British Medical Journal 2002 (Oct 5); 325 (7367): 743–745 ~ FULL TEXT
Paula Hakala, Arja Rimpelä, Jouko J Salminen,
Suvi M Virtanen, Matti Rimpelä
Tampere School of Public Health,
University of Tampere,
FIN-33014 Tampere, Finland.
Objectives: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and 2001.
Design: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001.
Participants: 62,677 - 12, 14, 16, and 18 year olds and 127,217 - 14-16 year olds.
Main Outcome Measures: Pain in the back and neck, neck and shoulder, or lower back, at least weekly.
Results: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds.
Conclusion: Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.
What is already known on this topic
What this study adds
Back pain, particularly of the lower back, is common in children and adolescents, and the lifetime prevalence of back pain is in the range 30-51%
Neck-shoulder pain has been little studied in children and adolescents
Degeneration of lower lumbar discs has been observed at the age of 15 and is a significant risk factor for chronic lower back pain in early adulthood
In two independent data sets—one for the lower back and another for neck-shoulder—the prevalence of pain increased in adolescents through the 1990s, particularly in the latter half of the decade
Neck-shoulder pain is common in 12-18 year olds
From the Full-Text Article:
Pain in the neck and shoulder and in the back in adolescence has not been considered as a widespread problem, and only a few studies have been published. A survey in the early 1980s found that more than 20% of Finnish 11-17 year olds had back or neck pain.  In the 1990s, population surveys confirmed that back pain, particularly in the lower back, was common in children and adolescents. [2-4] In studies with a sample size of at least 300, the lifetime prevalence of back pain in the range 30-51%.  A Finnish population survey in 1991 found 15% of 12-18 year olds had pain in the neck-shoulder at least once a week, and 8% had pain in the lower back.  Among Finnish 10-12 year olds, about 30% had musculoskeletal pain at least weekly; painin lower limbs and the neck was most common. 
Among adults, back pain can be disabling and lead to economic loss.  Most people experience pain of the back, neck, and shoulder at some time, although few have pain over long periods. In Finland, 80% of people aged 30 years and older have experienced some back pain; half these people have had pain more than five times. 
Degeneration of the lower lumbar discs has been discovered in 15 year olds; it may be a risk factor for chronic pain of the lower back in early adulthood.  Also, in a one year follow up of 10-12 year olds, musculoskeletal pain symptoms, especially neck pain, were common.  These two recent longitudinal studies consider the increase in back and neck-shoulder pain in adolescents from a public health point of view. An increase in pain in adolescents suggests more musculoskeletal pain and more disability and economic loss in adulthood.
We studied changes in back and neck-shoulder pain in Finnish adolescents from 1985 to 2001. In these 16 years, the everyday life of adolescents changed substantially, particularly because of their use of new technology.  We used two Finnish population surveys: the adolescent health and lifestyle survey, which covers the entire period, and the school health promotion survey, which covers 1996-2001.
Pain of the neck, shoulder, and lower back of adolescents increased in the 1990s, and this trend is continuing. The most sudden increase was at the end of the 1990s. Few trend studies among adolescents have been carried out. Findings from health behaviour in school aged children, however, show that in 11-15 year olds, 20% had weekly backache in 1993-4 and a third in 1997-8. [13, 14] The increase in weekly backache among 11, 13, and 15 year olds was similar in most of the participating 24 countries from Europe and Canada. In Finland, no increase in back pain among adults has been observed since 1985,  but, in the United Kingdom, a recent survey has suggested an increase. 
We found that musculoskeletal pain was more common in girls and in older children. Our results support the evidence that lower back pain is relatively common in adolescence, with greater prevalence in older children. [3, 6, 17-19] The prevalence of neck-shoulder pain was the same as for other studies at the same ages. [6, 20] Our results show that neck-shoulder pain is a common and increasing problem in adolescents, especially girls, suggesting more problems in the young adults of the future.
The two large scale population surveys, representing the whole of Finland, give weight to the results. The studies were carried out independently and data were collected by different methods: postal or classroom surveys. Still, prevalences and trends were similar. Comparability was guaranteed among the years by using identical questions and methods. The overall response rate in the adolescent health and lifestyle survey decreased gradually, to being the lowest in 2001. Selection bias did not become evident, however, with diminishing response rates, and test-retest reliability was good.
Substantial changes to Finnish society and among adolescents may have contributed to the increase in pain. In the 1990s, information technology began to have a tremendous impact on the everyday life of 12-18 year olds. At the end of the 1980s, computer use in schools or at home was still negligible,  but in 2001, according to the adolescent health and lifestyle survey, 86% of 12-18 year olds use the internet, 27% daily, and 93% used computer and console games, 54% daily. Musculoskeletal symptoms may be related to risk factors such as repetitive movements, static postures, and static muscular activation patterns in work with computer mice. 
Unemployment and cuts in healthcare and school budgets during and after the economic recession of the early 1990s are still being felt today. Biological maturity is reached at a younger age,  and other health indicators, in addition to pain of the neck, shoulder, and lower back, have shown adverse development for example, increasing obesity. [23, 24] Children often carry heavy loads during their school day, yet no change in these loads was evident in the 1990s. The reports of health behaviour in schoolchildren from several European countries support our findings, [13, 14] suggesting that the factors behind the increase might apply throughout the Western world.
Return to the PEDIATRICS Section
Return to the LOW BACK PAIN Section
Return to the CHIROPRACTIC AND CHRONIC NECK PAIN Page