Pubertal development and growth are prospectively associated with spinal pain in young people (CHAMPS study-DK)

  • Jeffrey J. HebertEmail author
  • Charlotte Leboeuf-Yde
  • Claudia Franz
  • Arnaud Lardon
  • Lise Hestbæk
  • Neil Manson
  • Niels Wedderkopp
Original Article



To examine the prospective associations of pubertal development and linear growth with spinal pain frequency and duration in children.


We recruited students from 10 public primary schools. Over 42 months, pubertal development was assessed four times and categorized according to Tanner stages 1–5, and height was measured on seven occasions. Occurrences of spinal pain were reported weekly via text messaging. We constructed variables for spinal pain duration (total weeks with pain) and frequency (number of episodes). Potential associations between pubertal development and growth were examined with generalized estimating equations and reported with incident rate ratios (IRRs). All models were adjusted for potential confounders.


Data from 1021 children (53% female; mean [SD] age = 9.4 [1.4] years), with median participation duration of 39 months, were included. Advancing pubertal development was associated with increased spinal pain duration (IRR [95% CI] = 1.90 [1.45, 2.49] to 5.78 [4.03, 8.29]) and frequency of pain episodes (IRR [95% CI] = 1.32 [1.07, 1.65] to 2.99 [2.24, 3.98]). Similar associations were observed for each 1-cm change in height in 6 months with spinal pain duration (IRR [95% CI] = 1.19 [1.15, 1.23]) and frequency (IRR [95% CI] = 1.14 [1.11, 1.17]). The relations between pubertal development and spinal pain, as well as growth and spinal pain, were largely independent.


In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose–response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Puberty Growth and development Body height Risk factors Back pain 



The authors gratefully acknowledge the valuable work of numerous students who assisted with data collection in the CHAMPS study-DK. We also thank the participating children, their parents, and teachers in the schools involved in the project. We are grateful for the cooperation with The Svendborg Project, Sport Study Sydfyn, and the Municipality of Svendborg. Finally, we wish to acknowledge members of the CHAMPS study-DK not listed as co-authors in this paper: E. Jespersen, M. Heidemann, and C.T. Rexen.


The TRYG Foundation, University College Lillebaelt, University of Southern Denmark, The Nordea Foundation, The IMK foundation, The Region of Southern Denmark, The Egmont Foundation, The A.J. Andersen Foundation, The Danish Rheumatism Association, Østifternes Foundation, Brd. Hartmann’s Foundation, TEAM Denmark, The Danish Chiropractor Foundation, and The Nordic Institute of Chiropractic and Clinical Biomechanics. The funding sources played no role in the design, conduct, or reporting of this study.

Conlict of interest

Prof. Hebert receives salary support from the Canadian Chiropractic Research Foundation and the New Brunswick Health Research Foundation. The authors declare no additional conflicts of interest.

Supplementary material

586_2019_5905_MOESM1_ESM.pptx (845 kb)
Supplementary material 1 (PPTX 845 kb)


  1. 1.
    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1545–1602. CrossRefGoogle Scholar
  2. 2.
    Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? JAMA 268:760–765CrossRefGoogle Scholar
  3. 3.
    Manek NJ, MacGregor AJ (2005) Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol 17:134–140. Google Scholar
  4. 4.
    van Tulder M, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16:761–775. CrossRefGoogle Scholar
  5. 5.
    Disease GBD, Injury I, Prevalence C (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211–1259. CrossRefGoogle Scholar
  6. 6.
    Stallknecht SE, Strandberg-Larsen K, Hestbaek L, Andersen AN (2017) Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the Danish National Birth Cohort. Eur J Pediatr 176:807–814. CrossRefGoogle Scholar
  7. 7.
    Kjaer P, Wedderkopp N, Korsholm L, Leboeuf-Yde C (2011) Prevalence and tracking of back pain from childhood to adolescence. BMC Musculoskel Disord 12:98. CrossRefGoogle Scholar
  8. 8.
    Hestbaek L, Leboeuf-Yde C, Kyvik KO (2006) Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population. BMC Musculoskel Disord 7:29. CrossRefGoogle Scholar
  9. 9.
    Kamper SJ, Yamato TP, Williams CM (2016) The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: an overview of systematic reviews. Best Pract Res Clin Rheumatol 30:1021–1036. CrossRefGoogle Scholar
  10. 10.
    Dolphens M, Vansteelandt S, Cagnie B, Vleeming A, Nijs J, Vanderstraeten G, Danneels L (2016) Multivariable modeling of factors associated with spinal pain in young adolescence. Eur Spine J 25:2809–2821. CrossRefGoogle Scholar
  11. 11.
    Hulsegge G, van Oostrom SH, Picavet HS, Twisk JW, Postma DS, Kerkhof M, Smit HA, Wijga AH (2011) Musculoskeletal complaints among 11-year-old children and associated factors: the PIAMA birth cohort study. Am J Epidemiol 174:877–884. CrossRefGoogle Scholar
  12. 12.
    Janssens KA, Rosmalen JG, Ormel J, Verhulst FC, Hunfeld JA, Mancl LA, Oldehinkel AJ, LeResche L (2011) Pubertal status predicts back pain, overtiredness, and dizziness in American and Dutch adolescents. Pediatrics 128:553–559. Google Scholar
  13. 13.
    Wedderkopp N, Andersen LB, Froberg K, Leboeuf-Yde C (2005) Back pain reporting in young girls appears to be puberty-related. BMC Musculoskel Disord 6:52. CrossRefGoogle Scholar
  14. 14.
    Wheeler MD (1991) Physical changes of puberty. Endocrinol Metab Clin North Am 20:1–14CrossRefGoogle Scholar
  15. 15.
    Tanaka T, Suwa S, Yokoya S, Hibi I (1988) Analysis of linear growth during puberty. Acta Paediatr Scand Suppl 347:25–29Google Scholar
  16. 16.
    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 20:2101–2107 (discussion 2108) CrossRefGoogle Scholar
  17. 17.
    Fairbank JC, Pynsent PB, Van Poortvliet JA, Phillips H (1984) Influence of anthropometric factors and joint laxity in the incidence of adolescent back pain. Spine 9:461–464CrossRefGoogle Scholar
  18. 18.
    Feldman DE, Shrier I, Rossignol M, Abenhaim L (2001) Risk factors for the development of low back pain in adolescence. Am J Epidemiol 154:30–36CrossRefGoogle Scholar
  19. 19.
    Hasler CC (2013) Back pain during growth. Swiss Med Wkly 143:w13714. Google Scholar
  20. 20.
    Lardon A, Leboeuf-Yde C, Le Scanff C, Wedderkopp N (2014) Is puberty a risk factor for back pain in the young? a systematic critical literature review. Chiropr Man Therap 22:27. CrossRefGoogle Scholar
  21. 21.
    Swain M, Kamper SJ, Maher CG, Broderick C, McKay D, Henschke N (2018) Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review. Br J Sports Med. Google Scholar
  22. 22.
    Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, Ogilvie D, Petticrew M, Reeves B, Sutton M, Thompson S (2012) Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health 66:1182–1186. CrossRefGoogle Scholar
  23. 23.
    Wedderkopp N, Jespersen E, Franz C, Klakk H, Heidemann M, Christiansen C, Moller NC, Leboeuf-Yde C (2012) Study protocol. The childhood health, activity, and motor performance school study Denmark (the CHAMPS-study DK). BMC Pediatr 12:128. CrossRefGoogle Scholar
  24. 24.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243CrossRefGoogle Scholar
  25. 25.
    Tanner JM (1962) Growth at adolescence, with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity. Blackwell Scientific Publications, OxfordGoogle Scholar
  26. 26.
    Duke PM, Litt IF, Gross RT (1980) Adolescents’ self-assessment of sexual maturation. Pediatrics 66:918–920Google Scholar
  27. 27.
    Baranowski T, Smith M, Baranowski J, Wang DT, Doyle C, Lin LS, Hearn MD, Resnicow K (1997) Low validity of a seven-item fruit and vegetable food frequency questionnaire among third-grade students. J Am Diet Assoc 97:66–68. CrossRefGoogle Scholar
  28. 28.
    Peterson L, Harbeck C, Moreno A (1993) Measures of children’s injuries: self-reported versus maternal-reported events with temporally proximal versus delayed reporting. J Pediatr Psychol 18:133–147CrossRefGoogle Scholar
  29. 29.
    Johansen B, Wedderkopp N (2010) Comparison between data obtained through real-time data capture by SMS and a retrospective telephone interview. Chiropr Osteopat 18:10. CrossRefGoogle Scholar
  30. 30.
    Davis PJ, Williams HJ (2008) The investigation and management of back pain in children. Arch Dis Child Educ Pract Ed 93:73–83. CrossRefGoogle Scholar
  31. 31.
    Jakes AD, Phillips R, Scales M (2015) Teenagers with back pain. BMJ 350:h1275. CrossRefGoogle Scholar
  32. 32.
    Bhatia NN, Chow G, Timon SJ, Watts HG (2008) Diagnostic modalities for the evaluation of pediatric back pain: a prospective study. J Pediatr Orthop 28:230–233. CrossRefGoogle Scholar
  33. 33.
    Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075–2094. CrossRefGoogle Scholar
  34. 34.
    Shah SA, Saller J (2016) Evaluation and diagnosis of back pain in children and adolescents. J Am Acad Orthop Surg 24:37–45. CrossRefGoogle Scholar
  35. 35.
    Franz C, Moller NC, Korsholm L, Jespersen E, Hebert JJ, Wedderkopp N (2017) Physical activity is prospectively associated with spinal pain in children (CHAMPS study-DK). Sci Rep 7:11598. CrossRefGoogle Scholar
  36. 36.
    Hill AB (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300Google Scholar
  37. 37.
    Itz CJ, Geurts JW, van Kleef M, Nelemans P (2013) Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 17:5–15. CrossRefGoogle Scholar
  38. 38.
    Pengel LH, Herbert RD, Maher CG, Refshauge KM (2003) Acute low back pain: systematic review of its prognosis. BMJ 327:323. CrossRefGoogle Scholar
  39. 39.
    Lemeunier N, Leboeuf-Yde C, Gagey O (2012) The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap 20:33. CrossRefGoogle Scholar
  40. 40.
    Hancock MJ, Maher CM, Petocz P, Lin CW, Steffens D, Luque-Suarez A, Magnussen JS (2015) Risk factors for a recurrence of low back pain. Spine J 15:2360–2368. CrossRefGoogle Scholar
  41. 41.
    Ardakani EM, Leboeuf-Yde C, Walker BF (2018) Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review. Chiropr Man Ther 26:1. CrossRefGoogle Scholar
  42. 42.
    Jones GT, Macfarlane GJ (2005) Epidemiology of low back pain in children and adolescents. Arch Dis Child 90:312–316. CrossRefGoogle Scholar
  43. 43.
    Rasmussen AR, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, Hagen CP, Tinggaard J, Mouritsen A, Mieritz MG, Main KM (2015) Validity of self-assessment of pubertal maturation. Pediatrics 135:86–93. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of KinesiologyUniversity of New BrunswickFrederictonCanada
  2. 2.School of Psychology and Exercise ScienceMurdoch UniversityMurdochAustralia
  3. 3.Institute for Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
  4. 4.Private PracticeHaderslevDenmark
  5. 5.Danish Agency for Patient ComplaintsAarhusDenmark
  6. 6.Institut Franco-Européen de ChiropraxieIvry sur SeineFrance
  7. 7.CIAMSUniversité Paris-Sud, Université Paris-SaclayOrsay CedexFrance
  8. 8.CIAMSUniversité d’OrléansOrléansFrance
  9. 9.Nordic Institute of Chiropractic and Clinical BiomechanicsOdenseDenmark
  10. 10.Canada East Spine CentreSaint JohnCanada
  11. 11.Department of Orthopaedic SurgerySaint John Regional HospitalSaint JohnCanada
  12. 12.Department of Orthopaedic SurgeryDalhousie UniversityHalifaxCanada
  13. 13.Orthopedic DepartmentHospital of Southwestern JutlandEsbjergDenmark
  14. 14.Department of Regional Health ResearchUniversity of Southern DenmarkEsbjergDenmark

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