European Spine Journal

, Volume 14, Issue 4, pp 331–336 | Cite as

Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study

  • Ismail BejiaEmail author
  • Nabiha Abid
  • Kamel Ben Salem
  • Mondher Letaief
  • Mohamed Younes
  • Mongi Touzi
  • Naceur Bergaoui
Original Article


Low back pain (LBP) in children was considered for many years to be a rare condition revealing a serious disease, but in the last two decades, epidemiological studies have shown that the prevalence of nonspecific LBP in children is high. This study was aimed at analyzing the prevalence, severity, consequences and associated factors of LBP in children. A cross-sectional study was undertaken in two preparatory schools in the city of Monastir, Tunisia, in April 2002. This study included a total of 622 children and adolescents—326 females and 296 males—with a mean age of 14 years (range: 11–19 years). They completed the questionnaire in the presence of the physician. For the first 201 questionnaires collected, the corresponding children and adolescents underwent a spine medical examination, with evaluation of pain by visual analog scale if LBP was present. A stepwise logistic regression analysis was carried out to determine the risk factors associated with LBP and chronic LBP. The cumulative lifetime prevalence of LBP was 28.4%. Eight percent of the subjects suffered from chronic LBP. LBP was responsible for 23% of school absenteeism and 29% for sports absenteeism. Medical care requirement was observed in 32.2% and psychological symptoms in 75%. Stepwise logistic regression analysis showed that three factors were associated with LBP: school failure (held back 1 year), odds ratio (OR) =2.6 (95% confidence interval [CI], 1.96–3.44), family history of LBP (parental or sibling LBP), OR=3.80 (95% CI, 2.94–5.92), dissatisfaction with school chair (in height and comfort), OR=3.40 (95% CI, 2.24–5.29). Two factors were associated with chronic LBP: dissatisfaction with school chair, OR=1.62 (95% CI, 1.46–3.32) and football playing, OR=3.07 (95% CI, 2.15–5.10). The prevalence of LBP among Tunisian schoolchildren and adolescents is high. This requires preventive measures and longitudinal studies, which are very important from the standpoint of public health.


Low back pain Children Prevalence Risk factors 



Professor Adel Rdissi’s help with the editing is gratefully acknowledged


  1. 1.
    Afshani E, Kuhn JP (1991) Common causes of low back pain in children. Radiographics 11(2):269–291PubMedGoogle Scholar
  2. 2.
    Balagué F, Skovron ML, Nordin M, Dutoit G, Pol LR, Waldburger M (1995) Low back pain in schoolchildren. A study of familial and psychological factors. Spine 20(11):1265–1270PubMedGoogle Scholar
  3. 3.
    Balagué F, Dudler J, Nordin M (2003) Low-back pain in children. Lancet 361(9367):1403–1404CrossRefPubMedGoogle Scholar
  4. 4.
    Bejia I, Letaief M, Touzi M, Bergaoui N (2003) Reproducibility of a low back pain questionnaire in Tunisian adolescents. Rheumatology 24:119 [Abstract]Google Scholar
  5. 5.
    Brattberg G (1994) The incidence of back pain and headache among Swedish school children. Qual Life Res 3 [Suppl 1]: S27–S31Google Scholar
  6. 6.
    Coleman N, Hull BP, Ellitt G (1998) An empirical study of preferred settings for lumbar support on adjustable office chairs. Ergonomics 41(4):401–419CrossRefPubMedGoogle Scholar
  7. 7.
    Coste J, Paolaggi JB (1989) Epidemiology of back pain. Current knowledge and perspectives. Rev Rhum Mal Osteoartic 56(12):861–867PubMedGoogle Scholar
  8. 8.
    Duggleby T, Kumar S (1997) Epidemiology of juvenile low back pain: a review. Disabil Rehabil 19(12):505–512PubMedGoogle Scholar
  9. 9.
    Gunzburg R, Balague F, Nordin M, Szpalski M, Duyck D, Bull D et al (1999) Low back pain in a population of school children. Eur Spine J 8(6):439–443CrossRefPubMedGoogle Scholar
  10. 10.
    Harreby M, Nygaard B, Jessen T, Larsen E, Storr-Paulsen A, Lindahl A et al (1999) Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study. Eur Spine J 8(6):444–450CrossRefPubMedGoogle Scholar
  11. 11.
    Jones GT, Watson KD, Silman AJ, Symmons DP, Macfarlane GJ (2003) Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Pediatrics 111(4 Pt 1):822–828CrossRefPubMedGoogle Scholar
  12. 12.
    Kovacs FM, Gestoso M, Gil del Real MT, Lopez J, Mufraggi N, Mendez JI (2003) Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Pain 103(3):259–268CrossRefPubMedGoogle Scholar
  13. 13.
    Kujala UM, Taimela S, Erkintalo M, Salminen JJ, Kaprio J (1996) Low-back pain in adolescent athletes. Med Sci Sports Exerc 28(2):165–170PubMedGoogle Scholar
  14. 14.
    Kujala UM, Taimela S, Oksanen A, Salminen JJ (1997) Lumbar mobility and low back pain during adolescence. A longitudinal three-year follow-up study in athletes and controls. Am J Sports Med 25(3):363–368PubMedGoogle Scholar
  15. 15.
    Leboeuf-Yde C, Kyvik KO, Bruun NH(1998) Low back pain and lifestyle. Part I: Smoking. Information from a population-based sample of 29,424 twins. Spine 23(20):2207–2214CrossRefPubMedGoogle Scholar
  16. 16.
    Legolf P, Bontoux D (1998) Sport: a risk factor of low back pain. Rev Rhum Engl Ed 65 (3):43–47Google Scholar
  17. 17.
    Olsen TL, Anderson RL, Dearwater SR, Kriska AM, Cauley JA, Aaron DJ et al (1992) The epidemiology of low back pain in an adolescent population. Am J Public Health 82(4):606–608PubMedGoogle Scholar
  18. 18.
    Piko B (1999) Epidemiology of psychosomatic symptoms and subjective health evaluation among secondary school students. Orv Hetil 140(23):1297–1304PubMedGoogle Scholar
  19. 19.
    Salminen JJ (1984) The adolescent back. A field survey of 370 Finnish schoolchildren. Acta Paediatr Scand Suppl 315:1–122PubMedGoogle Scholar
  20. 20.
    Salminen JJ, Pentti J, Terho P (1992) Low back pain and disability in 14-year-old schoolchildren. Acta Paediatr 81(12):1035PubMedGoogle Scholar
  21. 21.
    Salminen JJ, Erkintalo M, Laine M, Pentti J (1995) Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine 20(19):2101–2108PubMedGoogle Scholar
  22. 22.
    Sheldon MR (1994) Lifting instruction to children in an elementary school. J Orthop Sports Phys Ther 9(2):105–10.Google Scholar
  23. 23.
    Sjolie AN (2002) Psychosocial correlates of low-back pain in adolescents. Eur Spine J 11(6):582–588CrossRefPubMedGoogle Scholar
  24. 24.
    Staes F, Stappaerts K, Lesaffre E, Vertommen H (2003) Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain. Acta Paediatr 92(4):444–451PubMedGoogle Scholar
  25. 25.
    Szpalski M, Gunzburg R, Balague F, Nordin M, Melot C (2002) A 2-year prospective longitudinal study on low back pain in primary schoolchildren. Eur Spine J 11(5):459–464CrossRefPubMedGoogle Scholar
  26. 26.
    Taimela S, Kujala UM, Salminen JJ, Viljanen T (1997) The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine15;22(10):1132–1136Google Scholar
  27. 27.
    Troussier B, Balagué F, Phelip X (1998) Risk factors of non specific low back pain in children and adolescents. Rev Rhum Engl Ed 65[Suppl 3]: 49–57Google Scholar
  28. 28.
    Troussier B, Marchou-Lopez S, Pironneau S, Alais E, Grison J, Prel G et al (1999) Back pain and spinal alignment abnormalities in schoolchildren. Rev Rhum Engl Ed 66(7–9):370–380Google Scholar
  29. 29.
    van Deursen LL, Patijn J, Durinck JR, Brouwer R, van Erven-Sommers JR, Vortman BJ (1999) Sitting and low back pain : the positive effect of rotary dynamic stimuli during prolonged sitting. Eur Spine J 8(3):187–193CrossRefPubMedGoogle Scholar
  30. 30.
    Van Dieen JH, de Looze MP, Hermans V (2001) Effect of dynamic office chairs on trunk kinematics, trunk extensor EMG and spinal shrinkage. Ergonomics 44(7):739–750CrossRefPubMedGoogle Scholar
  31. 31.
    Verni E, Prosperi L, Lucaccini C, Fedele L, Beluzzi R, Lubich T (1999) Lumbar pain and fin swimming. J Sports Med Phys Fitness 39(1):61–65PubMedGoogle Scholar
  32. 32.
    Viry P, Creveuil C, Marcelli C (1999) Nonspecific back pain in children. A search for associated factors in 14-year-old schoolchildren. Rev Rhum Engl Ed 66(7–9):381–388Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Ismail Bejia
    • 1
    Email author
  • Nabiha Abid
    • 1
  • Kamel Ben Salem
    • 2
  • Mondher Letaief
    • 2
  • Mohamed Younes
    • 1
  • Mongi Touzi
    • 1
  • Naceur Bergaoui
    • 1
  1. 1.Department of RheumatologyEPS MonastirMonastirTunisia
  2. 2.Department of Epidemiology and BiostatisticsFaculty of MedicineMonastirTunisia

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