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Published in: BMC Musculoskeletal Disorders 1/2006

Open Access 01-12-2006 | Research article

Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren

Authors: Ashraf El-Metwally, Jouko J Salminen, Anssi Auvinen, Hannu Kautiainen, Marja Mikkelsson

Published in: BMC Musculoskeletal Disorders | Issue 1/2006

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Abstract

Background

The child's lower limb is the most commonly reported musculoskeletal location with pain and also the most commonly injured site in sports. Some potential risk factors have been studied, but the results are inconsistent. We hypothesized that distinction of traumatic from non-traumatic pain would provide a clearer picture of these factors. The aim of this study is to assess factors associated with lower extremity pain and its impact on preadolescents in a population-based cohort.

Methods

A structured pain questionnaire was completed by 1756 schoolchildren of third and fifth grades to assess musculoskeletal pain, psychosomatic symptoms, subjective disabilities, school absence and frequency of exercise. In addition, hypermobility and physical fitness were measured.

Results

The knee was the most common site of pain followed by the ankle-foot and thigh. Of the children who reported pain in their lower extremity, approximately 70% reported at least one disability and 19 % reported school absence attributed to their pain during the previous three-month period. Children with traumatic pain had a higher subjective disability index than those with non-traumatic pain (P = 0.02). Age less than 11 years, headache, abdominal pain, depressive feelings, day tiredness, and vigorous exercise were more common in children with lower limb pain than those free of it. In the stratified analysis, younger age was related to both traumatic and non-traumatic pain groups. Vigorous exercise was positively associated with traumatic pain, while subjects with non-traumatic pain had more frequent psychosomatic symptoms.

Conclusion

Risk factors and consequences of traumatic and non-traumatic lower limb pain are not similar. Traumatic lower limb pain is associated with practicing vigorous exercise and high level of physical fitness, while non-traumatic pain is more correlated with psychosomatic symptoms. These differences might be one of the reasons for the discrepancy of previous research conclusions. The two conditions need to be treated as different disorders in future studies.
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Literature
1.
go back to reference Øster J, Nielsen A: Growing pains. A clinical investigation of a school population. Acta Paediatr Scand. 1972, 61: 329-34.CrossRefPubMed Øster J, Nielsen A: Growing pains. A clinical investigation of a school population. Acta Paediatr Scand. 1972, 61: 329-34.CrossRefPubMed
2.
go back to reference Puccini RF, Bresolin AM: Recurrent pain in children and adolescents. J Pediatr (Rio J). 2003, 79 (Suppl 1): S65-76. (in Portuguese)CrossRef Puccini RF, Bresolin AM: Recurrent pain in children and adolescents. J Pediatr (Rio J). 2003, 79 (Suppl 1): S65-76. (in Portuguese)CrossRef
3.
go back to reference Hunfeld JA, Perquin CW, Bertina W, Hazebroek-Kampschreur AA, van Suijlekom-Smit LW, Koes BW: Stability of pain parameters and pain-related quality of life in adolescents with persistent pain: a three-year follow-up. Clin J Pain. 2002, 18: 99-106. 10.1097/00002508-200203000-00005.CrossRefPubMed Hunfeld JA, Perquin CW, Bertina W, Hazebroek-Kampschreur AA, van Suijlekom-Smit LW, Koes BW: Stability of pain parameters and pain-related quality of life in adolescents with persistent pain: a three-year follow-up. Clin J Pain. 2002, 18: 99-106. 10.1097/00002508-200203000-00005.CrossRefPubMed
4.
go back to reference Anderson SJ: Lower extremity injuries in youth sports. Pediatr Clin North Am. 2002, 49: 627-41. 10.1016/S0031-3955(02)00010-X.CrossRefPubMed Anderson SJ: Lower extremity injuries in youth sports. Pediatr Clin North Am. 2002, 49: 627-41. 10.1016/S0031-3955(02)00010-X.CrossRefPubMed
5.
go back to reference Rosenberg AM: Analysis of a pediatric rheumatology clinic population. J Rheumatol. 1990, 17: 827-30.PubMed Rosenberg AM: Analysis of a pediatric rheumatology clinic population. J Rheumatol. 1990, 17: 827-30.PubMed
6.
go back to reference Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H: Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br. 1984, 66: 685-93.PubMed Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H: Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br. 1984, 66: 685-93.PubMed
7.
go back to reference Vähäsarja V: Prevalence of chronic knee pain in children and adolescents in northern Finland. Acta Paediatr. 1995, 84: 803-5.CrossRefPubMed Vähäsarja V: Prevalence of chronic knee pain in children and adolescents in northern Finland. Acta Paediatr. 1995, 84: 803-5.CrossRefPubMed
8.
go back to reference Rocha ES, Pedreira AC: Common orthopedic problems in adolescents. J Pediatr (Rio J). 2001, 77 (Suppl 2): S225-33. (in Portuguese)CrossRef Rocha ES, Pedreira AC: Common orthopedic problems in adolescents. J Pediatr (Rio J). 2001, 77 (Suppl 2): S225-33. (in Portuguese)CrossRef
9.
go back to reference Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S: The health and productivity cost burden of the "top 10" physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med. 2003, 45: 5-14.CrossRefPubMed Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S: The health and productivity cost burden of the "top 10" physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med. 2003, 45: 5-14.CrossRefPubMed
10.
go back to reference Rasmussen BK, Jensen R, Olesen J: Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Community Health. 1992, 46: 443-446.CrossRefPubMedPubMedCentral Rasmussen BK, Jensen R, Olesen J: Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Community Health. 1992, 46: 443-446.CrossRefPubMedPubMedCentral
11.
go back to reference Shrier I, Ehrmann-Feldman D, Rossignol M, Abenhaim L: Risk factors for development of lower limb pain in adolescents. J Rheumatol. 2001, 28: 604-9.PubMed Shrier I, Ehrmann-Feldman D, Rossignol M, Abenhaim L: Risk factors for development of lower limb pain in adolescents. J Rheumatol. 2001, 28: 604-9.PubMed
13.
go back to reference Knapik J, Ang P, Reynolds K, Jones B: Physical fitness, age, and injury incidence in infantry soldiers. J Occup Med. 1993, 35: 598-603.CrossRefPubMed Knapik J, Ang P, Reynolds K, Jones B: Physical fitness, age, and injury incidence in infantry soldiers. J Occup Med. 1993, 35: 598-603.CrossRefPubMed
14.
go back to reference Orchard J, Marsden J, Lord S, Garlick D: Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med. 1997, 25: 81-5.CrossRefPubMed Orchard J, Marsden J, Lord S, Garlick D: Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med. 1997, 25: 81-5.CrossRefPubMed
15.
16.
go back to reference Oberklaid F, Amos D, Liu C, Jarman F, Sanson A, Prior M: "Growing pains": clinical and behavioral correlates in a community sample. J Dev Behav Pediatr. 1997, 18: 102-6.CrossRefPubMed Oberklaid F, Amos D, Liu C, Jarman F, Sanson A, Prior M: "Growing pains": clinical and behavioral correlates in a community sample. J Dev Behav Pediatr. 1997, 18: 102-6.CrossRefPubMed
17.
go back to reference Bruusgaard D, Smedbraten BK, Natvig B: Bodily pain, sleep problems and mental distress in schoolchildren. Acta Paediatr. 2000, 89: 597-600. 10.1080/080352500750027925.CrossRefPubMed Bruusgaard D, Smedbraten BK, Natvig B: Bodily pain, sleep problems and mental distress in schoolchildren. Acta Paediatr. 2000, 89: 597-600. 10.1080/080352500750027925.CrossRefPubMed
18.
go back to reference Mikkelsson M, Salminen JJ, Kautiainen H: Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents. J Rheumatol. 1996, 23: 1963-67.PubMed Mikkelsson M, Salminen JJ, Kautiainen H: Joint hypermobility is not a contributing factor to musculoskeletal pain in pre-adolescents. J Rheumatol. 1996, 23: 1963-67.PubMed
19.
go back to reference Mikkelsson M, Salminen JJ, Kautiainen H: Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain. 1997, 73: 29-35. 10.1016/S0304-3959(97)00073-0.CrossRefPubMed Mikkelsson M, Salminen JJ, Kautiainen H: Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain. 1997, 73: 29-35. 10.1016/S0304-3959(97)00073-0.CrossRefPubMed
20.
go back to reference King A, Wold B, Tudor-Smith C, Harel Y: The Health of Youth: A Cross-sectional Survey. 1996, Geneva: WHO, 68-69. (European Series No. 69) King A, Wold B, Tudor-Smith C, Harel Y: The Health of Youth: A Cross-sectional Survey. 1996, Geneva: WHO, 68-69. (European Series No. 69)
22.
go back to reference Leger LA, Lambert J: A maximal multistage 20-m shuttle run test to predict VO2 max. Eur J Appl Physiol Occup Physiol. 1982, 49: 1-12. 10.1007/BF00428958.CrossRefPubMed Leger LA, Lambert J: A maximal multistage 20-m shuttle run test to predict VO2 max. Eur J Appl Physiol Occup Physiol. 1982, 49: 1-12. 10.1007/BF00428958.CrossRefPubMed
23.
go back to reference Committee of experts on sports research: Eurofit. Handbook for the Eurofit tests of physical exercise. 1988, Rome: Council of Europe, Committee for the Development of Sport, 24- Committee of experts on sports research: Eurofit. Handbook for the Eurofit tests of physical exercise. 1988, Rome: Council of Europe, Committee for the Development of Sport, 24-
24.
go back to reference Smedbraten BK, Natvig B, Rutle O, Bruusgaard D: Self-reported bodily pain in schoolchildren. Scand J Rheumatol. 1998, 27: 273-6.PubMed Smedbraten BK, Natvig B, Rutle O, Bruusgaard D: Self-reported bodily pain in schoolchildren. Scand J Rheumatol. 1998, 27: 273-6.PubMed
25.
go back to reference Adirim TA, Cheng TL: Overview of injuries in the young athlete. Sports Med. 2003, 33: 75-81. 10.2165/00007256-200333010-00006.CrossRefPubMed Adirim TA, Cheng TL: Overview of injuries in the young athlete. Sports Med. 2003, 33: 75-81. 10.2165/00007256-200333010-00006.CrossRefPubMed
26.
go back to reference Yates CK, Grana WA: Patellofemoral pain in children. Clin Orthop. 1990, 255: 36-43.PubMed Yates CK, Grana WA: Patellofemoral pain in children. Clin Orthop. 1990, 255: 36-43.PubMed
27.
go back to reference Salminen JJ: The adolescent back. A field survey of 370 Finnish schoolchildren. Acta Paediatr Scand. 1984, 315 (Suppl): 1-122.CrossRef Salminen JJ: The adolescent back. A field survey of 370 Finnish schoolchildren. Acta Paediatr Scand. 1984, 315 (Suppl): 1-122.CrossRef
28.
go back to reference Bury RG: A study of 111 children with recurrent abdominal pains. Aust Paediatr J. 1987, 23: 117-19.PubMed Bury RG: A study of 111 children with recurrent abdominal pains. Aust Paediatr J. 1987, 23: 117-19.PubMed
29.
go back to reference Alfven G: Psychological tension headaches among children. A survey. Läkartidningen. 1986, 45: 3827-8. (in Swedish) Alfven G: Psychological tension headaches among children. A survey. Läkartidningen. 1986, 45: 3827-8. (in Swedish)
30.
go back to reference El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M: Prognosis of non-specific musculoskeletal pain in preadolescents: A prospective 4-year follow-up study till adolescence. Pain. 2004, 110: 550-559. 10.1016/j.pain.2004.03.021.CrossRefPubMed El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M: Prognosis of non-specific musculoskeletal pain in preadolescents: A prospective 4-year follow-up study till adolescence. Pain. 2004, 110: 550-559. 10.1016/j.pain.2004.03.021.CrossRefPubMed
31.
go back to reference Tamminen TM, Bredenberg P, Escartin T, Kaukonen P, Puura K, Rutanen M, Suominen I, Leijala H, Salmelin R: Psychosomatic symptoms in preadolescent children. Psychother Psychosom. 1991, 56: 70-7.CrossRefPubMed Tamminen TM, Bredenberg P, Escartin T, Kaukonen P, Puura K, Rutanen M, Suominen I, Leijala H, Salmelin R: Psychosomatic symptoms in preadolescent children. Psychother Psychosom. 1991, 56: 70-7.CrossRefPubMed
32.
go back to reference Aro H, Paronen O, Aro S: Psychosomatic symptoms among 14–16 year old Finnish adolescents. Soc Psychiatry. 1987, 22: 171-6. 10.1007/BF00583852.CrossRefPubMed Aro H, Paronen O, Aro S: Psychosomatic symptoms among 14–16 year old Finnish adolescents. Soc Psychiatry. 1987, 22: 171-6. 10.1007/BF00583852.CrossRefPubMed
33.
go back to reference Krivickas LS, Feinberg JH: Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness. Arch Phys Med Rehabil. 1996, 77: 1139-43. 10.1016/S0003-9993(96)90137-9.CrossRefPubMed Krivickas LS, Feinberg JH: Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness. Arch Phys Med Rehabil. 1996, 77: 1139-43. 10.1016/S0003-9993(96)90137-9.CrossRefPubMed
34.
go back to reference Hartig DE, Henderson JM: Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med. 1999, 27: 173-6.PubMed Hartig DE, Henderson JM: Increasing hamstring flexibility decreases lower extremity overuse injuries in military basic trainees. Am J Sports Med. 1999, 27: 173-6.PubMed
35.
go back to reference El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M: Lower limb pain in a preadolescent population, prognosis and risk factors for chronicity: A prospective 1-and 4-year follow-up study. Pediatrics. 2005, 116: 673-81. 10.1542/peds.2004-1758.CrossRefPubMed El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M: Lower limb pain in a preadolescent population, prognosis and risk factors for chronicity: A prospective 1-and 4-year follow-up study. Pediatrics. 2005, 116: 673-81. 10.1542/peds.2004-1758.CrossRefPubMed
Metadata
Title
Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren
Authors
Ashraf El-Metwally
Jouko J Salminen
Anssi Auvinen
Hannu Kautiainen
Marja Mikkelsson
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2006
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-7-3

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