European Spine Journal

, Volume 19, Issue 4, pp 641–649 | Cite as

Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents

  • Juha P. AuvinenEmail author
  • Tuija H. Tammelin
  • Simo P. Taimela
  • Paavo J. Zitting
  • Marjo-Riitta Järvelin
  • Anja M. Taanila
  • Jaro I. Karppinen
Original Article


The quantity and quality of adolescents’ sleep may have changed due to new technologies. At the same time, the prevalence of neck, shoulder and low back pain has increased. However, only a few studies have investigated insufficient quantity and quality of sleep as possible risk factors for musculoskeletal pain among adolescents. The aim of the study was to assess whether insufficient quantity and quality of sleep are risk factors for neck (NP), shoulder (SP) and low back pain (LBP). A 2-year follow-up survey among adolescents aged 15–19 years was (2001–2003) carried out in a subcohort of the Northern Finland Birth Cohort 1986 (n = 1,773). The outcome measures were 6-month period prevalences of NP, SP and LBP. The quantity and quality of sleep were categorized into sufficient, intermediate or insufficient, based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for having musculoskeletal pain were obtained through logistic regression analysis, adjusted for previously suggested risk factors and finally adjusted for specific pain status at 16 years. The 6-month period prevalences of neck, shoulder and low back pain were higher at the age of 18 than at 16 years. Insufficient quantity or quality of sleep at 16 years predicted NP in both girls (OR 4.4; CI 2.2–9.0) and boys (2.2; 1.2–4.1). Similarly, insufficient sleep at 16 years predicted LBP in both girls (2.9; 1.7–5.2) and boys (2.4; 1.3–4.5), but SP only in girls (2.3; 1.2–4.4). After adjustment for pain status, insufficient sleep at 16 years predicted significantly only NP (3.2; 1.5–6.7) and LBP (2.4; 1.3–4.3) in girls. Insufficient sleep quantity or quality was an independent risk factor for NP and LBP among girls. Future studies should test whether interventions aimed at improving sleep characteristics are effective in the prevention and treatment of musculoskeletal pain.


Musculoskeletal pain Adolescent Sleep Risk factors Prospective study 



This study was partly funded by the Ministry of Education, Academy of Finland (grant 200868), the Research Foundation of the Institute of Sports, Finland (Urheiluopistosäätiö), the Juho Vainio Foundation, the Yrjö Jahnsson Foundation and the Orion Corporation Research Foundation. The authors acknowledge Professor Simo Näyhä from the University of Oulu and the Finnish Institute of Occupational Health for his valuable comments on the manuscript.


  1. 1.
    Achenbach TM, Rescorla LA (2001) Manual for the ASEBA School. Age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families, BurlingtonGoogle Scholar
  2. 2.
    Auvinen J, Tammelin T, Taimela S, Zitting P, Karppinen J (2008) Associations of physical activity and inactivity with low back pain in adolescents. Scand J Med Sci Sports 18:188–194PubMedCrossRefGoogle Scholar
  3. 3.
    Auvinen J, Tammelin T, Taimela S, Zitting P, Karppinen J (2007) Neck and shoulder pains in relation to physical activity and sedentary activities in adolescence. Spine 32:1038–1044CrossRefPubMedGoogle Scholar
  4. 4.
    Bailly D, Bailly-Lambin I, Querleu D, Beuscart R, Collinet C (2004) Sleep in adolescents and its disorders. A survey in schools. Encephale 30:352–359CrossRefPubMedGoogle Scholar
  5. 5.
    Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 8:429–438CrossRefPubMedGoogle Scholar
  6. 6.
    Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39:411–418CrossRefPubMedGoogle Scholar
  7. 7.
    Carskadon MA, Acebo C, Seifer R (2001) Extended nights, sleep loss, and recovery sleep in adolescents. Arch Ital Biol 139:301–312PubMedGoogle Scholar
  8. 8.
    Carskadon MA, Harvey K, Duke P, Anders TF, Litt IF, Dement WC (1980) Pubertal changes in daytime sleepiness. Sleep 2:453–460PubMedGoogle Scholar
  9. 9.
    Diepenmaat A, van der Wal M, de Vet H, Hirasing R (2006) Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 117:412–416CrossRefPubMedGoogle Scholar
  10. 10.
    El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M (2004) Prognosis of non-specific musculoskeletal pain in preadolescents: a prospective 4-year follow-up study till adolescence. Pain 110:550–559CrossRefPubMedGoogle Scholar
  11. 11.
    Gunzburg R, Balague F, Nordin M, Szpalski M, Duyck D, Bull D, Melot C (1999) Low back pain in a population of schoolchildren. Eur Spine J 8:439–443CrossRefPubMedGoogle Scholar
  12. 12.
    Hakala P, Rimpelä A, Salminen JJ, Virtanen SM, Rimpelä M (2002) Back, neck, and shoulder pain in Finnish adolescents: national cross-sectional surveys. BMJ 325:743CrossRefPubMedGoogle Scholar
  13. 13.
    Harreby M, Nygaard B, Jessen T, Larsen E, Storr-Paulsen A, Lindahl A, Fisker I, Laegaard E (1999) Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study. Eur Spine J 8:444–450CrossRefPubMedGoogle Scholar
  14. 14.
    Hasler G, Buysse DJ, Klaghofer R, Gamma A, Ajdacic V, Eich D, Rossler W, Angst J (2004) The association between short sleep duration and obesity in young adults: a 13-year prospective study. Sleep 27:661–666PubMedGoogle Scholar
  15. 15.
    Hill AB (1965) The environment and disease: association or causation? Proc Roy Soc Med 58:295–300PubMedGoogle Scholar
  16. 16.
    Irwin M (2002) Effects of sleep and sleep loss on immunity and cytokines. Brain Behav Immun 16:503–512CrossRefPubMedGoogle Scholar
  17. 17.
    Janson C, Lindberg E, Gislason T, Elmasry A, Boman G (2001) Insomnia in men: a 10-year prospective population-based study. Sleep 24:425–430PubMedGoogle Scholar
  18. 18.
    Jones GT, Macfarlane GJ (2005) Epidemiology of low back pain in children and adolescents. Arch Dis Child 90:312–316CrossRefPubMedGoogle Scholar
  19. 19.
    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 111:822–828CrossRefPubMedGoogle Scholar
  20. 20.
    Järvelin M-R, Hartikainen-Sorri A-L, Rantakallio P (1993) Labour induction policy in hospitals of different levels of specialisation. Br J Obstet Gynaecol 100:310–315PubMedGoogle Scholar
  21. 21.
    Kaila-Kangas L, Kivimäki M, Härma M, Riihimäki H, Luukkonen R, Kirjonen J, Leino-Arjas P (2006) Sleep disturbances as predictors of hospitalization for back disorders: a 28-year follow-up of industrial employees. Spine 31:51–56CrossRefPubMedGoogle Scholar
  22. 22.
    Kaneita Y, Ohida T, Osaki Y, Tanihata T, Minowa M, Suzuki K, Wada K, Kanda H, Hayashi K (2006) Insomnia among Japanese adolescents: a nationwide representative survey. Sleep 29:1543–1550PubMedGoogle Scholar
  23. 23.
    Kennedy C, Kassab O, Gilkey D, Linnel S, Morris D (2008) Psychosocial factors and low back pain among college students. J Am Coll Health 57:191–195CrossRefPubMedGoogle Scholar
  24. 24.
    Kotagal S, Pianosi P (2006) Sleep disorders in children and adolescents. BMJ 332:828–832CrossRefPubMedGoogle Scholar
  25. 25.
    Kovacs F, Gestoso M, Gil del Real M, López J, Mufraggi N, Méndez J (2003) Risk factors for non-specific low back pain in schoolchildren and their parents: a population-based study. Pain 103:259–268CrossRefPubMedGoogle Scholar
  26. 26.
    Kujala UM, Taimela S, Viljanen T (1999) Leisure physical activity and various pain symptoms among adolescents. Br J Sports Med 33:325–328CrossRefPubMedGoogle Scholar
  27. 27.
    Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, Mullington JM (2004) Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 43:678–683CrossRefPubMedGoogle Scholar
  28. 28.
    Mikkelsson M, Sourander A, Piha J, Salminen JJ (1997) Psychiatric symptoms in preadolescents with musculoskeletal pain and fibromyalgia. Pediatrics 100:220–227CrossRefPubMedGoogle Scholar
  29. 29.
    Mikkonen P, Leino-Arjas P, Remes J, Zitting P, Taimela S, Karppinen J (2008) Is smoking a risk factor for low back pain in adolescents? A prospective cohort study. Spine 33:527–532CrossRefPubMedGoogle Scholar
  30. 30.
    Morrison DN, McGee R, Stanton WR (1992) Sleep problems in adolescence. J Am Acad Child Adolesc Psychiatry 31:94–99CrossRefPubMedGoogle Scholar
  31. 31.
    Mustard C, Kalcevich C, Frank J, Boyle M (2005) Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up. Am J Epidemiol 162:779–786CrossRefPubMedGoogle Scholar
  32. 32.
    Mäkelä M, Heliövaara M, Sievers K, Impivaara O, Knekt P, Aromaa A (1991) Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 134:1356–1367PubMedGoogle Scholar
  33. 33.
    Newcomer K, Sinaki M (1996) Low back pain and its relationship to back strength and physical activity in children. Acta Paediatr 85:1433–1439CrossRefPubMedGoogle Scholar
  34. 34.
    Niemi S, Levoska S, Kemila J, Rekola K, Keinanen-Kiukaanniemi S (1996) Neck and shoulder symptoms and leisure time activities in high school students. J Orthop Sports Phys Ther 24:25–29PubMedGoogle Scholar
  35. 35.
    Norris R, Carroll D, Cochrane R (1990) The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being. J Psychosom Res 34:367–375CrossRefPubMedGoogle Scholar
  36. 36.
    Oginska H, Pokorski J (2006) Fatigue and mood correlates of sleep length in three age-social groups: school children, students, and employees. Chronobiol Int 23:1317–1328CrossRefPubMedGoogle Scholar
  37. 37.
    O’Brien EM, Mindell JA (2005) Sleep and risk-taking behavior in adolescents. Behav Sleep Med 3:113–133CrossRefPubMedGoogle Scholar
  38. 38.
    Palmer KT, Syddall H, Cooper C, Coggon D (2003) Smoking and musculoskeletal disorders: findings from a British national survey. Ann Rheum Dis 62:33–36CrossRefPubMedGoogle Scholar
  39. 39.
    Ranjit N, Diez-Roux AV, Shea S, Cushman M, Seeman T, Jackson SA, Ni H (2007) Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Arch Intern Med 167:174–181CrossRefPubMedGoogle Scholar
  40. 40.
    Regression Models (2003) SPSS 12.0. inc., Chicago, pp 3–23Google Scholar
  41. 41.
    Salminen J, Pentti J, Terho P (1992) Low back pain and disability in 14-year-old schoolchildren. Acta Paediatr 81:1035–1039CrossRefPubMedGoogle Scholar
  42. 42.
    Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinanen-Kiukaanniemi S (2004) Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine 29:1662–1669CrossRefPubMedGoogle Scholar
  43. 43.
    Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC (2006) Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 63:824–830CrossRefPubMedGoogle Scholar
  44. 44.
    Smedbraten BK, Natvig B, Rutle O, Bruusgaard D (1998) Self-reported bodily pain in schoolchildren. Scand J Rheumatol 27:273–276PubMedGoogle Scholar
  45. 45.
    Staes F, Stappaerts K, Vertommen H, Nuyens G, Coppieters M, Everaert D (2000) Comparison of self-administration and face-to-face interview for surveys of low back pain in adolescents. Acta Paediatr 89:1352–1357CrossRefPubMedGoogle Scholar
  46. 46.
    Stallones L, Beseler C, Chen P (2006) Sleep patterns and risk of injury among adolescent farm residents. Am J Prev Med 30:300–304CrossRefPubMedGoogle Scholar
  47. 47.
    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 11:459–464CrossRefPubMedGoogle Scholar
  48. 48.
    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. Spine 22:1132–1136CrossRefPubMedGoogle Scholar
  49. 49.
    Tammelin T, Ekelund U, Remes J, Näyhä S (2007) Physical activity and sedentary behaviors among Finnish youth. Med Sci Sports Exerc 39:1067–1074CrossRefPubMedGoogle Scholar
  50. 50.
    The Reproductive Health of Adolescents: A strategy for action, A Joint WHO/UNFPA/UNICEF Statement, World Health Organization, Geneva, 1989Google Scholar
  51. 51.
    Van der Velden PG, Grievink L, Olff M, Gersons BP, Kleber RJ (2007) Smoking as a risk factor for mental health disturbances after a disaster: a prospective comparative study. J Clin Psychiatry 68:87–92CrossRefPubMedGoogle Scholar
  52. 52.
    Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman AJ, Macfarlane GJ (2003) Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child 88:12–17CrossRefPubMedGoogle Scholar
  53. 53.
    Warburton DE, Nicol CW, Bredin SS (2006) Health benefits of physical activity: the evidence. CMAJ 174:801–809PubMedGoogle Scholar
  54. 54.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH (1997) Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 337:869–873CrossRefPubMedGoogle Scholar
  55. 55.
    Vikat A, Rimpelä M, Salminen JJ, Rimpelä A, Savolainen A, Virtanen SM (2000) Neck or shoulder pain and low back pain in Finnish adolescents. Scand J Public Health 28:164–173PubMedGoogle Scholar
  56. 56.
    Wolfson AR, Carskadon MA (1998) Sleep schedules and daytime functioning in adolescents. Child Dev 69:875–887PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Juha P. Auvinen
    • 1
    • 2
    Email author
  • Tuija H. Tammelin
    • 1
  • Simo P. Taimela
    • 3
  • Paavo J. Zitting
    • 2
  • Marjo-Riitta Järvelin
    • 4
  • Anja M. Taanila
    • 4
  • Jaro I. Karppinen
    • 1
    • 2
  1. 1.Finnish Institute of Occupational HealthOuluFinland
  2. 2.Department of Physical and Rehabilitation MedicineInstitute of Clinical Sciences, Oulu University HospitalOuluFinland
  3. 3.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  4. 4.Department of Public Health Science and General PracticeInstitute of Health Sciences, University of OuluOuluFinland

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