Background Spinal pain is an important health issue for adolescents resulting in functional limitations for many and increasing the risk of spinal pain in adulthood. Whilst human and animal studies suggest nutrition could influence spinal pain, this has not been investigated in adolescents. The objective of this exploratory cross sectional study was to evaluate associations between diet and adolescent spinal pain. Methods This study surveyed the spinal pain (neck and back) and nutrition (specific nutrients, broad food groups, diet quality and dietary pattern) of 1424 male and female adolescents at 14 years of age, in Western Australia. Results Back or neck pain were experienced by around half of the adolescents, with females more likely to experience spinal pain. Nutrition differed between sexes and deviated from optimal intakes. Vitamin B12, eggs, cereals and meat consumption were related to spinal pain in sex specific multivariate analyses including primary carer education level and adolescent waist girth and smoking. Conclusions The findings of this study suggest that certain aspects of diet may have an association with spinal pain in adolescence.

STUDY DESIGN Cross-sectional survey. OBJECTIVES To assess the associations between adolescent back pain and fitness, motor competence, and body composition. BACKGROUND Although deficits in physical fitness and motor control have been shown to relate to adult back pain, the evidence in adolescents is less clear. METHODS AND MEASURES In this cross-sectional study, 1608 "Raine" cohort adolescents (mean age, 14 years) answered questions on lifetime, month, and chronic prevalence of back pain, and participated in a range of physical tests assessing aerobic capacity, muscle performance, flexibility, motor competence, and body composition.A history of any diagnosed back pain in the adolescent was obtained from the primary caregiver. RESULTS After multivariate logistic regression analysis, increased likelihood of back pain in boys was associated with greater aerobic capacity, greater waist girth, and both reduced and greater flexibility. Back pain in girls was associated with greater abdominal endurance, reduced kinesthetic integration, and both reduced and greater back endurance. Lower likelihood of back pain was associated with greater bimanual dexterity in boys and greater lower extremity power in girls. CONCLUSION Physical characteristics are commonly cited as important risk factors in back pain development. Although some factors were associated with adolescent back pain, and these differed between boys and girls, they made only a small contribution to logistic regression models for back pain. The results suggest future work should explore the interaction of multiple domains of risk factors (physical, lifestyle, and psychosocial) and subgroups of adolescent back pain, for whom different risk factors may be important.

Physical activity, physical fitness and motor competence are important health-related constructs. However, the relationship among them, particularly for children and adolescents, is still unclear. In this study, motor competence (measured by the McCarron Assessment of Neuromuscular Development), pedometer-determined physical activity and physical fitness (aerobic fitness, muscle strength, muscle endurance, flexibility and body composition) were examined in a cohort of 1585 adolescents (771 girls, 814 boys) of mean age 14.06 years. Significant gender differences were observed for all measures except motor competence. Apart from hip and shoulder flexibility, males outperformed females. For both males and females, motor competence was associated with all fitness measures, physical activity was associated only with aerobic fitness and aerobic fitness was associated with physical activity, motor competence, BMI and chest pass. Among males, aerobic fitness was also associated with all other fitness tests. The correlations were, in general, moderate to weak. The results challenge the current focus on physical activity rather than physical fitness as the preferred intervention.

QUESTION:Is neck/shoulder pain in adolescents related to their sitting spinal posture, taking account of gender?DESIGN:Cross-sectional survey and direct observation.PARTICIPANTS:1597 adolescents from the 'Raine' birth cohort study (781 females, 816 males) with a mean age of 14.1 years (SD 0.2).OUTCOME MEASURES:Neck/shoulder pain prevalence and gender was measured by survey. Spinal posture (7 angles) during sitting was measured from photographs.RESULTS:Life, month, and point prevalence for neck/shoulder pain among adolescents were 47%, 29%, and 5% respectively. Life prevalence was 10% higher in females than in males and month prevalence was 12% higher. When looking straight ahead, females sat with 2 degrees (95% CI 1 to 3) less neck flexion, 2 degrees (95% CI 0 to 3) less craniocervical angle, 7 degrees (95% CI 6 to 8) less cervicothoracic angle, 13 degrees (95% CI 12 to 14) less trunk angle, 10 degrees (95% CI 8 to 12) less lumbar angle, and 9 degrees (95% CI 7 to 11) more anterior pelvic tilt than males. Adolescents with neck/shoulder pain sat with 2 degrees (95% CI 1 to 3) less trunk angle, and 1 degree (95% CI 0 to 2) less cervicothoracic angle than those without pain. After controlling for gender, OR for neck/shoulder pain ever predicted by any angle ranged from 0.99 to 1.00 (range of 95% CI 0.98 to 1.01).CONCLUSION:Neck/shoulder pain is highly prevalent in Australian adolescents. Sitting spinal posture differs between males and females and differs slightly between those with and without neck/shoulder pain. However, posture was not predictive of neck/shoulder pain ever after controlling for gender.

ObjectivesThe study objectives were (1) to determine if adolescent back pain is related to carer back pain; and (2) to examine whether other carer and family factors accounted for any such relationship. MethodsBack pain experience was collected independently from 1608 fourteen-year-old adolescents and their care givers by questionnaire. Measures of back pain impact on carers were also collected (modified activities, missed work, sought professional help, took medication). Other carer factors examined were age, sex, smoking habits, depression, anxiety, and stress. Familial factors examined included income, stressful events, and family functioning. Odds ratios were calculated to describe familial associations with multivariate modeling used to examine the influence of other carer and family factors. ResultsLifetime prevalence of back pain was 46.5% for adolescents and 72% for their carers. Having a carer with back pain increased the risk of back pain for adolescents, and this was magnified if both carers had back pain (odds ratio 1.61). Adolescent back pain was not associated with primary carer age, sex, depression, anxiety, or stress but was related to family stressful events. However, these other factors did not diminish the association between carer back pain and adolescent back pain. DiscussionCarer experience of back pain is clearly associated with adolescent experience of back pain. Although other carer and family factors are also associated, the carer's back pain experience is not a surrogate measure of these other factors suggesting other genetic and behavioral mechanisms may be important for adolescent back pain development.

Posture and adolescent spinal pain may be linked, so adolescent posture measurement is important. Static photographic analysis of posture is practical for large-scale studies of adolescents, but only one adolescent study has investigated its reliability. The aim was therefore to assess the reliability of photographic spinal posture assessment in adolescents. Inter-rater reliability was measured, as the purpose was to assess the method for large-scale epidemiological studies with multiple raters. Twenty-two healthy adolescent subjects (11 males, 11 females) aged 13–17 were photographed by four different examiners while standing, sitting and slumped. Eight spinal postural angles and four distance measures were derived. Inter-rater reliability was quantified by interclass correlation coefficients (ICCs) for consistency, ICCs for absolute agreement between raters and standard errors of measurement (SEMs). Inter-rater reliability was fair (ICC >0.4) to good (ICC >0.75) for all measures in standing except pelvic tilt and sway angle, and for all measures in sitting except head flexion and craniocervical angle. Poorer ICCs for agreement than consistency were observed, reflecting a significant rater effect for most measures. Photographic analysis of adolescent posture has fair reliability, and is appropriate for large-scale adolescent studies. Future studies should observe several precautions to optimize reliability.

Neck/shoulder pain (NSP) is a common problem for adolescents and posture has been suggested as an important risk factor. The aim of this cross sectional study was to examine the relationship between prolonged NSP and habitual sitting posture in adolescents. The habitual sitting postures of 1593, 14-year-old adolescents with and without prolonged NSP were assessed using sagittal plane digital photographs. Cervicothoracic and lumbopelvic posture angles were calculated from the digital images using motion analysis software. Adolescents reported experience of NSP by questionnaire. Differences between postures of males and females and those with and without prolonged NSP were examined using independent t-tests. The relationships between cervicothoracic and lumbopelvic postures and presence of prolonged NSP were investigated using logistic regression models controlling for gender. Prolonged NSP was reported by 5.3% of the adolescents, with females reporting a higher prevalence rate (6.5%) than males (4.2%). Females also sat more erect with a more lordotic lumbar posture than males. Adolescents with prolonged NSP had more flexed cervicothoracic posture, more erect trunk and more lumbar lordosis. When gender was controlled, only lumbar lordosis was related to the presence of prolonged NSP.

Question: Are use and perceived load of school bags and the prevalence of spinal pain different between male and female adolescents? Is use of school bags related to perceived load of school bags? Are use and perceived load of school bags related to spinal pain? Design: Cross-sectional observational study. Participants: 1202 adolescents recruited from the 'Raine' Cohort Study. Outcome measures: Use and perceived load of school bags as well as spinal pain were measured by questionnaire. Results: The prevalence of back and neck pain was approximately 50%; 53% of females reported neck pain compared with 44% of males (p < 0.01). Almost half of participants carried their school bag for more than 30 minutes per day with 85% carrying their bag over both shoulders. School bags were felt to be heavy by 54% and to cause fatigue by 51%. Carrying a school bag for more than 30 minutes daily and taking an inactive form of transport to school (car or bus) increased the odds of having both back (OR 1.40, 95% Cl 1.08 to 1.82) and neck pain (OR 1.47, 95% Cl 1.13 to 1.91). Conclusion: Neck pain is as common as back pain amongst adolescents. Perceived school bag load, duration of carriage and method of transport to school are associated with back and neck pain. Physical activity in the form of walking or riding to school may offset the potentially provocative effects of prolonged bag carriage and warrants further investigation.

Background Adolescent neck/shoulder pain (NSP) is a common and sometimes debilitating problem. Several risk factors for this condition have been investigated, but no studies have previously evaluated associations between fitness, motor competence, body composition and adolescent NSP. Methods 1608 males and females of mean age 14 years answered questions on their history of NSP (4 measures), and were tested for aerobic fitness, upper and lower limb power, trunk endurance, grip strength, shoulder flexibility, motor competence and anthropometric factors. Univariate and multivariate logistic regressions were used to test for associations between NSP and physical variables. Results There were significant gender differences for most physical and pain variables. After multivariate analysis, males had lower odds of NSP if they had reduced back endurance [OR: 0.66 (95% CI: 0.46–0.97)], reduced persistent control [0.42 (0.19–0.95], and increased muscle power [0.33 (0.12–0.94)], and higher odds of NSP if they had a higher basketball throw [2.47 (1.22–5.00)] and jump performance [3.47 (1.55–7.74)]. Females had lower odds for NSP if they had a reduced jump performance [0.61(0.41–0.92)], a better basketball throw [0.60(0.40–0.90)], lower shoulder flexibility [0.54 (0.30–0.98)] and a higher aerobic capacity [0.61 (0.40–0.93)], and higher odds for NSP if they had greater abdominal endurance [1.57(1.07–2.31)] and greater bimanual dexterity [1.77(1.18–2.65)]. Females showed a U shaped relationship between NSP and back endurance [low: 2.12 (1.20–3.74); high 2.12 (1.18–3.83)]. Conclusion Adolescent NSP was associated with fitness and motor competence, although the associations varied with gender, and their strength was limited.

OBJECTIVE:Computer use is common in adolescents, and there is evidence that adolescent spinal posture alters during computer use. However, it is unknown if computer use and habitual postures are associated. The objective of this study was to evaluate associations between adolescent computer use and habitual postures.METHODS:Eight hundred eighty-four adolescents (408 females, 476 males, mean age, 14.0 years, standard deviation, 0.2) completed a questionnaire assessing weekly computer use. Habitual spinal posture was assessed by photographic analysis while standing and sitting.RESULTS:Computer use was associated with adolescent habitual postures. In males, increased computer use was associated with increased head flexion and neck flexion. In females, increased computer use was associated with increased lumbar lordosis.CONCLUSIONS:The amount of weekly computer use was associated with changes in habitual spinal postures, and these depended on gender. These associations may result from temporary computer postures leading to adaptive neuromusculoskeletal changes, though further multivariate and longitudinal studies are needed to confirm causality. As some habitual posture changes may place a greater strain on the musculoskeletal system, computer use by adolescents should be viewed as a possible health concern.

STUDY DESIGNA single-group comparative study.OBJECTIVESTo compare lumbopelvic kinematics and muscle activation patterns while sitting on stable and unstable surfaces.BACKGROUNDUnstable surfaces are commonly used during the rehabilitation of certain low back pain disorders. The benefits postulated are increased muscle activity and facilitation of sustainable midrange positions via neuromuscular control. The use of unstable sitting devices in the workplace is controversial, as the postulated increase in muscle activity is thought to lead to a muscle fatigue/pain response. However, little evidence exists for or against the ability of these devices to alleviate or prevent spinal pain.METHODS AND MEASURESThis study included 26 healthy adults (14 male, 12 female). Fastrak 3-dimensional motion analysis detected lumbar curvature, pelvic tilt, and postural sway during sitting on a stable and unstable surface over 5-minute periods. Surface electromyography was used to measure activity in the superficial lumbar multifidus, transverse fibers of internal oblique, and iliocostalis lumborum pars thoracis.RESULTSSpinal postures were similar for sitting on a stable and unstable surface. Significant increases in postural sway were detected (P = .013) in 3 dimensions of movement during sitting on an unstable surface. Gender differences were noted. No EMG amplitude or variance differences were detected between seating conditions.CONCLUSIONSPreliminary data show that sitting on unstable surfaces induces greater spinal motion, but does not significantly alter the lumbosacral posture nor the amount of activity in the superficial trunk muscles under investigation.

Musculoskeletal disorders such as neck pain have been related to computer use in adults and an association between computer use, neck posture and neck pain has been suggested. Computer use in increasing in children and thus the potential for related neck pain and postural changes is increasing. This study evaluated the neck pain, neck posture and computer use of 884 adolescents. Over one third (38%) of adolescents reported using computers for > 7 hours per week, with 4.5% reporting > 21 hours per week. Nearly one half (46.7%) reported ever having neck/shoulder pain, with 7.7% reporting chronic neck/shoulder pain. Computer use was related to neck/shoulder pain and to neck/shoulder postures. Adolescents who reported no use of computers or high use of computers were about twice as likely to report neck/shoulder pain as those who reported moderate use of computers (Odds Ratio = 1.79 and 2.51 respectively). Increasing computer use was related to increased head, neck and thorax flexion during usual sitting (rho=0.069, 0.067 and 0.129, p<.001 respectively). The results demonstrate neck/shoulder pain is a significant problem in adolescence and the potential impact of computer use needs exploring with longitudinal studies.