The Course of Low Back Pain From Adolescence to Adulthood

Eight-Year Follow-up of 9600 Twins

Lise Hestbaek, DC, PhD; Charlotte Leboeuf-Yde, DC, MPH, PhD; Kirsten Ohm Kyvik, MD, PhD; Claus Manniche, Dr. Med Sci


Spine. 2006;31(4):468-472. 

In This Article

Abstract and Introduction


Study Design: Prospective study with 8-year follow-up.
Objective: To describe the evolution of low back pain from adolescence into adulthood.
Summary of Background Data: High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. It is important to understand the nature of such a link if effective preventive programs are to be established.
Methods: Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30).
Results: Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain. Twenty-six percent of those with low back pain for more than 30 days during the baseline year also had more than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample.
Conclusions: Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.


Present evidence suggests that low back pain (LBP) is rarely a self-limiting disorder but characterized by unpredictable variations in pain status, with temporary, rather than permanent, remissions. The few studies in which the nature of such variations have been investigated[1,2,3] all confirm the fluctuating pattern of LBP. These studies were based on adult populations; thus, the knowledge of the natural course of LBP appearing already in adolescence is limited.

During the past decades, there has been an increasing awareness of LBP in children and adolescents,[4] an area that previously was largely ignored. Several studies have shown that LBP occurs to a large extent in the early years of life. Combs and Caskey even showed back pain with no organic cause to be the most frequent primary diagnosis in a study of pediatric patients.[5] In the cohort used for the present study, the cumulative incidence of LBP was previously reported to increase considerably from 12 to 22 years with more than 50% of 20-year-olds having experienced LBP. For subjects 23 to 41 years of age, there was only a minor increase in prevalence.[6] Lifetime prevalence rates above 50% have been reported for even earlier ages in other populations.[7,8]

Several cross-sectional studies of LBP in young people have been performed. However, there exist only a few longitudinal studies, and two of these have focused on risk factors for LBP rather than on the course of the disorder.[9,10] To our knowledge, children and teenagers have been followed into adulthood to study the association between LBP in adolescence and LBP in adulthood in three longitudinal studies.[11,12,13] Both Hellsing and Bryngelsson[11] and Darre et al[12] found that LBP at age 18, the time of military enlistment, significantly increased the risk of LBP at age 40 and 30, respectively, while Harreby et al found that 90% of schoolchildren with LBP suffered from LBP 25 years later.[13]

Thus, there is a need to establish the extent and the nature of the association between LBP in adolescence and LBP in adulthood. It has been theorized that LBP in childhood may have important consequences for chronic LBP in adulthood.[14] This study aims to describe the evolution of LBP as youngsters grow into adulthood.

The objective is to describe the change of LBP over an 8-year period as subjects change from youngsters to adults. Besides the general description of change over time, the specific question of whether persistent LBP in adolescence predicts persistent LBP in adulthood will be addressed.


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