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Risk Factors for Low Back Pain in Childhood and Adolescence. A Systematic Review

Calvo-Muñoz Inmaculada PT PhD; Kovacs, Francisco M. MD, PhD; Roqué, Marta BSc; Gago Fernández, Inés PT; Seco Calvo, Jesús MD, PT,PhD
The Clinical Journal of Pain: Post Acceptance: September 14, 2017
doi: 10.1097/AJP.0000000000000558
Review Article: PDF Only


To identify factors associated with low back pain (LBP) in children and adolescents.


A systematic review was conducted (Prospero CRD42016038186). Observational studies analyzing LBP risk factors among subjects aged between 9 and 16 were searched for in 13 electronic databases and 8 specialized journals until March 31st, 2016, with no language restrictions. Additionally, references in the identified studies were manually tracked. All identified studies which included ≥50 subjects aged 9 to 16, were reviewed. Their methodological quality was assessed by two reviewers separately, using validated tools which scored, from worst to best, 0-100 for cross-sectional and 0-12 for cohort studies. A sensitivity analysis only included studies which had adjusted for confounders, ≥500 subjects and a methodological score of ≥50%.


5142 citations were screened and 61 studies, including 137,877 subjects from 5 continents, were reviewed. Their mean (range) methodological scores were 74.56 (50-100) for cross-sectional studies, and 7.36 (5-9) for cohort ones. Studies had assessed 35 demographic, clinical, biological, family, psychological, ergonomic and lifestyle risk factors. Mean (range) prevalence of LBP ranged between 15.25% (3.20,57.00) for point prevalence, and 38.98% (11.60, 85.56) for lifetime prevalence. Results on the association between LBP and risk factors were inconsistent. In the sensitivity analysis, “older age” and “participation in competitive sports” showed a consistent association with LBP.


Future studies should focus on muscle characteristics, the relationship between body and backpack weights, duration of carry, characteristics of sport practice, and factors associated with chronic pain.

Source of Funding: This study was funded by the Spanish Back Pain Research Network, a non-profit private organization specializing in medical research on neck and back pain, with no links to the health industry.

Conflicts of Interest: The authors do not have any conflicts of interest to report.

Reprints: Francisco M. Kovacs, MD, PhD, Unidad de la Espalda Kovacs. Hospital Universitario Moncloa. Avda. Valladolid Nº 83. 28008 Madrid. Spain (e-mail:

Received February 13, 2017

Accepted August 29, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.