Is Puberty a Risk Factor For Back Pain in the Young?
A Systematic Critical Literature Review
SOURCE: Chiropractic & Manual Therapies 2014 (Oct 15); 22 (1): 27
Arnaud Lardon, Charlotte Leboeuf-Yde,
Christine Le Scanff and
Niels Wedderkopp
EA 4532 CIAMS, Université Paris-Sud,
UFR STAPS, 91405 Orsay, France ;
Institut Franco-Européen de Chiropraxie,
24 Bld Paul Vaillant Couturier,
94200 Ivry sur Seine, France.
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.
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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.
KEYWORDS: Adolescent; Aetiology; Back pain; Cause; Puberty; Systematic review
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Background
Back pain in young age
It has previously been established that back pain starts during childhood. [1-4] According to two recent systematic literature reviews [1, 2], the lifetime prevalence increases between the ages of 7 and 12 (on average from 1% to 17%) to reach the adult level around the age of 20. [5] In relation to low back pain, it appears that puberty is the time for a rapid increase. Girls start puberty earlier than boys, which may explain why they report back pain earlier than boys. [5]
Puberty and back pain
The time of puberty is the transition period from childhood to adulthood and over only a few years, both body and soul will undergo many changes. The most apparent morphological differences are increased height and a change in body composition. It has been proposed that these may impact back pain. [6-8] The growth spurt, defined as an average gain of 10 cm per year [9], could be considered a particularly vulnerable period due to sudden mechanical loading changes on the spine. According to a longitudinal study [10], in a healthy population of white girls, the fat mass was shown to increase at the end stage of pubertal development. If this fat replaces active muscle fibers, this too could result in back problems.
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