European Spine Journal

, Volume 20, Issue 12, pp 2126–2133 | Cite as

Low back pain at school: unique risk deriving from unsatisfactory grade in maths and school-type recommendation

  • Cordula Erne
  • Achim ElferingEmail author
Original Article


Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils’ back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4 weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.


Low back pain Schoolchildren Stress Educational selection 


Conflict of interest



  1. 1.
    Adams M, Mannion AF, Dolan P (1999) Personal risk factors for first-time low back pain. Spine 24:2497–2505PubMedCrossRefGoogle Scholar
  2. 2.
    Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 8:429–438PubMedCrossRefGoogle Scholar
  3. 3.
    Ball J, Lohaus A, Miebach Ch (2006) Psychische Anpassungen und schulische Leistungen beim Wechsel von der Grundschule zur weiterführenden Schule [Psychological adjustment and school achievement during transition from elementary to secondary school]. Z Entwicklungspsychol Padagog Psychol 38:101–109Google Scholar
  4. 4.
    Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ (2006) COST B13 working group on guidelines for prevention in low back pain. Chapter 2—European guidelines for prevention in low back pain. Eur Spine J 15:S136–S168PubMedCrossRefGoogle Scholar
  5. 5.
    Cardon G, Balague F (2004) Low back pain prevention’s effects in schoolchildren. What is the evidence? Eur Spine J 13:663–679PubMedCrossRefGoogle Scholar
  6. 6.
    Chan CW, Goldman S, Ilstrup DM, Kunselman AR, O’Neill PI (1993) The pain drawing and Waddell’s nonorganic physical signs in chronic low-back pain. Spine 18:1717–1722PubMedCrossRefGoogle Scholar
  7. 7.
    Elfering A, Mannion AF (2008) Epidemiology and risk factors of spinal disorders. In: Boos N, Aebi M (eds) Spinal disorders—fundamentals of diagnosis and treatment. Springer, Berlin, pp 153–173Google Scholar
  8. 8.
    Eschenbeck H, Lohaus A, Kohlmann C-W (2007) Instrumente zur Erfassung von Stress und Coping im Kindesalter [Stress and coping assessment instruments in children]. In: Seiffge-Krenke I, Lohaus A (eds) Stress und Stressbewältigung im Kindes- und Jugendalter. Hogrefe, Göttingen 2007, pp 29–46Google Scholar
  9. 9.
    Goodman R, Meltzer H, Bailey V (1998) The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry 7:125–130PubMedCrossRefGoogle Scholar
  10. 10.
    Gunzburg R, Balagué F, Nordin M, Szpalski M, Duyck D, Bull D, Mélot C (2006) Low back pain in a population of school children. Eur Spine J 8:439–443CrossRefGoogle Scholar
  11. 11.
    Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15:S17–S24PubMedCrossRefGoogle Scholar
  12. 12.
    Jacobshagen N, Rigotti T, Semmer NK, Mohr G (2009) Stress at school: reasons to initiate strain management earlier. Int J Stress Manag 16:195–214CrossRefGoogle Scholar
  13. 13.
    Kristjansdottir G, Rhee H (2002) Risk factors of back pain frequency in schoolchildren: a search for explanations to a public health problem. Acta Paediatr 91:849–854PubMedCrossRefGoogle Scholar
  14. 14.
    Margolis RB, Chibnall JT, Tait RC (1988) Test–retest reliability of the pain drawing instrument. Pain 33:49–51PubMedCrossRefGoogle Scholar
  15. 15.
    Maserio S, Carraro E, Celia A, Sarto D, Ermani M (2008) Prevalence of nonspecific low back pain in schoolchildren aged between 13 and 15 years. Acta Paediatr 97:212–216CrossRefGoogle Scholar
  16. 16.
    Moser U (2004) Jugendliche zwischen Schule und Berufsbildung [Adolescents between school and vocational education and training]. h.e.p., BernGoogle Scholar
  17. 17.
    Murphy S, Buckle P, Stubbs D (2007) A cross-sectional study of self-reported back and neck pain among English schoolchildren and associated physical and psychological risk factors. Appl Ergon 38:797–804PubMedCrossRefGoogle Scholar
  18. 18.
    Neuenschwander MP, Garrett JL (2008) Causes and consequences of unexpected educational transitions in Switzerland. J Soc Issues 64:41–57CrossRefGoogle Scholar
  19. 19.
    Neuenschwander MP, Malti T (2009) Selection processes in the transition to lower and upper secondary education. Zeitschrift für Erziehungswissenschaft 12:216–232CrossRefGoogle Scholar
  20. 20.
    Salancik GR, Pfeffer J (1979) A social information processing approach to job attitudes and task design. Adm Sci Q 23:224–253CrossRefGoogle Scholar
  21. 21.
    Savedra MC, Tesler MD, Holzemer WL, Wilkie DJ, Ward JA (1989) Pain location: validity and reliability of body outline markings by hospitalized children and adolescents. Res Nurs Health 12:307–314PubMedCrossRefGoogle Scholar
  22. 22.
    Schott GD (2010) The cartography of pain: the evolving contribution of pain maps. Eur J Pain 14:784–791PubMedCrossRefGoogle Scholar
  23. 23.
    Semmer NK, Grebner S, Elfering A (2004) Beyond self-report: using observational, physiological, and event-based measures in research on occupational stress. In: Perrewé PL, Ganster DC (eds) Emotional and physiological processes and positive intervention strategies. Research in occupational stress and well-being, vol 3. JAI Press, Amsterdam, pp 205–263CrossRefGoogle Scholar
  24. 24.
    Siambanes D, Martinez JW, Butler EW, Haider T (2004) Influence of school backpacks on adolescent back pain. J Pediatr Orthop 24:211–217PubMedCrossRefGoogle Scholar
  25. 25.
    Trevelyan FC, Legg SJ (2006) Back pain in school children—where to from here? Appl Ergon 37:45–54PubMedCrossRefGoogle Scholar
  26. 26.
    Udén A, Aström M, Bergenudd H (1988) Pain drawings in chronic back pain. Spine 13:389–392PubMedCrossRefGoogle Scholar
  27. 27.
    Van Gent Ch, Dols JJCM, de Rover CM, Hira Sing RA, de Vet HCW (2003) The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine 28:916–921PubMedGoogle Scholar
  28. 28.
    Watson KD, Papageorgiou AC, Jones GJ, Symmons DPM, Silman AJ, Macfarlane GJ (2003) Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child 88:12–17PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of BernBern 9Switzerland

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