
(1997) (mean) sectional in Polish) pain Secondary school pupils 60%
High-school students 32%
Leboeuf- Denmark 29, 424 12-41 years Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence 1 year prevalence Point prevalence
Yde and sectional Answered at home 1 year prevalence pain 12 yrs 7% 12 yrs 7% 12 yrs 1%
Kyvik Point prevalence 41 yrs 67% 41 yrs 56% 41 yrs 14%
(1998)
McMeeken Australia 14 9-27 years Cross Questionnaire 1 year prevalence Low back
et al (2001) sectional Answered at home Lifetime prevalence pain 1 year prevalence Lifetime Prevalence
M F M F
Dancers 47% 32% Dancers 59% 49%
Gymnasts 50% 36% Gymnasts 67% 64%
Control 34% 31% Control 53% 44%
Total
1 year prevalence Lifetime prevalence
Low back pain 35% Low back pain 50%
Mierau et al Canada 402 14-18 years Cross Interview 6 month prevalence Low back 6 month prevalence
(1989) sectional pain Low back pain: 33%
Murphy et UK 679 11-14 years Cross Questionnaire 1 week prevalence Low back Area 1 week 1 month prevalence
al (2003) sectional Answered at school 1 month prevalence pain prevalence
Upper back Low back 20 36
pain Upper back 17 30
Neck Neck 23 49

pain
Niemi et al Finland 718 High school Cross Questionnaire Lifetime prevalence Neck and Lifetime prevalence
1997 students sectional shoulder Neck and shoulder pain:
pain Girls 21%
Boys 10%
Nissenen et Finland 859 12.8 -13.8 Longitudinal Interview 1 year prevalence Low back 1 year prevalence 1 month prevalence
al (1994) years 1 month prevalence pain Low back pain: 17.6% Low back pain: 9.8%
Olsen et al USA 1242 11-17 years Cross Questionnaire 1 year prevalence Low back 1 year prevalence Lifetime prevalence
(1992) sectional Lifetime prevalence pain Low back pain: 22% Low back pain: 30.4%
Perquin et Holland 5423 4-18 years Cross Questionnaire 3 month prevalence Low back 3 month prevalence
al (2000) sectional 4 -7 years answered pain Age M F Ave
with parents 8-11 years 58.4% 74.8% 66.5%
>8 years answered at 12-15 years 59.7% 76.2% 68.9%
home 16-18 years 42.6% 63.9% 53.1%
Petersen et Sweden 1121 6-13 years Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence
al (2003) sectional 6-10 years answered Spinal pain
at home Recurrent monthly pain 18%
11-13 years answered recurrent weekly or more pain approx 50%
at school
Prista et al Mozambique 204 11-16yrs Cross Questionnaire 1 year prevalence Low back 1 year Disabling pain Lifetime Disabling pain
(2004) sectional Answered at school Lifetime prevalence pain prevalence prevalence
Low back pain 13.5% Low back pain 28%
Romicka et Poland 3386 6-17yrs Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence
al (2003) sectional Spinal pain 10.14%
Back pain 5.1%
Low back pain 3.44%
Cervical pain 3.04%
Roth- Germany 751 4-18yrs Cross Questionnaire 3 months Spinal pain 3 months prevalence Disabling pain
Isigkeit et al sectional 4 -9 years answered prevalence Spinal Pain 30.2% Spinal Pain 36.4%
(2005) with parents
>10 years answered
at home
Salminen et Finland 1503 14yrs Cross ?? 1 month prevalence Low back 1 month prevalence Lifetime prevalence
al (1992) sectional Lifetime prevalence pain Low back pain 10.8% Low back pain 30%
Sciatica 1.8%
Salminen et Finland 1377 15yrs Longitudinal Questionnaire 1 month incidence Low 1 month incidence Lifetime prevalence
al (1995) Answered at school Lifetime prevalence Boys 33% Boys (no LBP at baseline) 33%
back Girls 32% Boys (LBP at baseline) 94%
pain Girls (no LBP at baseline) 42%
Girls (LBP at baseline) 93%
Shehab et Kuwait 400 10-18yrs Cross Questionnaire Point prevalence Low back Point prevalence Lifetime prevalence
al (2004) sectional Administered through Lifetime prevalence pain Low back pain 35% Low back pain 57.8%
an interview Male 20.6% Male 50.8%
 Female 39.3% Female 64.7%

Sheir-Neiss USA 1126 12-18yrs Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence
et al (2003) sectional Answered at school Spinal pain 74.4% (of N=1122 back pack users)
Siivola et al Finland 714 15-18yrs Longitudinal Questionnaire 6 month incidence Neck and 6 month incidence Lifetime prevalence
(2004) Answered at school Lifetime prevalence shoulder Neck and shoulder pain 59% Neck and shoulder pain:
pain (occasional or weekly pain) 15-18 yrs 17%
22-25 yrs 28%
Staes et al Belgium 182 15-21yrs Cross Questionnaire Point prevalence Low back Point prevalence Lifetime prevalence
(1995) sectional Lifetime prevalence pain Low back pain 38.5% Low back pain 47.8%
Staes et al Belgium 620 16-18yrs Cross Questionnaire 1 month prevalence Low back 1 month prevalence
(2003) sectional Answered at school pain Low back pain 24.7%
Taimela et Finland 1171 7-16yrs Cross Questionnaire 1 year prevalence Low back 1 month prevalence 7 yrs 1.1%
al (1997) sectional Answered at school pain Low back pain 10 yrs 6.0%
(except first graders Male 10.1% 14 yrs 18.0%
answered at home Female 9.4% 16 yrs 18.4%
with help of
parent/guardian)
Troussier et France 1178 6-20yrs Cross Questionnaire Lifetime prevalence Spinal pain Lifetime prevalence
al (1994) sectional Older children Spinal pain 51.2%
answered at school Male 43.2%
Parents of younger Female 58.1%
children answered at
home
Troussier et France 972 10-14yrs Cross Questionnaire Point prevalence Spinal pain Spinal pain Fifth grade Ninth grade Total
al (1999) sectional Answered at school (actually 1 week)
without help ‘Cumulative’ Cumulative 8 17.4 13.3
prevalence (frequent prevalence
or daily back pain in Point prevalence 14.3 24 19.8
previous school
years)
Vikat et al Finland 11,095 12-18yrs Cross Questionnaire Lifetime prevalence Low back Lifetime prevalence (pain once a week or more)
(2000) sectional Answered at home pain Low back pain 8%
Neck and Neck and shoulder pain 15%
shoulder
pain
Viry et al France 123 8th graders Cross Questionnaire Point prevalence Spinal pain Point prevalence 1 year prevalence
(1999) sectional Answered at school 1 year prevalence Spinal pain 27.6% Spinal pain 82.9%
without help

Watson et UK 1160 11-14yrs Cross Questionnaire 1 month prevalence Low back 1 month prevalence
al (2002) sectional Answered at school pain Low back pain 23.9%
by students and at Male 19%
home by parents Female 28%
Wedder- Denmark 806 8-10yrs Cross Questionnaire 1 month prevalence Spinal pain 1 month prevalence
kopp et al 14-16yrs sectional Answered at home Spinal pain 39%
(2001) (parents)
Interview (children)
Whittfield et New Zealand 140 13 & 16 yrs Cross Questionnaire 1 week prevalence Any pain 1 week prevalence
al (2005) sectional Answered at school
3rd form (mean age 6th form (mean age Total
 13.6 yrs) 17.1 yrs)
Females Males Females Males
Neck 51.4 37.1 51.4 37.1 44.3
Upper 51.4 22.9 40 31.4 36.4
back
Low back 28.6 25.7 45.7 40 35