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13Non-specific back pain, physical activity and ways of coping with pain among school-aged children and youth
UDC 796.011.3
PhD Agnieszka K^dra1
1Jozef Pilsudski University of Physical Education in Warsaw, Faculty of Physical Education and Health, Biala Podlaska, Poland
Corresponding author: [email protected]
Abstract
Back pain (BP) is a serious problem of contemporary society. Research has shown that a low level of physical activity is a BP risk factor. The study sought to characterise non-specific BP and ways of coping with it and to analyse physical activity (PA) among children and youth aged 10-19 with and without BP.
The final analysis included 900 students aged 10-19 years (556 girls and 344 boys). The author's own questionnaire was applied as a research tool. Prior to the study, the questionnaire reliability was assessed. Kappa coefficient in all the analysed variables was equal to or higher than 0.92. Nearly 70% of the respondents declared that they had experienced BP in the last 12 months. Physically active students reported back pain much less frequently than those who were not active. It was revealed that with age, the percentage of students who were taking OTC painkillers increased.
Keywords: back pain (BP), non-specific BP, children, youth, physical activity (PA).
Background. Musculoskeletal pains constitute a serious problem of contemporary society. Research revealed that back pain (BP) occurring in adolescence is a risk factor of BP in adulthood [5]. In the majority of cases, BP in children and youth is non-specific. While diagnosing non-specific BP in children and youth, such causes as Scheuermann's disease, infections (discitis and osteomyelitis), tumours (leukaemia, sarcomas), spondylolysis, spondylolisthesis and rheumatic diseases should be excluded [3,6].
The study sought to characterise non-specific BP and ways of coping with it and to analyse PA among children and youth aged 10-19 years with and without BP.
Research methods and organization. The research included 914 children and youth (566 girls and 348 boys) from Biala Podlaska. The study sample was selected in a two-stage cluster sampling. At the first stage, schools from three levels of education were randomly selected, while at the second stage, particular groups of students were selected [2]. The
final analysis included 900 students aged 10-13 years (primary school), 14-16 years (lower-secondary school) and 17-19 years (upper-secondary school), which constituted 98.5% of the whole study sample. All the students provided a consent to participate in the study.
The author's own questionnaire was applied as a research tool. It was divided into two parts: (1) personal data and (2) main part. The first part included such data as gender, date of birth, body mass and height. The main part regarded PA, the most common forms of spending free time, i.e. (a) active (swimming, dancing, team games, gymnastics, fitness, martial arts, rollerblading, cycling), (b) passive (reading books and press, watching TV, using a computer, games console, Internet, smart-phone, listening to music) and experiencing (or not) BP in the last 12 months. Persons who responded negatively did not complete the remaining part of the questionnaire, which included questions regarding the frequency and location of BP, situations in which BP occurred or increased and ways of coping with BP.
After consulting a school doctor, students with such spinal diseases which may cause BP as Scheuermann's disease, spondylolysis, spondylolisthesis, rheumatic diseases, tumours, sarcomas, etc., were excluded from the study. In the case of girls, those who experience BP only during menstruation were also excluded.
The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Senate Research Ethics Committee of Jozef Pilsudski University of Physical Education in Warsaw, Poland.
Parameters were described using basic measurements of descriptive statistics for qualitative variables, i.e. percentage. Chi-square test was applied in order
to evaluate associations between the presence of BP and gender, age and physical activity. Statistical significance was set at p<0.05. The collected material was organised and analysed with the use of Statistica 13 software by Statsoft (PL).
Results and discussion. The Kappa coefficient for all the variables analysed during reliability assessment was equal to or higher than 0.91. No significant differences between the results obtained in the two tests were revealed (p<0.05).
Among 900 respondents, 628 (69.8%) declared that they had experienced BP in the last 12 months. Girls reported BP more often than boys (73.6%vs.63.7%) (p<0.1). The percentage of persons with BP increased with age (p<0.01) (Tab. 1).
Table 1. The prevalence of BP with regard to gender, age and PA of the respondents (n=900)
Variables n (%) Absence of BP n (%) Presence of BP n (%) p value
Total 272 (30.2) 628 (69.8) <0.01
Gender Girls n=556 (61.7) 147 (26.4) 409 (73.6)
Boys n=344 (38.2) 125 (36.3) 219 (63.7)
Age 10-13 years n=313 (34.8) 111 (35.5) 202 (64.5) <0.01
14-16 years n=135 (15.0) 46 (34.1) 89 (65.9)
17-19 years n=452 (50.2) 115 (25.4) 337 (74.6)
PA Only PE lesson n=465 (51.7) 38 (8.2) 427 (91.8) <0.001
Additional activity n=435 (48.3) 234 (53.8) 201 (46.2)
Forms of spending free time Passive (reading books and press, watching TV, using a computer, games console, Internet, smartphone, listening to music) n=440 (48.9) 31 (7.0) 409 (93.0) <0.001
Active (swimming, cycling, rollerblading, fitness, team games, gymnastics, martial arts) n=460 (51.1) 241(52.4) 219 (47.6) <0,001
Table 2. Frequency and location of BP among students according to gender and age (n=628)
Total n=628 Gender Age
Girls n=409 Boys n=219 10-13 years n=202 14-16 years n=89 17-19 years n=337
n (%) n (%) n (%) n (%) n (%) n (%)
BP location (segment)*
Cervical 210 (33.4) 143 (35.0) 67 (30.6) 88 (41.9) 30 (33.7) 92 (27.3)
Thoracic 190 (30.3) 118 (28.9) 72 (32.9) 74 (36.6) 31 (34.8) 85 (25.2)
Lumbar 390 (62.1) 264 (64.5) 126 (57.5) 89 (44.1) 51 (57.3) 250 (74.2)
BP frequency
Very rare BP (1-2/year) 294 (46.8) 174 (42.5) 120 (54.8) 98 (48.5) 50 (56.2) 146 (43.2)
BP a few times a year (3-6/year) 251 (40.0) 180 (44.0) 71 (32.4) 76 (37.6) 29 (32.6) 146 (43.2)
Frequent or constant BP (more than 1-2 months) 83 (13.2) 55 (13.5) 28 (12.8) 28 (13.9) 10 (11.2) 45 (13.6)
* The numbers do not add to 100% since the respondents were allowed to choose more than one answer
In the next part, the frequency of BP depending on PA was analysed. For nearly 52% of the students, PE lesson was the only form of PA. It was revealed that students who take up PA only during PE lessons report BP more often than those who take up additional
PA p<0.001 (Tab.1). The analysis of forms of spending free time by students with and without BP revealed that those who spend time in a passive way experience BP more often than those who choose active forms p<0.001 (Tab.1)
Table 3. Ways of coping with BP, difficulties caused by BP and situations in which BP occurs or increases with regard to gender and age (n=628)
Gender Age
Total n=628 Girls n=409 Boys n=219 10-13 years n=202 14-16 years n=89 17-19 years n=337
n (%) n (%) n (%) n (%) n (%) n (%)
Seeking doctor's help
Yes 105 (16.7) 76 (18.6) 29 (13.2) 39 (19.3) 13 (14.6) 53 (15.7)
No 523 (83.7) 333 (81.4) 190 (86.8) 163 (80.7) 76 (85.4) 284 (84.3)
Ways of coping with LBP*
Medicines prescribed by a doctor 26 (4.1) 18 (4.4) 8(3.7) 10 (5.0) 4 (4.5) 12 (3.6)
Generally available painkillers 85 (13.5) 64 (15.7) 21 (9.6) 18 (8.9) 11 (12.4) 56 (16.6)
Electrotherapy procedures 139 (22.1) 107 (26.2) 32 (14.6) 45 (22.3) 25 (28.1) 69 (20.5)
Physiotherapeutic treatment other than electrotherapy (gymnastics, exercises) 272 (43.3) 181 (44.3) 91 (41.6) 89 (44.1) 70 (33.7) 153 (45.4)
Rest 456 (72.6) 309 (75.6) 147 (67.1) 139 (68.8) 63 (70.8) 254 (75.4)
Other 32 (5.1) 18 (4.4) 14 (6.4) 13 (6.4) 6(6.7) 13 (3.9)
Circumstances in which BP occurred*
Lifting heavy objects 327 (52.1) 241 (58.9) 86 (39.3) 118 (58.4) 43 (48.3) 166 (49.3)
Carrying a school backpack 412 (65.6) 307 (75.1) 105 (48.0) 149 (73.8) 61 (68.5) 202 (59.9)
Physical exercises 129 (20.5) 83 (20.3) 46 (21.0) 42 (20.8) 16 (18.0) 71 (21.1.)
PE lesson 114 (18.2) 80 (19.6) 34 (15.5) 48 (23.8) 22 (24.7) 44 (13.1)
Sitting for a long time 309 (49.2) 228 (55.8) 81 (37.0) 103 (51.0) 37 (41.6) 169 (50.2)
Mental stress 53 (8.4) 42 (10.3) 11 (5.0) 17 (8.4) 9 (10.1) 27 (8.0)
Changeable weather 44 (7.0) 27(6.6) 17(7.8) 9(4.5) 9 (10.1) 26 (7.7)
Other 48 (7.6) 32 (7.8) 16 (7.3) 16 (7.9) 8(8.9) 24 (7.1)
BP hampers*
Sleep 88 (14.0) 53 (13.0) 35 (16.0) 27 (13.4) 21 (23.6) 40 (11.9)
Sitting 237 (37.7) 174 (42.5) 63 (28.8) 57 (28.2) 30 (33.7) 150 (44.5)
Standing 156 (24.8) 122 (29.8) 34 (15.5) 38 (18.8) 23 (25.8) 95 (28.2)
Studying 117 (18.6) 78 (19.1) 39 (17.8) 29 (14.4) 17 (19.1) 71 (21.1)
Concentrating and focusing on an activity 193 (30.7) 140 (34.2) 53 (24.2) 62 (30.7) 20 (22.5) 111 (32.9)
Fun 82 (13.1) 44 (10.8) 38 (17.4) 36 (17.8) 16 (18.0) 30 (8.9)
Sports 111 (17.7) 64 (15.7) 47 (21.5) 42 (20.8) 20 (22.5) 49 (14.5)
Other 20 (3.2) 11 (2.7) 9 (4.1) 3(1.5) 6(6.7) 11 (3.3)
BP does not hinder performing any activities 147 (23.4) 85 (20.8) 62 (28.3) 53 (26.2) 17 (19.1) 77 (22.9)
* The numbers do not add to 100% since the respondents were allowed to choose more than one answer
In the next part, the location (multiple choice question) and frequency of BP were analysed. BP was mostly located in the lumbar spine (62.1%). Such a situation was noted in the case of both genders and in all age groups (Tab. 2).
While analysing the declared frequency of BP, it may be noted that the largest group included the respondents who experienced pain rarely, i.e. 1-2 times a year. It was declared by 46.8% of the respondents. While analysing the frequency of BP with regard to gender, it was concluded that girls declared BP occurring 3-6 times a year more often than boys (44.0% vs. 32.4%) (Tab. 2).
The research revealed that a small group of students (16.7%) sought doctor's help due to BP. This percentage decreased with age (19.3% vs. 14.6% vs. 15.7%) (Tab. 3).
The most common way of coping with BP was rest (72.6%). It could be noted in all age groups. A considerable percentage of students (13.5%) mitigated BP by taking OTC painkiller. It was revealed that this percentage increased with age (8.9% vs. 12.4% vs. 16.6%) (Tab.3).
In the next part, situations in which BP occurred or increased were analysed. Carrying a school backpack, lifting heavy objects and sitting for a long time were such situations (65.6% vs. 52.1% vs. 49.2%). Over 18% of the students (19.6% girls and 15.5% boys) declared that they experienced BP during or immediately after a PE lesson (Tab. 3). The research revealed that sitting (37.7%) as well as concentrating and focusing on something (30.7%) were activities the performance of which is mostly hampered due to BP (Tab. 3).
Similar studies that analysed BP in children and youth were conducted in other countries. They revealed that BP regarded 39%-74.4% of the students [1,7,10]. Differences regarding percentage values may result from the fact that some studies took into account BP occurring within the last month or two since the date of the research, while other studies analysed a longer period, e.g. one year
The present study analysed the period of the last year, which may have led to the fact that the percentage of individuals reporting BP was higher
The data available in the literature regarding the influence of PA on BP are not unanimous; however, numerous studies underlined positive effects of moderate PA on BP. Vigorous PA has been associated with an increased risk of self-reported back pain, while moderate PA is protective [4,8]. Studies by other authors revealed that taking up PA by persons with BP protects them from returning and chronic pain [9]. The present results prove that physically active students report BP less frequently than individuals who do not take up PA.
The presented results may serve as a stimulus for further investigations aimed at defining BP risk factors in children and youth.
Conclusions
1. The research revealed very high (69.8%) prevalence of BP and the percentage increased with age p<0.01.
1. Students who choose passive forms of spending free time and take up PA only during PE lessons report BP more often than those taking up PA in their free time p<0.001.
1. BP was mostly located in the lumbar spine (62.1%). The percentage of students seeking doctor's help due to BP decreased, while that of students taking OTC painkillers increased with age.
1.
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