European Spine Journal

, Volume 25, Issue 2, pp 635–642 | Cite as

Accumulation of psychosocial and lifestyle factors and risk of low back pain in adolescence: a cohort study

  • Paula MikkonenEmail author
  • Eveliina Heikkala
  • Markus Paananen
  • Jouko Remes
  • Simo Taimela
  • Juha Auvinen
  • Jaro Karppinen
Original Article



Low back pain (LBP) is common already in adolescence, and many risk indicators including both psychosocial and lifestyle factors have been recognized. Our purpose was to assess whether the co-occurrence of psychosocial (externalizing and internalizing) problems and lifestyle factors (leisure time physical activity, sedentary behaviour, sleep, smoking, and overweight/obesity) associate with LBP at 16 years cross-sectionally or with new LBP at 18-year follow-up.


The study population, drawn from the Northern Finland Birth Cohort 1986, consisted of 1625 participants (712 boys and 913 girls) who completed a questionnaire on potential explanatory factors at 16 years and on LBP at 16 and 18 years. The outcome measure was ‘reporting LBP’ or ‘consultation for LBP’ during the past 6 months. Latent Class Analysis (LCA) was utilized to study the co-occurrence of the explanatory factors.


Among both genders, four clusters were found. Externalizing behaviour problems were associated with ‘reporting LBP’ (RR 1.5, boys 1.4, girls) and ‘consultation for LBP’ (RR 1.6 for both genders) at baseline among both genders. In addition, the cluster of multiple risk behaviours was associated with both ‘reporting LBP’ (RR 1.3) and ‘consultation for LBP’ (RR 2.5) and the obese cluster with ‘consultation for LBP’ (RR 1.7) among girls. Externalizing behaviour problems at 16 years predicted ‘consultation for LBP’ at 18 years among girls (RR 3.6).


Our results stress the role of psychosocial factors in reporting and seeking care for adolescent LBP.


Adolescent Care seeking Cohort studies Latent class analysis Low back pain Risk factors 



This study was supported by the Yrjö Jahnsson Foundation and the Academy of Finland (to J.K.; 129504 and 121620).

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Paula Mikkonen
    • 1
    Email author
  • Eveliina Heikkala
    • 1
  • Markus Paananen
    • 1
  • Jouko Remes
    • 2
  • Simo Taimela
    • 3
  • Juha Auvinen
    • 4
  • Jaro Karppinen
    • 1
    • 5
  1. 1.Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
  2. 2.Finnish Institute of Occupational Health, Statistics and Health EconomicsOuluFinland
  3. 3.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  4. 4.Institute of Health SciencesUniversity of OuluOuluFinland
  5. 5.Finnish Institute of Occupational Health, Health and Work Ability, and Disability Prevention CentreOuluFinland

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